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April 13, 1984

Second Opinion

Author Affiliations

Decatur, Ga

JAMA. 1984;251(14):1881. doi:10.1001/jama.1984.03340380063027

Twenty years ago I was a medical resident. I remember one night I had seen three patients and none could be called interesting. Mr Thomas was my fourth patient. His chief complaint was weakness. He had little spontaneity, his face was expressionless, his eyelids drooped, and his voice was nasal. My fatigue began to give way to excitement. Mr Thomas was a very interesting patient. He answered yes to: Do you ever see double? Do you tire easily? Do you have trouble swallowing? Does food or water come back through your nose? Has your voice changed? Do your eyelids droop? Mr Thomas wasn't impressed with the astuteness of my questions. If anything he became more apathetic. I had to strain to hear and understand him. "Mr Thomas, I think I know what is wrong with you. I want to give you a small dose of medicine in the vein of