We still miss appendicitis. While this is not surprising in itself – after all, appendicitis is known to be a condition that may be elusive and may masquerade as other pathologies – what is surprising to me in my work as an investigator of serious clinical incidents is the number of occasions when appendicitis does not appear to have occurred to a clinician as a possible diagnosis. If it features at all within the clinical notes it appears almost by proxy in the form of single comments in the examination notes, such as ‘no guarding, no rebound’ from which clinical colleagues may infer that the clinician had excluded the presence of appendicitis.