Ophyr Mourad

A 45-year-old woman from northern Ontario presented to her local hospital with a 2-year history of asymmetric migratory arthralgias involving the left knee, ankles, elbows, and fingers. She also had morning stiffness, increasing fatigue, an erythematous, nonpruritic rash after sun exposure, and a 3-month history of chest pain that was relieved when she was in an upright position. She did not have fevers, dry eyes or mouth, oral ulcers, or eye irritation or pain.

Background  There is little research on the impact of medical education on patient outcome. We studied whether teaching capability is associated with altered short‐term patient outcomes. Methods  We performed a multicentre retrospective cross‐sectional study involving 40 clinician teachers who had attended on the general internal medicine services in hospitals affiliated with the University of Toronto along with the clinical outcomes of consecutive patients treated for community‐acquired pneumonia, congestive heart failure, chronic obstructive pulmonary disease and gastrointestinal bleeding ( n = 4377) between 1999 and 2001. Doctors were characterised by teaching effectiveness scores ( n = 677) as high‐rated or low‐rated according to house staff ratings. Results  There was no correlation between the teaching effectiveness scores and the mean length of stay for those patients treated for community‐acquired pneumonia (high‐rated = 10.3 versus low‐rated = 8.1 days, P = 0.058), congestive heart failure (high‐rated = 10.1 versus low‐rated = 9.9 days, P = 0.978), chronic obstructive pulmonary disease (high‐rated = 9.4 versus low‐rated = 9.9 days, P = 0.419) and gastrointestinal bleeding (high‐rated = 6.3 versus low‐rated = 6.8 days, P = 0.741). In addition, we observed no significant correlation between teaching effectiveness scores and 7‐day, 28‐day and 1‐year readmission rates for all pre‐specified diagnoses. Conclusion  There is no large correlation between teaching effectiveness scores and short‐term patient outcomes, suggesting that doctor teaching capabilities, as perceived by house staff, does not generally impact clinical care.

FEVER OF unknown origin (FUO) identifies a syndrome of fever that does not resolve spontaneously, in which the cause remains elusive after an extensive diagnostic workup. Petersdorf and Beeson¹ first coined the term fever of unknown origin in 1961 and explicitly defined it as a temperature higher than 38.3°C on several occasions and lasting longer than 3 weeks, with a diagnosis that remains uncertain after 1 week of investigations in hospital. Petersdorf and Beeson chose 3 weeks of fever to eliminate self-limited viral illnesses and to allow sufficient time for appropriate initial investigations to be completed. Over the past 40 years, health care has shifted from the inpatient to the ambulatory setting. As a result, it has now become widely accepted that the requirement for a 1-week evaluation in hospital be modified so that evaluations may now be completed in an outpatient setting.²