was." From the first, Falchuk was reading Anne Dodge's body language. Everything was a potential clue, telling him something about not only her physical condition but also her emotional state. This was a woman beaten down by her suffering. She would need to be drawn out gently.

Medical students are taught that the evaluation of a patient should proceed in a discrete, linear way: you first take the patient's history, then you perform a physical examination, order tests, and analyze the results. Only then should you formulate hypotheses about what might be wrong. These hypotheses should be winnowed by assigning statistical probabilities, based on existing databases, to each symptom, physical abnormality, and laboratory test; then you calculate the likely diagnosis. This is Bayesian analysis, a method of decision-making favored by those who construct algorithms and strictly adhere to evidence-based practice.

But, in fact, few if any physicians work with this mathematical paradigm. The physical examination begins with the first visual impression in the waiting room, with the tactile feedback gained by shaking a person's hand. Hypotheses about the diagnosis come to a doctor's mind even before a word of the medical history is spoken. And in cases like Dodge's, of course, the specialist has a diagnosis on the referral form from the internist, confirmed by the multitude of doctors' notes in the patient's medical record.

Falchuk recalled for me ushering Anne Dodge into his office, his hand on her elbow, lightly guiding her to a chair facing his desk. She looked at a stack of papers some six inches high. It was the dossier she had seen on the desks of her endocrinologists, hematologists, infectious disease physicians, psychiatrists, and nutritionists. For 15 years, she'd watched it grow from visit to visit.

Then Dr. Falchuk did something that

While modern medicine is aided by a dazzling array of technologies, like MRI scans and DNA analyses, language is still the bedrock of clinical practice. It is also essential that even the most astute doctors doubt their thinking, repeatedly considering the possibility that they may be wrong.

caught Dodge's eye: he moved those records to the far side of his desk, withdrew a pen from the breast pocket of his white coat, and took a clean tablet of lined paper from his drawer. "Before we talk about why you are here today," Falchuk said, "let's go back to the beginning. Tell me about when you first didn't feel good."

For a moment, she was confused. Hadn't the doctor spoken with her internist and looked at her records? "I have bulimia and anorexia nervosa," she said softly. Her clasped hands tightened. "And now I have irritable bowel syndrome."

Falchuk offered a gentle smile. "I want to hear your story, in your own words."

Dodge glanced at the clock on the wall, the steady sweep of the second hand ticking off precious time. Her internist had told her that Dr. Falchuk was a prominent specialist, that there was a long waiting

list to see him. Her problem was hardly urgent, and she'd gotten an appointment in less than two months only because of a cancellation in his Christmas-week schedule. But she detected no hint of rush or impatience in the doctor's manner. His calm made it seem as though he had all the time in the world.

Tortuous Story
So Dodge began, as Falchuk requested, at the beginning, reciting the long and tortuous story of her initial symptoms, the many doctors she had seen, the tests she had undergone. As she spoke, Falchuk would nod or interject short phrases: "Uh-huh." "I'm with you." "Go on."

Occasionally Dodge found herself losing track of the sequence of events. It was as if Dr. Falchuk had given her permission to open the floodgates, and a torrent of painful memories was pouring forth. She was tumbling forward, swept along as she had been as a child on Cape Cod when a powerful wave caught her unawares. She couldn't recall exactly when she had had the bone marrow biopsy for her anemia.

"Don't worry about exactly when," Falchuk said. For a long moment Dodge sat mute, still searching for the date. "I'll check it later in your records. Let's talk about the past months. Specifically, what you have been doing to try to gain weight." This was easier for Dodge; the doctor had thrown her a rope and was slowly tugging her to the shore of the present. As she spoke, Falchuk focused on the details of her diet. "Now, tell me again what happens after each meal," he said.

Dodge thought she had already explained this, that it all was detailed in her records. Surely her internist had told Dr. Falchuk about the diet she had been following. But she went on to say, "I try to get down as much cereal in the morning as possible, and then bread and pasta at lunch and dinner." Cramps and diarrhea followed nearly every meal, Dodge explained. She was taking antinausea medication that had greatly reduced her vomiting but did