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A Piece of My Mind
July 9, 2003

Patients Like Linda

Author Affiliations

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

JAMA. 2003;290(2):165-166. doi:10.1001/jama.290.2.165

As I finished reviewing voluminous records describing Linda's* condition and headed toward the examining room to meet her, I could feel my anxiety rising. I knew the next hour would be extremely taxing, requiring all my skills. Having practiced almost 30 years as a neuromuscular specialist and academic neurologist, I wondered why this particular case evoked such concern in me. Linda's records indicated that numerous competent doctors, including two neurologists, found her examination normal, and myriad negative results from laboratory tests and imaging studies supported their conclusion that no identifiable organic illness was causing her myalgia, fatigue, joint pain, and insomnia. Linda was not being referred to me to diagnose one of the many degenerative neuromuscular disorders I usually treat such as amyotrophic lateral sclerosis. Certainly her physicians wanted my consultation to rule out the possibility that she had a neuromuscular disorder, but more to the point, they wanted my ongoing help because Linda's symptoms had been refractory to a host of standard treatments.