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The New England Journal of Medicine, the premier doctor publication of this country, has a regular feature called Case Records of the Massachusetts General Hospital. Written in an extremely formal style, it presents unusual medical cases seen at MGH, regularly considered one of the top institutions of the country. The tone of these pieces brings to mind a medical conference of stern and wizened doctors, in stiff and starched lab coats of the brightest white, each with more titles and diplomas than the last, sitting at attention around a vast walnut table, frowning at slides being shown through one of those old-timey slide projectors, and saying things like “radiograph” instead of “X-ray.” An army of residents and med students observe in the hushed gallery, frantically yet soundlessly taking notes, praying they do not get called upon and thereby embarrass their Harvard or Yale educations.

I will occasionally post real cases that I see at my job at the urgent care. As one can imagine, this job is about as far removed from the lofty heights of academic medicine as possible, and the language will reflect that. For instance, I promise to never, ever use the term “radiograph.” And if the NEJM’s series is ultimately a celebration of Western medicine in its Platonic ideal, this series is a catalogue of Western medicine as it is experienced by the vast majority of patients whose cases will not, in fact, be the subject of a formal academic article. (And trust me, this is a good thing — you don’t ever want to be an interesting medical case. It brings to mind the old Steve Martin joke: “The doctor said first, the good news is, I was going to have a disease named after me…”)

Some identifying details will be altered to keep this blog HIPAA-compliant, but other than that, every story will be true to the best of my knowledge. Each will feature a page break, asking you to guess the diagnosis. I am sure some people will be smarter than me and will have guessed it before I did in real life. That is OK. I do not pretend to be the greatest doctor since the Mayo brothers opened a small clinic in Rochester, MN, unlike many medical blogs out there, and I welcome comments.

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