What Was Causing a Healthy Older Man to Be Nauseated by Food?

A vigorous retiree suddenly couldn’t eat a thing. Is the problem in his stomach or his head?


Comments: 107

  1. Great story and all the best to the recovered patient. Brings to mind my own circumstance, of seeing a respected family GP , who as is the common case, referred me to a specialist, neither knew what disease I had. Luckily, the Specialist referred me, to what I surprisingly learned, was a renowned Physician in his field. Point being, after several years of no diagnosis, it took but one visit, and all is being properly looked after. There is no cure for MDS but I am stable/in remission .

  2. Interesting story and glad a cure for found for this person.

    However, I can guarantee that any hypochondriac that is reading this story and from past posts on stories like this there are many, will now claim they have the malady.

  3. What's your point, Paul? Hypochondriacs will claim they have anything. Should this not have been reported in the Times because some hypochondriac somewhere might claim to have this obscure disorder, and therefore darken physicians' doors? I'm sure physicians would rather put up with a couple of hypochondriacs in the exam room now and again if it means that the publication of this article will help them arrive at the correct diagnosis for patients who are truly suffering.

  4. Right--because we all know "hypochondriacs" never have a difficult-to-diagnose illness. *eye roll*

  5. I had similar experience - different disease but similar circumstances EXCEPT I did not have a personal physician who knew ME. My experience with the family physicians or internists - gate keepers - I had encountered was that mostly they dispensed pills. I was youngish and healthyish so did not go regularly. My experience is that gatekeeper/primary care physicians are harder and harder to find and that those that practice seldom have time to do more than low-level problem solving. As a patient I have to hope I get sent to right specialist. My particular issue was solved when I called a department in a nearby university hospital and had records forwarded. It was the clinicians there that got me to the right place. But I had to take the initiative; none of the primary care folks I met with knew enough about me to really believe in me. And though good people, did not really have time to care all that much.
    I wonder what the outcome for this man would have been had he not had a doctor in the family to begin with. But kudos to this primary care physician. We need more of these in this country, but I can't tell there is much incentive for medical students to want to go into family practice. No doubt there are considerable problem solvers in medicine if they have time and incentive. Glad this gentleman is well now.

  6. I wonder what the outcome for this man would have been if he hadn't had a really good health insurance policy. Starvation?

  7. The benefit in knowing and being known: misunderstandings are less likely to happen, and what you report is less likely to be dismissed or seen as poor reporting. The "normal" you is a known quantity - not just a construct based on reported and recorded history. That has to help a Dr. to ferret out odd symptoms and possible causes.

    I went a long time when I was in my 20's and 30's without a regular physician, but have been spoiled in the last 30 years.

  8. Unfortunately the family physician is an ancient relic..... have the luxury of being able to take time to listen and diagnose all the symptoms profered by their patients. Like everything else in this modern world the computer takes over and diagnosis skills suffer. Time is a luxury for the physician who must produce the income in. Today's corporate world of medicine .

  9. Great story! Also another example of how it pays to have medical professionals in the family and advocates for the patient.

  10. This also seems like a stellar example of persistence, advocacy, and specialization. The fellow was still comparatively young (I hope!), but a 73 yr old not eating, wasting away....over the last centuries for how many would this be the start of the end? And what will the future bring in terms of insights, diagnosis, and treatments? Fascinating.

  11. My primary doctor has been an important member of my "family" for 40 years, though we are not related. He knows us, who we are , our history, our lifestyle, and has been there through every non-event or crisis. There is a trust that cannot be understated, and difficult to find these days. I find it almost alarming that these long-term family doctors are disappearing... a diagnosis is in part an art, one cannot separate the patient from the disease, and that doctors knowledge of the individual is invaluable.

  12. It’s almost impossible for a modern worker to keep the same doctor to build this kind of trust and wonderful consistency of care. Most people in my community change jobs every few years, and with that is new insurance which usually means a new doctor. The wait to get an appointment with a new doctor is typically 3 months. Everyone is so busy with little time off, that going to see a doctor when we’re not sick, just to become an “established patient”, isn’t a priority. When sickness happens, we have no provider and go to Urgent Care, or our insurance tells us to call a “Telemedicine” line. It’s not the way it used to be, with a pediatrician till you’re 18 and a PCP who really knows you. Another failure of our fractured and misaligned health care industry.

  13. I have known my PCP since I was four! She was my mom’s doctor and took such excellent care of her that when I was in college I started seeing her as my physician. She is in her early 60s now and I don’t know what I am going to do when she retires! I don’t think I will ever trust another doctor like I trust her.

  14. I had such a doctor.One day, he sent a letter to all his patients :

    "Dear Patient,

    I will no longer be accepting any form of insurance."

    Truly.

    ___________ M.D.

  15. When I was small I had a rare intestinal disorder that caused extreme stomach pain. Doctor after doctor dismissed it as a kid faking a stomach ache. Thankfully my mother was persistent and I was eventually treated after being in pain for weeks.

    When I was in college, I had appendicitis. My appendix nearly burst because it took three trips to the ER before it was properly diagnosed and the appendix removed.

    It is very difficult to be a patient when doctors don't listen.

  16. Hey you're a female, just another hysteric to our lovely doctors and that includes female docs.

  17. I am a 73-year old woman, and was upset when my primary care doc told me several years ago that he wanted to see me every six months. I had rarely seen him and was healthy. When he explained that the reason was that he could track my health and see whatever changes might show up, I was still hesitant, but now accept that it's a smart thing to do. He's also a good listener, and I hope he stays around as long as I do.

  18. It totally helps to have a physician (or pharmacist) daughter or son who can immediately refer one to -- and get an appt. with -- the best specialists.

    [Smacks head] ... Ooops, I forgot to have children!! :)

  19. "The patient gives most of the credit to the doctor who knew him well."

    Ahem.

    What about his daughter, the medical doctor, who knew him even better, recognized a serious issue when she saw one, and made sure he got treatment?

    It's great that he gives his good-old-boy buddy doctor the credit, but his daughter deserves at least half.

    Don't get me wrong, I'm delighted that the patient made a full recovery. And I understand that a prophet is scorned in his (in this case HER) own town, and we sometimes take for granted the efforts made by our own families.

    But still... this would not be the first time in history that the female's contribution was ignored while the male's was lavishly praised.

  20. Clinicians: the point of this story is that bruits are significant. But you have to actually listen with your stethoscope in order to find them.

  21. We should all have internists as fantastic as Dr. Leibowitz.

  22. If only primary care providers received the compensation (and appreciation from administrators/insurance companies) they deserve, more IM-trained physicians would chose primary care instead of specializing!

  23. When I was an undergrad (at a US top 10 university) 30+ years ago, I thought I had developed lactose intolerance and went to student health. The nurse in charge said the only way to diagnose was for me to drink a large beaker of a liquid with a high level of lactose. I protested, telling her that just one third glass of milk made me ill. She insisted. I drank it and became incapacitated with severe pain and runs. I could not get out of the bathroom for nearly two hours. She banged on the door: “you have to get out, we’re closing”. I forced myself out of the bathroom. Sweating bullets from the pain & w blurred vision (probably just dehydration, but still), I limped to the front door while the nurse watched. Then she closed and locked the door behind me. And just across campus sat a “world renowned medical center.” I got back to my dorm (how, I don’t know) and went directly into the bathroom. Because I was on scholarship I never said anything, fearing it might impact the funding. Medicine CAN be great, but mostly it’s not and the weakest point in the delivery system is bad providers who are protected by the broader fraternity of providers. First, do no . . . oh, never mind.

  24. The patient gave credit to the doctor who knew him - the one who didn't believe that what couldn't be explained must be all in the head.

    Years ago my mother suffered from a lack of appetite, fatigue, sporadic fevers. She was tested for infection, cancer, assessed for a viral condition. But the biggest impediment to finding the solution was that the doctor did not know her. She told him her appetite would disappear; he kept hearing nausea, even when she insisted she wasn't nauseous. What the doctor did not know is that my intelligent mother is a word maven - the term she used was the term she experienced.

    And afternoon of research unearthed the culprit - her blood pressure medication had leached her magnesium levels. Fifteen years later, we check the magnesium, but then, it was not routine.

    And it was easy to discover, once you looked at anorexia and not nausea when you googled the symptoms. Once you understood that the patient meant what she said, exactly.

  25. Unfortunately not all patients are accurate historians, nor do they use words precisely. For example, I've lost count of clients who have spoken about "my stomach" when they were actually referring to their bowels.

  26. I did have an internist several years ago who I thought knew me but when I lost 20 pounds in a short amount of time due to nausea and diarrhea, she insisted that menopause was the cause. When I finally insisted on seeing a gastroenterologist, I was diagnosed on the first visit with GERD and now know how to treat symptoms as they come up. But it has left me with anxiety every time I go to my current PA, whom I really like, with something new, wondering how much I will have to suffer before getting appropriate treatment.

  27. All those expensive tests at Yale and all it took was a stethoscope. The first thing any doctor in France does is use the stethoscope and check your BP. Your health "system" is a joke.

  28. My cousin in Florida raves about how quickly diagnostics are administered in the U.S. vs Canada. After her 17th mammogram in 9 years, I'd suggest your medical "system" created the speck of breast cancer her doctors detected last year.

  29. I am a doctor and I hear abdominal bruits at least twice a day. Not a rare thing and most often not causing any syndromes. This was a lucky diagnosis that could just have easily been found at the first hospital or missed by the latter.

  30. Well, to be fair, that's the first thing most doctors do in the US too, or at least the ones I've seen.

  31. A friends husband died of a similar condition that was not diagnosed for over a year. The condition was discovered after exploratory but by that time his gut was dead - call the family time.
    Interesting that the same hospital doctors almost killed his wife. Lucky her, her nurse daughter saved her life. Most of use are not that lucky.

  32. I had similar symptoms (nausea and dramatic loss of weight), and my primary care physician was stumped after doing many tests. I eventually went to a gastroenterologist and finally convinced him to do an endoscopy. He found evidence of celiac disease, which was unexpected due to the fact that my blood work was negative. It definitely pays to be persistent!

  33. My husband has had a number of health problems over the past five years. The most severe was cardiac arrest, from which he miraculously recovered. But there were odd problems that cropped up, like collateral damage--one of which was that his feet felt as if every bone in them were broken when he tried to walk. We have found that good doctors are important--and that not all doctors are good. He has been replacing the clueless ones and now has a pretty good team. I think it cannot be dismissed that all of these doctors are at MGH, arguably the best hospital in the world.

  34. Another wonderful whodoneit - medical story.

    I am approaching 70 and have never had a primary care doctor who had known me. In many of these stories, this fact is often highlighted and I am thinking it's getting late for me to have a doc like that.

    My fault to be sure as I move around a lot.

    But is it really necessary to have a primary doctor or its luck of the draw.

    I think this man's primary doctor was a good doc who knew what to listen or where.

    I am not sure him being his long term doctor had anything to do with it.

    Am I wrong here??

  35. My peers and I agree that as you reach those "Golden Years" your primary doc loses any real interest in your problems.

  36. You are right, it's luck. Every primary care doctor has their own process for a check-up. There is no standardized procedure for the annual health exam. The more doctors you see, the more luck you'll have.

  37. FYI. Dr. Richard Green is a vascular surgeon, who has been practicing for 42 years. Is there a better diagnostic method on the horizon such as consulting Watson, the super-computer?

  38. Wonderful for the gentleman that his daughter is a Yale emergency room physician. "In the emergency room he was seen promptly." Wonder how often patients get seen promptly in an emergency room unless they are dying right then and there. In medicine it helps to have connections.....

  39. I have found that vomiting in the ER waiting room really gets their attention.

  40. A heartwarming story, but an utter fantasy for most people. No daughter-doctor to smooth the way, so you sit many hours in emergency only to have the aggravated doctor tell you to go home, there’s nothing wrong. And there is no doctor at ‘your’ practice that remembers your name, let alone any characteristics that haven’t been typed into the computer. The same computer that the doctor spends the whole appointment typing on, without looking at you. Or maybe you will be sent to the np, who might have time to listen but can’t do anything without talking to the doctor, which means waiting weeks or months. And certainly you won’t be able to see anyone who could figure any of this out.

  41. I wonder why it took so long for this man to get an ultrasound and CT scan?
    He was obviously in serious trouble, losing weight by the day. Even if doctors did not know what they were looking for, why wouldn’t they have done an exploratory scan to try to find out what was going on? I don’t get it,

  42. France has a good medical system, why didn't the daughter send him to them first?

  43. Communication perhaps? Americans are not well known for their mastery of languages (including, ahem, English... sorry). They may also not have had medical insurance for travel - millions of you can't afford health care in your own country let alone overseas.

  44. Good point, probably because of the unknowns. Also keep in mind that Medicare does not provide coverage outside of the USA.

  45. This case was solved from the hint of a semeiotic sign a “ bruit “ .
    It appears that now only old fashion doctors are still able to perform a physical examination that is truly coned down on resolving the problem and providing a diagnosis.
    Today’s trained doctors rarely have the time to listen , examine and truly “ digest “ a clinical case , apparently easy but definitely complex and rare .
    Having a concerned daughter- physician also helped this gentleman .
    The family physician had an outstanding part in resolving this unusual and difficult case , he should be considered an example for young professionals .
    Thank you for sharing this medical case with a successful ending.

  46. I lost a dear friend to suicide after she developed chronic nausea, the cause of which was never diagnosed, even post-mortem. It is still hard to let go of guilt, the feeling that if only I could have dragged her to another doctor, she could have been properly diagnosed, even cured. I don't think any of us could tolerate months of endless nausea. I am thankful that in the case described her, there was a happy ending.

  47. Years ago, when I was sick as a dog and had lost 15 pounds, I went to my primary physician, one of the most well known infectious disease specialists in New York. Looking for something exotic, she started by asking if I had traveled to India or Africa. When the answer was no, she immediately leapt to the idea that I might have cancer and tested for that. When that proved wrong she ran out of ideas and suggested I see a psychiatrist. I protested that I was not mentally ill, but to no avail. At that point I was confined to bed, too sick and weak to seek another doctor. A few days later my sister, who is not a doctor, called. After listening to me describe my symptoms, she said, “Sounds like Lyme disease.” She was right.

    Listening to the patient sure is a good start.

  48. Reminds me of the PCP (not
    mine) who noticed I was limping from a knee injury and thus concluded I had pain from a pulled a back muscle. I actually had shingles (Classic symptoms except no rash). Because of his mistake, I missed the window of effectiveness for the antiviral used to treat shingles. Doctors will never acknowledge criticism of a colleague, but when I went back the next day to see my own PCP ( who’s a good diagnostician), I made sure to tell her what happened and what I thought of her practice colleague. Even if she didn’t really respond, she heard me and she saw his notes in my record.

  49. I've had the same terrific primary care doctor for 25 years, since we moved to this community. She was recommended by a realtor, believe it or not. Every time we have a troubling or confusing or complicated issue that requires further investigation by a specialist, Dr B's informed diagnosis and probable treatment plan winds up being right on the money as to what the specialist diagnoses. Oh yes, and she remembers our names, even when we cross paths at the nearby grocery store.....We consider ourselves lucky that she is our doctor.

  50. My 18 year old son just went through a bout of gastroparesis. It is very scary...a few bites and he couldn’t eat anymore. It felt like a brick in his upper abdomen. He is very thin to begin with and lost weight - down to 137. We saw a GI, he took a few medications for gas and pain and limited his diet to bland foods (no fruit, no vegetables), very small portions. We don’t know what caused it and while it is a little better now he is not 100%.

  51. " The imaging showed that the muscular inner wall of the artery had been torn open by the fast-moving blood coming from the heart."

    So what caused this?

    No offense to the allopathic medical world (allopathic doctors do a lot of good), but can we get to the root cause?

    Why would an artery be torn open by fast-moving blood coming from the heart? What weakened the artery? Was it genetics, age, and/or something else?

  52. It was lack of vitamin C which is needed for collagen formation.

  53. I agree
    A spontaneous dissection of the gastric artery? Seems bizarre.

  54. It’s called an arterial dissection and my understanding is that the cause is unknown. My husband had one in his left carotid artery. Afterward the doctors quizzed him on whether there is any connective tissue disorder in his family. None was found.

  55. It is important to keep in mind: As in any profession, different people have different skills, talents, and abilities.

    Being a good diagnostician is actually a natural talent, not a skill that can be learned.

    This is true whether you are talking about tradespeople (e.g. plumbers, HVAC professionals), computer and software professionals, and ... yes, even doctors.

  56. Well, that’s a scary thought! I would prefer it be a skill, not a talent. It seems to me that the more knowledge one has, the higher chance of getting an accurate diagnosis. To say it’s a talent minimizes the importance of continuous education and research and investigation. That puts everyone in danger.

  57. I have been seen by 3 GI doctors and not one has every touched me much less listened to my gut. I am undiagnosed even though I have had many tests that are mostly normal.
    My point is no one ever examined me ,the GI doctors just run their expensive tests and get rich. If you don't have one of the common GI disorders that show up on testing then its hopeless.
    Of course being female I am then offered anti-depressants. One of my major problems is being awaken from a sound sleep in severe pain in my gut, yep doesn't that sound like depression(irony here)
    Lucky this was a man.

  58. Is the pain coming from a muscle cramp? Have you looked into magnesium deficiency? I chased similar symptoms for years until a nurse suggested I try magnesium supplements. (No, I’m not selling anything- just glad to be sleeping better).

  59. I had a similar problem, being awakened from sleep with severe lower right abdominal pain 1 1/2 to 2 hours after falling asleep (one of many problems I developed in an adverse reaction to omeprazole). I was "treated" with an antidepressant too, which did enable me to sleep through the night after 3-4 months of interrupted sleep. Too, the indifference I experienced from the GI physicians I consulted really amazed me. Doctors really have to learn to use the internet. The least they could do is check the Mayo Clinic website.

  60. Have you ruled out lactose intolerance? I spent months having numerous tests, visiting a nutritionist and multiple physicians for terrible pain. It turned out to be a rather simple solution.

  61. Surely by now some kind of online diagnostic algorithm is available to doctors. It's absurd to expect one person to know every symptom of every disease or condition, especially as our knowledge of physiology and illness is always expanding. If laypeople can go online and make rough guesses at what's bothering them, then trained physicians should have online access to more sophisticated and medically accurate symptoms, types of tests, and other information for prompt diagnoses. Based on the article and the comments, everyone is relying simply on what they've learned along the way. Yikes!

  62. Incredible how many docs practice "hands off" medicine.
    It's all about the electronic records of multiple tests.
    I switched primary docs a few years ago because the first one, highly recommended by neighbors in my new location, Florida, never once in 5 years actually layed hands on me, anywhere, but for listening to my heart.

    I don't know why I waited so long to switch practices! I now see a doctor who actually touches me, the patient, during every exam. Hmmmm, she's a woman. I'm a woman. Maybe that's an important distinction. I now feel all my doctors, all women, really listen to me when I answer their queries. And they listen when I ask them questions too.
    Be your own advocate!!

  63. NH -this demonstrates how important a long term relationship with a healthcare provider can be. In this age of continuing corporate buy-outs of medical practices and the changes in providers it brings we lose the relationship built over time that is critical to diagnosis and healing. Pretty inexpensive infrastructure; a consistent provider and a stethoscope that led to the correct diagnosis and cure.

  64. I've had the same cardiologist for over 13 years here in south Florida. The practice is out of network with my medicare Part B policy. Consequently I pay substantially more to see him than a cardiologist that would be in network. But I would never consider changing to in network. He knows me and my history. When I question the meds I take he listens and we've made changes that have erased unwanted side effects.

  65. I wonder what would’ve happened if he did not have a well-connected daughter & if he had no insurance?

  66. As I read this, I feel two things.
    First, I'm glad things turned out so well for this gentleman.
    Second, I'm overwhelmed at the amount, depth, frequency—call it what you will—of his health care. A doctor here, all sorts of tests. Another doctor, more tests. A surgeon. More tests.
    Who can afford all this?
    My aunt is having surgery in a couple of hours. She's been obese and a heavy smoker for decades. She took a fall, it took two fire/ambulance people—6 men—to transport her to the hospital, and within a day she had had more medical attention than I've had in my life. She went home after racking up a $500,000 bill. She kept smoking and stayed obese. Then a second fall two years later, which precipitated a years-long stay in rehab, plus back-and-forth trips to the hospital, multiple surgeries, 20 visits to a hyperbaric (not spelled right) chamber; again, an overwhelming amount of medical attention. (At rehab she gets her "vitals" checked twice a day. Do you know how long it's been since anyone checked my vitals?) Despite having teachers insurance from a wealthy northern state, she's now complaining to anyone who'll listen that she worked her whole life to pay for the medical care she's receiving now.
    I'm telling you what: as soon as I have any significant health issue, I'm checking out.

  67. No you are not checking out. Let your aunt live.

  68. I recently was diagnosed with "an infection of unknown origin." Not a diagnosis per se, but I was taken from my doctor's office in an ambulance to the nearest hospital to figure it out. (I didn't even have time to arrange for cat sitting, and had to give away the ice cream I had just bought to make myself feel better.) Ultimately I was diagnosed with pneumonia and possible Legionnaire's. While in the hospital for 8 days I had 3 or 4 blood tests per day, electrocardiogram, MRI, CT, the attention of several specialists, all my medications, follow up visit, and other things (as well as some pretty awful food). Cost to me: $0.00. I never filled out a form, never saw a bill. You live in the wrong country.

    PS: life expectancy is about two years longer here than in the US

  69. Nice to have financial resources.

  70. Never underestimate the power of a stethoscope and a good ole (thorough) physical exam.

  71. So true! Yet increasing younger doctors practice medicine by ordering lots of tests. The actual history and physical exam are given very little time, and considered old fashioned.

  72. So true. This is why I prefer my GP to be an osteopath - most of whom take the time to really examine their patients.

  73. I noticed that underneath the article, there's a statement that if one has diagnosed a case ,one can contact Dr. Sanders.

    What if one has a case, that none of of the top physicians in New York. including Chiefs of Departments at major Manhattan teaching hospitals, Professors of Medicine, academic doctors. can diagnose, despite the symptoms being clearly visible ?

    Why not publish a column devote to the undiagnosed? That would provide the opportunity for millions of people, including physicians from all over the world, to read of the extremely unusual symptoms, possibly leading to a diagnosis ?

    The New York Times has such a column, years ago.

    I urge the New York Times to bring it back.

  74. I would like to nominate as a subject for this type of column my 24-year-old grandson who has had a severe sleep disorder since he was 17. Despite being seen by many specialists, his case is yet to be diagnosed. Everyone agrees that he only sleeps 3 or 4 hours within 24, but no one can say why. He has migraines and a compromised immune system, too.

  75. There is a column where I write about undiagnosed cases. Here's a link to one of the recent cases: https://www.nytimes.com/interactive/2018/05/04/magazine/netflix-diagnosi...
    It runs once a month and will continue for the next few months. The next case will appear on Wednesday, June 20. In this column I present a patient who hasn't been diagnosed and we reach out to our readers to look for possible answers.

  76. That column was "Think Like a Doctor." I miss it, too.

  77. I had gastroparesis for months in my 20s, but because I had a history of eating disorders, I was told it was 'all in my head'. It took one specialist - oddly an eating disorders one - to tell me, after less than five minutes of conversation, "it's not in your head, here, go get this medication from the chemist and you'll be ok". Less than 24 hours later, I was eating and drinking normally again, after literally months and months of agony which was, apparently, created in my mind.

    I also had endometriosis. Of course, it wasn't diagnosed back in my late teens when it started - it wasn't until I got to my forties that it was finally discovered, quite by accident, from another doctor who actually took the time to listen and take me seriously. It answered a lot about my extreme pain, and the fact that I could never have children.

    I work with doctors in my job, and am frequently amazed at how arrogant the are, and how little they actually listen. They think that because they went to university for x number of years that they know everything. They don't. Sometimes you have to push and push until you find someone who does want to listen, and who appreciates that you are not an idiot, and that you know, down to your bones, when something is actually wrong.

    They guy in this story is fortunate to have had a daughter who could help. Not all of us are that lucky.

  78. Sadly, many doctors appear unable to utter the words, "I don't know." That inability causes a lot of problems for their patients.

  79. My Mother had shortness of breath for ten years. Ten years of various theories followed. Finally an ENT in a backwater town my Dad happened to be assigned to temporarily thought to look down her throat and saw the problem as plain as the nose on her face. Her vocal chords had been damaged in a strep throat infection causing the obstruction ten years before.

  80. This piece illustrates why our medical costs are so high and our society distorted. Multiple visits to doctors, hospitals, emergency rooms, tests, all to repair a defective 73 year old who will die soon anyway. But, because his daughter has unlimited access to the best physicians and the patient unlimited access to medical care, all the rest of us die because we can't afford that or the scarce resources are allocated to people who don't any longer deserve to consume them.

  81. No, No. No.

  82. Maybe you are the one who does not deserve to consume resources?

  83. Who's going to decide who "deserves" care? You might feel differently when you get to 73.

  84. Happy that the man in the story was diagnosed and all went well.

    I am a little amazed at some of the comments, which have the base level assumption that we as a society can not afford health care, just because our current system makes health care unaffordable. I wonder if things will change in my lifetime, or if this belief proves self-fulfilling.

  85. "...assumption that we as a society can not afford health care, just because our current system makes health care unaffordable."

    This is a really astute observation. In a perverse way, high costs are working to the benefit of for-profit health care in more ways than just high profits.

  86. After reading the comments I am disheartened to see so many resent that there was a doctor in the family able to guide her father to a diagnosis. There seems to be even more resentment that the patient had health insurance. I suspect the anger is not personal, merely frustration that the writers aren't covered by a health insurance plan themselves.
    The answer is so obvious. Instead of being angry and jealous, a simple solution is for everyone to contribute a few dollars to fund a single payor plan. Yes, I mean Medicare for all. I would be willing to contribute more to ensure everyone had medical care. Instead of begrudging your brother his insurance why not put a positive spin on that energy and insist on coverage for all? There has to be a better way!

  87. The better way lies in plain sight: publicly-supported health care operates in every developed country. Some of those have been in place for a century. It's the American system that isn't "normal" but the aberration. But Americans have to think their way is the only way.

  88. So many comments indicate frustration with our health care system. People don't seem to realize the power they have. How many of the commentors have ever called, emailed or written to their senators and congress persons to encourage them to push for a single payer health care system? How many commentors would be willing to pay higher taxes if it meant an improved health care system would be implemented? If congress was inundated every day with calls from taxpayers for reform, if their inboxes were flooded with demands for meaningful healthcare reform, if taxpayers made it known that they would be willing to pay more for better healthcare, then we might get it. Expressing frustration in a comment to the NYT is fine, but it does nothing to change the system.

  89. Nope- the GOP congress is owned by big $$ and will never go for single payer insurance. And their ignorant, bigoted, followers would not want single payer, because it would be "socialist".

  90. Two years ago, I had Gastroparesis for about a month and a half. It was hell getting it diagnosed. I could not eat or drink without it coming back up. I lost close to 80# during that time.
    By the time it was diagnosed, the condition was starting to resolve itself.
    My stomach and digestion have not been normal since.

  91. Yale-New Haven? Darien CT? Direct transportation from airport to CT hospital?
    This guy must be on Obamacare.

    Low income (yes, poor), even middle income, would never get much less afford this type of care in Trump’s America.

  92. He lives in Darien. So he's probably fortunate enough to have lots of resources at his disposal. Agree other demographics would not get the same level of focus!

  93. Note that nothing was made of the emotional consequences of the surgery ... Few M.D.s have even a rudimentary understanding of the psychological causes of dis-ease, so it is inevitable they celebrate their physical solutions.

  94. A middle aged female friend in New York City began experiencing problems with balance, body swelling, and had bouts of mental confusion. Visits to various male doctors over a period of a year gave her no relief. She was told

    1. She was just getting old
    2. She should see a psychiatrist
    3. She could get plastic surgery for her facial swelling

    A female doctor refused to let her go undiagnosed and ultimately found she was suffering from an endocrine disorder and after a few months of treatment she was back to her normal, active self.

    I despise doctors who dismiss difficult cases as a problem of aging or only needing psychiatric counseling.

  95. Not a sentiment I can identify with. I am convinced that should I one day be diagnosed with cancer, I will become the first person to become obese while on chemotherapy. I struggle daily to keep off the weight, including lots of exercise and a calorie-restricted diet high in protein and fiber. The only thing that might cause me to lose weight would be a gun shot to the stomach.

  96. What a morbid thought!

  97. At that point, obesity may be the least of your worries.

  98. I, too, would be nauseated by an unidentifiable, vaguely orange star-shaped food with brown elliptical polka dots.

  99. Kudos to his primary care doctor. His long standing relationships with his probably retiring internist saved this man’s life. Most new grads wouldn’t know how to use a stethoscope. He would of been sent to a Gastroenterologist, and placed on proton pump inhibitors until his bowels infarcted.

  100. My family has found it almost impossible to develop a "long-standing relationship" with any health provider because they come and go constantly. Blink, and they're gone, and you're starting over with someone who has never laid eyes on you.

  101. This is a result of the HMO craze. When doctors no longer establish private practices that they build up with years of good will and good service but instead work for an HMO as an employee they have a ready-to-hand patient base. Thus, if they want to move to Hawaii, say, for the lifestyle, they go there and have a ready-to-hand patient base. So doctors are a lot more mobile than they once were, untethered to a community. Another part of the failed promise of "Health Maintenance" Organisations.

  102. I'm happy for this gentlemen. Many people with good insurance have similar outcomes; those of us stuck with HMO plans seldom get this sort of first-class treatment.

  103. Practicing medicine is a science and fact based knowledge combined with experiences which the provider has had and may lead to an informed response.

    Think of it like this. At one time, I had a collector's car. Of course, being 50 years old meant that although many people understood the combustion engine, a very small percentage of those people were able to diagnose the problems I presented them with. Actually, I was better off with other collectors of the same car to get accurate information, and I had a mechanic's manual for this car!

    When a medical student graduates, passes their bar, and begins their practice, they are full of a lot of scientific facts and less of individual experience. It takes more than college and medical school to become a 'good' doctor (or nurse). Empathy is extremely important. These 3 factors are why 'the practice of medicine' is called an Art.

    Patients need to understand that they are unique individuals. You can go to McDonalds and get a hamburger if you're not too insistent on what constitutes a hamburger. You can go to a Doc-n-a-Box if you think we are all more clone-like than unique individuals. Chances are, if you are young and generally in decent health, you'll survive the appointment. But if you want to live a full life for as long as you can then find a doctor you can build a relationship with.

  104. Where I worked, there were always a few patients who bewildered the primary, even some specialists. The doctors would meet, hash out their theories, go back to the test results and see what could still be ordered to rule out their hypotheses. It does take time, perseverance, and some good hunches. In truth, some doctors are not great diagnosticians, but even the best cannot figure out some difficult situations alone.
    It takes teamwork. What does pay off, as other commenters noted, is knowing your patient over the long run, who is least likely to be a hypochondriac. No doctor with 10-15 minutes "to spare" could possibly do justice. That is why, sadly, more physicians are turning to boutique medicine.

  105. I have been dealing with similar symptoms for more than 3 months and also have connective tissue disease. I have been placed on 3 different meds (none have worked), had an upper gi scope and just went through gastric emptying. Everyone is still "stumped" or believe it is in my head despite losing 25lbs these past 3 months. Every time I ask if it could be related to my connective tissue disease, or anything else, I get the eye roll and a no. I am forwarding this article on to each and every one of my "specialists".

  106. If this man's daughter wasn't a doctor NOTHING would have been done other than endless appointments with zero results. It happened and still happens to me along with 23 million other citizens. As good as this article is the Times fails due to omissions in their news. They would serve their readers far better showing who our so called health care can barely diagnose anything despite expensive tests.

  107. all I can think is Thank God for good doctors. Most importantly is that this doctor was not dictated to by a corporation that owns his practice. The man was very lucky to have a good caring physician who knew him. Today, where many practices are owned by a corporation that only cares about money, this type of diagnosis will be less and less frequent. I think it was called the death squad.