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Paper Patients

Dean G. Kardassakis, MD
JAMA. 1990;264(10):1340. doi:10.1001/jama.1990.03450100132045.
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I recently went through one of the worst experiences of my life: I took the Boards in internal medicine. It's a little like playing the medical version of "Jeopardy," only you can't change the channel, it lasts for two long September days, and instead of winning money, you have to pay the AB IM $500 for the privilege of being hazed.

I arrived at the appointed location: an old army theater with laptop boards to serve as desks and a complement of officers to proctor the exam. Their rank gave authority to the standard instructions about when we could break the test seals and when we could begin. There were about 200 of us assembled—all began the day as lean, mean, test-taking machines.

The exam is made up of common presentations of uncommon diseases and of uncommon presentations of common ones. The cases were often patients initially mismanaged by their


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