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Previous Volume 354:509-514 February 2, 2006 Number 5 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 46-year-old Mexican immigrant presented to the hospital because of epigastric pain and the vomiting of coffee-grounds material. He had had fatigue, malaise, jaundice, and a 20-lb (9.1 kg) weight loss during the previous two months. He had also had dark stools, light-headedness, and mild shortness of breath, but no fever, chills, or night sweats.

The patient had upper gastrointestinal bleeding and . . . [Full Text of this Article]

Commentary

Source Information

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

Address reprint requests to Dr. Schmitt at the Legacy Emanuel Hospital and Health Center, 2801 N. Gantenbein Avenue, Suite 4100, Portland, OR 97227, or at aschmitt@lhs.org.

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