ABSTRACT
Figure 1.1 is a chest x-ray of an elderly lady who was living in a warden controlled flat. She came to the notice of her warden because she had stopped cleaning her flat. The patient herself denied having any symptoms. Her GP requested a domiciliary visit from a consultant physician in geriatric medicine; he noted abnormal signs in the chest and ordered investigations, including an x-ray of her chest. These revealed miliary shadowing consistent with tuberculosis. As a condition, tuberculosis will lead to weight loss, general malaise, cough with sputum and shortness of breath. This elderly person had
none of these features. Staff of the sheltered accommodation were alarmed by the diagnosis and accused the GP of placing them at risk of acquiring a serious infection. The GP arranged for the staff to meet the specialist and, after talking to him, the staff dropped their complaint against the GP.
