Current clinical practice is often heavily biased towards the exclusion of potentially serious, treatable diagnoses, such as deep venous thrombosis, rather than the positive diagnosis of the patient’s underlying illness which precipitates seeking medical attention. We report a case of leg swelling where deep venous thrombosis was repeatedly excluded as a cause of leg pain and swelling, but where arrival at the correct diagnosis was significantly delayed, in part due to protocol-driven practice.

Keywords Clinical acumen, leg swelling, Paget’s disease of bone

Declaration of Interests No conflict of interests declared.