A Síndrome de McCoy.
Originalmente publicado em: Baddini-Martinez J, Pádua AI. McCoy’s syndrome: a new medical entity. Lancet, 2012; 379: e32.
A 40-year-old woman was sent to our service for a bronchoscopy owing to multiple interstitial pulmonary
infi ltrates. She complained of a dry cough, dyspnoea, and wheezing of 4 months’ duration. She also reported
broncho spasm episodes in childhood. The patient had already been seen by three different clinicians and brought
with her several test results, including a thorax CT. She had been treated with antibiotics, bronchodilators, and
steroids, without improvement. Physical examination showed slight bilateral wheezing, and a hard mass measuring 5 cm × 5 cm in the right breast. The breast skin had a peau d’orange appearance and the nipple was ulcerated. Also found was a hard axillary lymph node measuring 2•5 cm × 2•5 cm. She had noticed the breast nodule 1 year previously. The radiological images were compatible with pulmonary lymphangitic carcinomatosis.
One of us had experienced a clinical situation like this before, and Abraham Verghese speaks about a similar case in one of his talks(1). This set of missed diagnoses illustrates a condition that we propose to name McCoy’s syndrome. Leonard McCoy is a science fi ction character—the doctor of the starship Enterprise in the original Star Trek television series. The story takes place in the 23rd century, where he uses a “medical tricorder” with a hand-held sensor to examine patients. This apparatus lets him make precise diagnoses, without the need to interview and examine patients in the traditional way. Unfortunately, McCoy’s syndrome seems to be widespread in the health system at the moment, striking mainly doctors, but also other healthcare professionals and even patients.
The most characteristic feature of the syndrome is the excessive faith in medical technology, particularly imaging. Other components that might also be present are the absence of clinical reasoning and of establishing emotional links with sick people. Some cases also show incapacity to think about common diagnostic hypotheses, particularly in
university hospital environments. Medical tricorders, unfortunately, are not a reality yet. The careful physical
examination of patients and history taking, although depreciated, is still the cornerstone of precise diagnostics.
We cannot deny the huge value of technological advances that have been seen in the medical fi eld during
recent decades. But we must use them wisely and with parsimony, and not ignore the simple, basic procedures
that depend only on our own vision and sense of touch.
1. Verghese A. A doctor’s touch. http://www.ted.com/talks/lang/en/abraham_verghese_a_doctor_s_touch.html (accessed Nov 11, 2011).