Back to the basics.

The history and physical examination skills are being replaced by the tools of technology in establishing the actual cause of illness. We present a patient where the history and physical examination were essential in establishing the diagnosis. A 28-year-old female presented to the Emergency Department (ED) with an acute episode of epigastric pain radiating to the back associated with vomiting. Laboratory examinations revealed pancreatitis, imaging showed gallstones and the patient was admitted with the diagnosis of gallstone pancreatitis. A more detailed history and physical examination, however, was notable for a family history of "Mediterranean blood" and abdominal examination demonstrated splenomegaly and laboratory examination showed a microcytic anemia. The recognition of the family history, splenomegaly and microcytic anemia led to the diagnosis of thalassemia as the cause of the gallstone pancreatitis. Clearly, the history was essential in establishing the underlying cause of the problem.