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A Piece of My Mind
April 7, 2004

Name Brand Medically Necessary: Do Not Substitute

Author Affiliations

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Editor.

JAMA. 2004;291(13):1541-1542. doi:10.1001/jama.291.13.1541

I first learned that Mr B was my patient when the radiologist called me early one morning. "We can't do the barium swallow," he said, "because Mr B keeps spitting it out on the table."

"Okay," I replied. "Send him back to his room." I am an attending physician in a teaching hospital. Late the night before, Mr B had been sent from the local veterans home to our emergency department, and the resident on my team had admitted him.

Outside Mr B's room, I looked over his records. Three days earlier he had stopped taking anything by mouth, including liquids and his medication for hypertension, depression, and agitation. Last night the veterans home staff hadn't been able to arouse him and had sent him to our ED. They suspected that he had had a stroke.

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