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Introduction

Some years ago, a man came to me as a first-time

patient, saying he'd picked me as his primary care physician
because of my open attitude about alternative sexual
behaviors and lifestyles. During his history and physical,
he told me he was monogamous and heterosexual. He
denied engaging in any alternative sexual behaviors
himself. When I asked about the scars on his abdomen, he
told me they were from an emergency appendectomy.

Thus, a few months later when he showed up in the

emergency room with a high fever, complaining of right
lower quadrant abdominal pain, looking and sounding
like someone with acute appendicitis, I was stumped.
Instead of rushing him off to surgery, I was getting ready
to order some very expensive tests. Then one of the nurses
in the ER recognized him she'd worked in his previous
doctor's office. "I don't know about an appendectomy,"
she told me, "but at least one of those scars is from where