A Piece of My Mind |


James T. Rosenbaum, MD
JAMA. 2009;302(9):929-930. doi:10.1001/jama.2009.1170.
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We all know the dictum: A physician who cares for himself has a fool for a doctor. Does a similar rule apply when your child has a fever, your mother has fatigue, or your spouse has unexplained weight loss?

Howard is a 58-year-old psychiatrist who lives in verdant Oregon. Kind, empathetic, generous, insightful, uncomplaining. Healthy. With a wonderful family and a dog who commands a great deal of his attention. And walking his dog was how his illness began.

The first symptom was thigh pain after the evening walk. The pain resembled claudication, but it did not disappear quickly with rest. Then the rigors started every evening, followed by a morning respite. The trip to North Africa suggested a tantalizing clue, but blood smears for malaria were negative. What about the dental implant, his love of gardening, or the travel a year ago to the Galápagos? The infectious disease specialist, the neurologist, and the rheumatologist each asserted that the illness belonged to a specialty other than his own. A medication effect? He was not on a statin, an obvious cause for muscle aches. Could his growing narcotic usage reflect a psychiatric diagnosis?


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