Margaret: a tragic case of spinal Red Flags and Red Herrings

Objective This case illustrates how easily patient misattribution can influence the clinical reasoning process and it alerts physiotherapists to safeguard from the influences of Red Herrings.

Design It is the second in a series of case studies considering patients with serious spinal pathology.

Setting This paper considers the case of a 49year old lady who was referred to a Spinal Assessment Clinic in a district general hospital. The clinic was established specifically to deal with more complex spinal patients, identifying those at risk of chronicity, surgical cases or those with more complex pathology. Unfortunately this case was subsequently diagnostically triaged as serious spinal pathology.

Conclusion As misattribution of symptoms by the patient is common, it is essential that the clinician considers a thorough subjective and objective assessment. When drawing inferences from the findings it is vital to stand back and consider if the attributed cause and effect is an inherent likelihood and consider whether there may be important information missing.