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Even Common Diseases Can Be Complex

William R. Barclay, MD
JAMA. 1977;238(25):2722. doi:10.1001/jama.1977.03280260052021.
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Frequently we lose sight of the fact that illness is not a matter of just an infection, an injury, a neoplasm, or a metabolic disorder, but of a combination of factors, not the least important of which may be life-style or behavior. Unless the multiple factors underlying an illness are recognized, the diagnosis may be missed or the treatment fail. Such a situation is described in the CLINICAL NOTE in this issue of The Journal (p 2718). Fiumara's account of diagnosing gonococcal proctitis in a married woman illustrates once more that the practice of medicine is as much an art as it is a science, and that the securing of a complete and detailed history is an important part of that art.

The time constraints of medical practice frequently pressure us into making a hurried diagnosis or instituting a routine form of treatment. Although this approach may suffice for most,


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