Clinical Microbiology: Open Access

Abstract

Where have you Gone, Sherlock Holmes?

John Fremont Fisher

Dr. Jack House is a fictitious infectious disease fellow who has been allowed to practice superficial and potentially harmful patient evaluations because attending physicians are too busy to adequately supervise him. His consultations on four critically ill patients have been performed in haste and recommendations have been based on faulty reasoning with inadequate data. He has failed to incorporate microscopy into his thought process and his clinical notes are overly brief, poorly written, and call for inappropriately broad-spectrum antimicrobial therapy. His consultation style is contrasted with real examples of patients who were evaluated by an infectious disease consultant who relied heavily on clinical exam and microscopic findings to arrive at an accurate diagnosis and to give recommendations for appropriate antimicrobial therapy. The article is a commentary on an increasingly pervasive type of infectious disease practice.