thought; symptoms may not begin until late adolescence or early adulthood, as Falchuk believes occurred in Anne Dodge's case. Yes, she suffered from an eating disorder. But her body's reaction to gluten resulted in irritation and distortion of the lining of her bowel, so nutrients were not absorbed. The more cereal and pasta she added to her diet, the more her digestive tract was damaged, and even fewer calories and essential vitamins passed into her system.

Anne Dodge was both elated and a bit dazed. After 15 years of struggling to get better, she had begun to lose hope. Now she had a new chance to restore her health. It would take time, she said, to rebuild not only her body but her mind. Maybe one day she would be, as she put it, "whole" again.

The Patients Story
"A lot of people look at a specialist like me as a technician," Falchuk told me. "They come to you for a procedure. And there is no doubt that procedures are important, or that the specialized technology we have these days is vital in caring for a patient. But I believe that this technology also has taken us away from the patient's story." Falchuk paused. "And once you remove yourself from the patient's story, you no longer are truly a doctor."

He explained that he conducts an inner monologue to guide his clinical thinking. "She told me she was eating up to 3,000 calories a day. Inside myself, I asked: 'Should I believe you? And if I do, then why aren't you gaining weight?'" That simple possibility had to be carried to its logical end: that she was actually trying, that she really was putting the cereal, bread, and pasta in her mouth, chewing, swallowing, struggling not to vomit, and still wasting away, her blood counts still falling, her bones still decomposing, her immune system still failing. "I have to give her the benefit of a doubt," Falchuk told himself.

Falchuk said something else might account for her condition. "Given how much weight you've lost, what's happened to your blood, your bones, and your immune system, it may be that your body can't digest the food you're eating, that those 3,000 calories are just passing through you."

Keeping an open mind was reflected in Falchuk's open-ended line of questioning. The more he observed Anne Dodge, and the more he listened, the more disquiet he felt. "It just seemed impossible to absolutely conclude it was all psychiatric," he said. "Everyone has written her off as some neurotic case. But my intuition told me the picture didn't entirely fit. And once I felt that way, I began to wonder: What was missing?"

Clinical intuition is a complex sense that becomes refined over years and years of practice, of listening to literally thousands of patients' stories, examining thousands of people, and, most important, remembering when you were wrong. Falchuk had done research at the National Institutes of Health on patients with malabsorption, people who couldn't extract vital nutrients and calories from the food they ate. This background was

key to recognizing that Anne Dodge might be suffering not only from anorexia nervosa or bulimia but also from some form of malabsorption. He told me that her case reminded him that he had been fooled in the past by a patient who was also losing weight rapidly. That woman carried the diagnosis of malabsorption. She said she ate heartily and had terrible cramps and diarrhea, and her many doctors believed her. After more than a month of evaluation, numerous blood tests, and an endoscopy, Falchuk found by chance under her hospital bed a bottle of laxatives she had forgotten to hide. Nothing was wrong with her gastrointestinal tract. Something was tragically wrong with her psyche. Falchuk learned that both mind and body have to be considered, at times independently, at times through their connections.

Different doctors achieve competency in remarkably similar ways, despite working in disparate fields. Primarily, they recognize and remember their mistakes and misjudgments and incorporate those memories into their thinking. Studies show that expertise is largely acquired not only by sustained practice but also by receiving feedback that helps you understand your technical errors and misguided decisions. During my training, I met a cardiologist who had a deserved reputation as one of the best in his field, not only a storehouse of knowledge but also a clinician with excellent judgment. He kept a log of all the mistakes he knew he had made over the decades and at times revisited this compendium when he was trying to figure out a particularly difficult case. He was characterized by many of his colleagues as eccentric, an obsessive oddball. Only later did I realize his implicit message to us was to admit our mistakes to ourselves, then analyze them and keep them accessible at all times, if we wanted to be stellar clinicians.

In Anne Dodge's case, Falchuk immediately recalled how he had taken at