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A trend I cannot endorse

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By Warren R. Heymann, MD
Feb. 17, 2017

A patient with a morbilliform eruption was assessed at our clinic. My resident evaluated him first before presenting the case to me.

“Did he have any systemic symptoms?” I inquired.

“He endorsed diarrhea,” my resident replied.

“You mean he liked it? Personally, I can endorse a good BM, but not diarrhea.”

“No, I meant he had diarrhea!”

“So why didn’t you just say that?”

In recent weeks, from rotating residents in different specialties, I have heard many symptoms “endorsed” ranging from joint pain, to shortness of breath, to irregular menses. I am sure the patients experienced these, but I am skeptical that they endorsed them.

I thought this might be just an institutional quirk, but I was wrong.
In an excellent case presentation of erythropoietic protoporhphyria (EPP), I read the following: “On review of systems, he endorsed photosensitivity during childhood only.” (1) I doubt that photosensitivity made him a happy child.

According to the Merriam-Webster dictionary, “endorse” is a transitive verb meaning “to approve openly or recommend” (or also “inscribe” as in endorsing a check).

Interestingly, in the same issue there is a letter critiquing the use of cimetidine for EPP (see the post from November 16, 2016 “Cimetidine offers a ray of sunshine for patients with erythropoietic protoporphyria”). Clearly, the authors do not endorse its use, but they endorse the development of a pediatric dose-form of afamelanotide (2). The authors of the index article endorse more rigorous clinical trials to examine the safety, efficacy, and optimal dosing of cimetidine in EPP (3).

I don’t know how this trend started but I hope it comes to a quick end. Bernie can endorse Hillary, Rihanna can endorse Nivea, but patients should not endorse their symptoms!  We should endorse accurate histories in an effort to improve patient care.

1. Sluzevich JC, Hoesly PM. Pruritic waxy and verrucous papules in a middle-aged man. JAMA Dermatology 2017; 153: 221-2.
2. Langendonk JG, Paul Wilson JH. Insufficient evidence of cimetidine benefit in protoporhyria. JAMA Dermatology 2017; 153: 237
3. Teng JC, Tu JH. In reply. JAMA Dermatology 2017; 153; 238.

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