The patient sat in the squeaky chair in my exam room and told me his back hurt. He was a Hispanic man in his early forties; I'll call him by his first initial, P. It was 2007 and I was a new doctor, just out of medical school, starting my medical residency in a primary care clinic. I went through the usual barrage of questions designed to rule out the most lethal causes of back pain: Did it wake him up at night? Was it worse when he was lying down? Had he recently lost weight? No, he hadn't lost weight, he said. Just the opposite. He'd gained forty pounds in the past six months.
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