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Real Medical Lessons in the Land of Make-Believe

In the inaugural post on this blog, Dr. Robert Marion poignantly wrote of the physician’s inability to suppress the urge to make a “hallway” diagnosis—when passing a stranger, conferring a diagnosis on that person based on his or her physical appearance or behavior.

Medical practitioners face a similar situation in the arts. We encounter fictional characters on television or in movies, plays, or novels displaying ailments—often neurological— that we cannot resist diagnosing: the gait disorder of Kevin Spacey’s character Roger “Verbal” Kint in the film The Usual Suspects (spoiler alert: it was a factitious disorder); the fluctuating confusion exhibited by the narrator of Saul Bellow’s final novel, Ravelstein (seemed like toxic-metabolic encephalopathy to me), and Dr. Rank’s spine ailment in Henrik Ibsen’s play A Doll’s House (widely speculated to be congenital syphilis leading to tabes dorsalis), among others. Some of these depicted ailments may be real-life abstractions from the authors’ own personal experiences.

Recently, I wrote a piece with one of my neurology residents, Dr. Sylvia Mohen, about Harry Potter and his recurrent, debilitating headaches, which was published in the journal Headache. We expounded upon an idea originally conceived by Dr. Fred Sheftell, a colleague, a former adjunct faculty member at Einstein and a past president of the American Headache Society, who co-authored a creative article, “Harry Potter and the Curse of Headache.”

In both articles we dissect the descriptions of Harry Potter’s head pain and associated symptoms throughout J. K. Rowling’s series. Although her mother’s long battle with multiple sclerosis affected her writing, there has been no indication that Harry’s headaches were related to any real-life observation.

Whereas Dr. Sheftell and colleagues felt Harry might have had migraine, we diagnosed nummular headache, a more rare disorder not well known among healthcare practitioners or even neurologists.

Why go through this exercise and publish our opinions? How is it useful to apply real medical diagnostic algorithms and thought to the land of make-believe?

Connecting with teenagers in the medical realm is no easy task, and adolescent headache disorders are consistently under-recognized or undertreated, and are particularly burdensome. A 13-year-old patient resistant to engage in a treatment plan for his severe headaches may not do so when I recount the experiences of a similar patient seen a few weeks ago, but would be more likely to do so if the discussion includes one of his heroes, albeit a fictional one.

Most importantly, indirectly educating the public about rare medical conditions, or common ones that are under-recognized, by highlighting popular-culture figures in an entertaining way can serve only to enhance the public acceptance and recognition of particular disorders that may not change a person’s outward physical appearance, but still affect that individual in profound and often devastating ways.

How else could nummular headache ever become a trending Twitter item?

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