A 63-year-old painter developed headaches that have become increasingly devastating, to the point where he becomes withdrawn, forgetful and easily angered. When struck with them, he goes from painting beautiful landscapes to dark images of serpents and half-destroyed houses.
Can you explain why? Adrian Budhram can.
The third-year Neurology resident has a knack for the quick diagnosis. A three-time winner of the Think Like a Doctor monthly feature in the New York Times, he has won back-to-back months, prompting long-time columnist Dr. Lisa Sanders to joke she may have to initiate a ‘let others play’ rule when it comes to Budhram.
“It’s a matter of recognizing things and spending a little time on it,” said Budhram, who was the first to figure out this month’s diagnosis of The Painter’s Headaches – a dural-arteriovenous fistula, by the way. “It’s fun because the cases are presented very well and you can learn quite a bit as a doctor from the approach people take. You see others who commented on the case and ask yourself why they went down that road, so you actually learn quite a bit.”
Every month, Sanders introduces readers to a real-life patient and asks them to consider their story and symptoms, along with medical records, in order to come up with a diagnosis. Readers are provided with all the information and images available to the doctor who made the initial diagnosis.
If the idea sounds familiar, Sanders column, which she has written for 14 years, was the inspiration for the Emmy-nominated medical drama House.
“I hope people like reading the column for the same reason I like writing them – because it’s cool to be the detective on the case to solving a mystery – a mystery you know saved, or at least improved, someone’s life,” said Sanders, an associate professor at the Yale School of Medicine. “And the fact they really are true cases makes it even better.”
Sanders said Budhram is starting to become a familiar name in her column, prompting her to joke she may need him to sit on his hands going forward and give others a chance for a change.
“Adrian is definitely going to be a hell of a doctor,” she said.
Budhram, who did his undergraduate and medical school at McMaster University, began checking out the column last year after friends said he might enjoy it. He gave it a shot a few times, but with his hectic schedule in residency, he cannot tackle it every month. He has used his medical know-how about six or seven times in an attempt to be the first to the diagnosis.
“Once I got it but was not the first one. There have been a couple times you’re humbled because you think you know what’s going on and then – nope,” said the 26-year-old. “You’re really dealing with a puzzle and you’re not sure if all the pieces are supposed to fit or not. Then you see how others attach them together and you see what pieces matter and how you might have been focusing on the wrong piece.
“Just reading through some of the other ideas, there are a lot of different thoughts you see, depending on what part of the world they might be from. Someone will mention a lesser-known infectious disease from, say, Africa, and then I will find myself reading about that. It’s simply fun, but also educational.”
So, is ‘A Three-time Winner of the Think Like a Doctor’ something you put on a resume?
“People were telling me to put it on my CV when I apply for fellowships after residency. That seems like a weird thing,” Budhram laughed. “I don’t know what section that falls under. ‘General trivia?’ ‘General things about me?’”