How a GP successfully defended a diagnostic dilemma


A case highlights the importance of 'safety-netting' and doctor-patient communication.

Clinical history

The patient was a 42-year-old accountant with a history of mitral valve replacement. He was working in Australia on a 457 visa and had had his mitral valve surgery in his home country. He presented to a GP complaining of fever, and aches and pains. He denied any other symptoms. He was taking warfarin and his latest INR was 2.5.

On examination,