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Previous Volume 351:1997-2002 November 4, 2004 Number 19 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows.

A 42-year-old white man presented with a history of eight months of pain in his low back, hips, ankles, and feet. He had begun experiencing progressively severe pain during a 16-month period of incarceration. Therapy with nonsteroidal antiinflammatory medication had provided no significant improvement. The pain had become so severe that the patient had difficulty walking. He had otherwise felt well but . . . [Full Text of this Article]

Commentary

Source Information

From the Department of Medicine, Legacy Emanuel and Legacy Good Samaritan Hospitals, Portland, Oreg. (R.J.H., D.J.G.); the Department of Medicine, San Francisco Veterans Affairs Medical Center and the University of California at San Francisco School of Medicine, San Francisco (G.D.); and the Ann Arbor Veterans Affairs Health Services Research and Development Center of Excellence; the Patient Safety Enhancement Program, University of Michigan Health System; and the Department of Internal Medicine, University of Michigan Medical School — all in Ann Arbor (S.S.).

Address reprint requests to Dr. Dhaliwal at the San Francisco Veterans Affairs Medical Center, 4150 Clement St. (111), San Francisco, CA 94121, or at gurpreet.dhaliwal@med.va.gov.

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