I woke up around 2am that Sunday breathless, with pain on inspiration. For a week prior to that, I had been coughing with a sore throat and unlike the typical Nigerian, I had not tried any medications. I had had previous bouts of similar symptoms which subsided on their own, a pointer to a viral infection of some sort. All I had to do was rest, take lots of water and fruits and rest again. This morning though, it seemed the wait and see option had backfired. I had to prop myself up and sleep semi awake till it was bright enough to take myself to the emergency department. My roommate was not around and I did not want to frighten my other friends. I mean, it was just pharyngitis gone bad, maybe pneumonia or a panic attack even. Nothing out of the norm.

At the emergency department later that morning, I had to wait a long time before I got to see the doctor. Breathing in still brought pain, although reduced, and my throat was still sore. When eventually the doctor would give a diagnosis, she asked, “you are a medical student, right?” I nodded in reply. She continued, “what you have is COSTOCHONDRITIS.”

Ladies and gentlemen, I was ‘shocked’.

She concluded by saying, “you know, common things occur commonly.”

Please note, she did not perform any examination, general or specific. She did not elicit tenderness which would have even been a pointer to her costochondritis diagnosis. She just…gave me costochondritis! I left the emergency department sad. Not just because of the diagnosis but because I learnt that many of my colleagues had received similar diagnosis on complaints of similar or even different symptoms.

Was costochondritis actually common or by the repeated misdiagnoses of the condition, the doctors had made it common?

“When you hear hoof beats, think horses not zebras” is a shorthand for the aphorism coined in the late 1940s by Dr. Theodore Woodward, professor at the University of Maryland School of Medicine. It is what we hear almost everyday here as. “Common things occur commonly”.

It is a very valuable mantra that encourages looking out for the common diseases/conditions based on location, season and presentation (horses) rather than chasing after the rare, high falloting diagnosis (zebras). This is why a 14year old with cough, clear chest and not a smoker would not be given Cystic fibrosis as a diagnosis. It is also why almost every child that goes to the hospital with a fever in Nigeria is treated for malaria.

In as much as this mantra is good, it might be the reason actual rare diagnosis are missed. Once the presentation does not fit the list of common things, the psychiatrists are called to review. The patient either accepts these symptoms are just in ‘his/her head’ or he/she keeps coming back to receive the treatments meant for things that occur commonly.

As for my costochondritis doctor, I think she decided to modify the list of common things to her taste. Shout out to all those who have been diagnosed with fake costochondritis. At least, I know one person who does have it. One.

So, when you think horses and not zebras, you look out for the common things first, you keep in mind the rare ones and you do not confabulate. That’s the Naija-doctor way. #winks.



NAME: Eunice Oladeji

DEPARTMENT: Medicine and Surgery


NOTE: I am a final year student of the University of Ibadan with deep love for writing. I appreciates using written words to ensure proper and effective communication. My hobbies include reading, writing, public speaking, singing and making people happy.