Clinical Problem-Solving: Remembering the ABC's

To the Editor: In the Clinical Problem-Solving case presented by Duffy (April 7 issue), 1 three ophthalmologists misdiagnosed vitamin A deficiency as simple conjunctivitis in a 40-year-old woman with mild Down's syndrome who had severe eye pain. The discussant (a nephrologist) and the author attributed their error to a number of factors: a tendency of physicians to overlook nutritional conditions; lack of familiarity with the patient's complex medical history, which made her a compromised host; and the rarity of vitamin A deficiency in the United States. I propose an additional explanation -- that medical decision making was influenced by a tendency . . .