I briefly went over parts of this book and there are two things that caught my eyes which I found very disturbing-

the first- this patient had severe generalized myasthenia with respiratory failure, response to acetyl-choline-esterase inhibitors and other commonly used treatments, but no neurologist was ready to take responsibility over her care, after many years of mismanagement.

In a dire state, after a very short and inadequate course of treatment in the hospital, she was treated at home by her GP and her partner was concerned that she would die. We are not talking about a demented 80 year old (who I do not think should be treated like that either), but a 35 year old talented woman, who we can read in-between the lines was sent to die in misery at home, of a treatable illness. This would have been considered malpractice if she had a heart condition, severe infection, malignant disease, but apparently not MG, or suspected MG. or maybe I am missing something?

the second- this book was written by a patient with a neurological disease, but the commentary was written by a psychiatrist. why would that be? why isn't there even one word in that commentary about this illness and the way it is managed? why isn't the general management of MG discussed? the problems in diagnosis, assessing severity and response to treatment? the very long time it takes for patients to be diagnosed? the horrible consequences of this approach? the true risk of death because of medical neglect? why isn't even this very problematic and ill-defined diagnosis of "conversion disorder (that was written on her chart, but never fully conveyed to her) discussed by this psychiatrist?

this patient did not have a psychiatric illness. she was wrongly diagnosed ,by exclusion because of the ignorance and arrogance of some physicians as suffering from one, so why should a psychiatrist write the clinical commentary on her illness, of which he doesn't seem to know much?

I looked at another book in this series, written by a patient with chronic pain. This book had an excellent commentary written by a physician taking care of patients with chronic pain-a pain specialist. he discussed the problems of this specific condition in a way that I could learn from as a physician. addressing all the dimensions-the physical, emotional, social of this medical problem, and mostly the shortcomings of those that are supposed to treat patients with chronic pain and what should be done about that.

what can a physician learn about MG and the problems in diagnosis and management of this illness, from this psychiatrist's commentary. how is his commentary related specifically to MG? and how can we expect anything to change if when discussing diagnosis he turns it into some vague discussion, when this book was written by someone who nearly died because of a wrong diagnosis.

would a commentary in a book of a patient who nearly died from cancer that was diagnosed very late, because physicians failed to address severe symptoms caused by it, discuss "diagnosis" in a similar way?

alice