Abstract
In the Clinical Problem-Solving case presented by Duffy (April 7 issue),1 three ophthalmologists misdiagnosed vitamin A deficiency as simple conjunctivitis in a 40-year-old woman with mild Down's syndrome who had severe eye pain. The discussant (a nephrologist) and the author attributed their error to a number of factors: a tendency of physicians to overlook nutritional conditions; lack of familiarity with the patient's complex medical history, which made her a compromised host; and the rarity of vitamin A deficiency in the United States. I propose an additional explanation -- that medical decision making was influenced by a tendency to take less seriously the symptoms reported by a mentally retarded person.

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