Liam Farrell: Why the pain in my heart may never heal

Mrs Magee had battered me for years with her headaches. Eventually I reckoned that she had delighted me for long enough and it was only fair that the torment should be shared with a neurologist.

I had vague hopes that Mrs Magee would come back to me dancing on air, but instead she returned with a rather sullen and dissatisfied countenance.

'He was no good,' she complained, 'all he did was a brain scan.'

I realised that a quantum leap of patient expectation had occurred - a Rubicon had not only been crossed but had had an exclusive golf and country club built on its banks.

Nostalgia is my great sin, and I remember a gentler time when patients with a headache used to dream of a brain scan; it was a kind of diagnostic Arcady, minus the frolicking naked peasants and the pan pipes. But now the miracle has become commonplace, our technological world turned to dross. Expectations become ever higher, familiarity breeds contempt, and our Snarks become Boojums. Even a trivial event can signify that nothing will ever be the same again. Last week I had a toothache and went to the dentist, and all she did was prescribe antibiotics.

Antibiotics? Is that it? I was most unimpressed. I wanted drama, I wanted abscesses lanced, blood and pus spurting everywhere in large and curiously satisfying amounts, my torment given physical form. That's dentists for you, I thought; what do they know? I had been reared to the prejudice that they are useless (antibiotics, not dentists), just something to be given out grudgingly to keep the patients happy; low prescribing of antibiotics has long been one of the arbiters of good practice.

Then, to my discomfiture, my toothache got better. I was astonished; the pain in my tooth was gone, but the pain in my heart may never heal. The mirror has cracked from side to side, the Lady of Shalott is no longer a virgin, and Lancelot rides rampant; if I could be so wrong about antibiotics, what else am I wrong about? Changing cars, changing jobs are all easy, but changing one's beliefs is much more disturbing.

And most painful was that I had no expectations, and the placebo effect was nil. And what good are doctors without the placebo effect?

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