Hugh was a few years older than I, a wonderful, happy, accomplished, kind man I had the privilege to have as a patient. One day he came in with some vague story of losing his ability to move right. Not much detail. What I had learned early on, in medical school, came to mind. As a fourth-year student, I followed a family doc in Lodi CA to the ER to see a young girl with leg pain. He had her walk, and I could also see her gait was off. “What’s wrong”, said I. “I don’t know, but that’s not a normal limp”. He ordered a hip Xray, which demonstrated a slipped capital femoral epiphysis (Look it up! Want me to google that FOR you? Sheesh!). Anyway, the principal is science. Make an observation, form a hypothesis, do a test, reformulate your hypothesis. He didn’t KNOW it was a hip limp, but he formed a good hypothesis, and the test provided the answer. “Hugh, let’s walk in the hall!” He walked away from me for about 15 ft. “Stop, turn around, walk back”. I watched. “Let’s go back in the exam room. Sit down. Hugh, I think you have Parkinson’s disease”.
When you and I walk, our arms swing in time with our legs, only opposite. His arms weren’t swinging. A clue to Parkinson’s. I referred him to neurology, who confirmed, and started him on treatment.
Like a lot of specialty APPROPRIATE care, the medications and copious choices available made having specialty management make sense, since I didn’t have enough Parkinson patients to be good at managing that many treatment choices. Early in HIV, specialty management for my one patient made no sense, since there was NO treatment. I watched my patient’s immune cell counts decline for many months, although he didn’t reach the threshold of AIDS. Just before he did, AZT came out, and I put him on it, watched his immune system recover, and later start to decline again. He neared the threshold of AIDS again, but by then the new then triple therapy came out, and I referred him to an infectious disease expert, and he stayed there to manage the growing number of treatments available. He got his HIV in about 1985. I lost track of him, but he was well when I last knew.
Hugh will return in another story.
Oh, and today, an AI tool could reach the same conclusion I did with a short video clip, or maybe just a short clip of his face and it’s reduced movement and expression, or perhaps just his handwriting.