Liam Farrell: What 30 years in practice will teach you

La Rochefoucauld, a 17th-century philosopher who thought all behaviour was determined by what he called 'self love', distilled his beliefs into a number of maxims.

Penguin Classics used to produce a nice edition and at college I always carried a copy around, to appeal to the more intellectual girls.

In homage to the great man, after 30 years in practice, I have developed a few maxims of my own, the medical equivalent of not invading Russia during the winter and never playing dice with a Sicilian when death is on the line.

Here they are:

At this moment, somebody somewhere is writing a protocol for writing protocols.

Drinking three litres of laxative before having a colonoscopy is an ordeal every doctor should endure before inflicting it on others.

There is, in the misfortune of other doctors, something not entirely unpleasant.

Doctors should never wear suede shoes.

On a home visit, if all the furniture is thrashed but the TV and Sky box remain intact, there is no psychosis involved.

It is easier to be wise for patients than for ourselves.

The more I see of patients, the more I like my dog (adapted from Mark Twain).

There are lies, damned lies and statistics, and then there's the graphs that drug reps show you (also adapted from Mark Twain).

Not everything that can be counted counts and not everything that counts can be counted.

Demand to cut bureaucracy leads to conferences, workshops and training courses on how to cut bureaucracy

No drug has yet been invented that will make you good-looking and popular with the opposite sex.

Learn from complementary medicine; if you can't baffle them with brilliance, boggle them with bullshit.

The light at the end of the tunnel means you are having a colonoscopy, and what’s worse, you're awake.

In any photo of any medical meeting, the good-looking ones are always the drug reps.      

Never condone medical mistakes. Except when you make them, of course.

Sometimes someone will have do something, and you'll be the only one who can do anything.

Don't appear naked in a fundraising calendar; we know fundraising is a handy excuse, you just like getting your kit off.

The hardest part of medicine is knowing when not to use it.

Sometimes there’s no right thing to do, just the least wrong thing; that’s real medicine for you.

When I was a lad, undermining other junior docs was an essential ingredient of career progression; what fun we had.

In medicine, what's right and what's necessary aren't always the same thing.

It’s not our job to be popular; it’s much more important that we like our patients than that they like us.

Being a patient, like being homeless, is a full-time, 24/7, exhausting job.

Osler advised equanimity as the second most important medical virtue, next to sarcasm, of course.

Patients can be bastards, just like everyone else.

When the Zombie Apocalypse occurs, when anyone dies, tie their shoelaces together. Hilarity will ensue!

People are multi-dimensional; 'patient' is only one dimension.

Shaking hands is now considered unhygienic, twerking a safer method of greeting patients.

Your patient will have been waiting for you, sometimes for hours/weeks/months, so no matter how busy you are, give them your full attention.

Be a whistleblower; go on, wreck your career.

Be strong in will; to strive, to seek, to find, and not to yield, especially to insalubrious body fluids.

On home visits, if the guard-dog has three heads, you're in big trouble.

Join the Foreign Legion; you'll kill fewer people.

Just because all the clinical findings and tests are normal, doesn't mean there's nothing wrong.

Doctors are the natural attorneys of the poor; never lose the rage to effect change.

A truly ill person will not come up with incredible sound effects.

Someone rolling around in pain is not in real pain.

Touch your patients; there is primal reassurance in being touched, knowing someone close wants to touch you.

Patients like to inspect the results of an ear syringe, and will be disappointed if they don't see big stuff.

In medicine, there is always somebody out to get you.

There is a form for everything, including ordering more forms.

Always sit the drug rep on a plastic seat that makes amusing farting noises whenever they shift position.

The more clothes to be removed, the less likely any relevant clinical finding.

Often what a patient needs most is a warm bath, a hot meal, a soft bed, some kindness, and the gentle touch of a human hand.

When body fluids are splashing around freely they will inevitably choose the most awkward destination.

Confusion is not an ignoble state, while certainty is a ridiculous one.

Don't address patients by their first names.

Be understanding of human frailty because you also are human and frail.

Always ask the carer, 'How are you?'

Look out for immigrants and treat them like you'd want our own exiles to be treated.

I learnt more about the human mind from Dostoyevsky's Crime and Punishment than from any psychiatry textbook.

There may be nothing wrong with your patient, but sometimes nothing can be a real cool hand.

Doughnuts are important.

Medicine is a cesspool of greedy doctors and whiny patients; there is also a negative side.

As with a tip for the horses, the responsibility for advice lies not with the donour but with the recipient.

The skill of extemporaneous dissembling, like most practical skills, is not taught in the textbooks.

Hunters: 'Never get between a she-bear and her cubs.' Docs: 'Never get between an elderly lady and her tablets.'

You know it, we all know it: a doctor’s most secret and unholy joy is making another doctor look like a klutz.

When writing sick notes, 'asthenia' sounds more plausible than just 'pure lazy.'

On confirming death; make the call, trust your judgment, and ignore funny noises coming from the death-bed.

Once you become a doctor, everyone else in the world automatically falls into the category 'patient.'

When you look annoyed all the time, people will think you're busy and ask someone else.

If trouble erupts in A&E, be ready to fling yourself heroically behind a desk or grab a human shield.

A drab delivering in a ditch, or some dull opiate being emptied to the drains; whatever it is, we have to handle it.

On home visits to lonely farmhouses in the deep of night, it is always raining heavily.

No one should be so sick/vulnerable/afraid/alone that we won't be there, reaching out a hand to cure or comfort.

Always carry a biro in case you get a chance to perform an emergency tracheostomy and Meg Ryan will then sleep with you.

In medicine there’s always a choice. The options might really suck, but doesn’t mean there isn’t a choice.

We don’t strive to give patients what they want, but what they need.

Patients aren’t your buddies; their expectations and what we consider their best interests often conflict.

If you hear hoofbeats, it's probably not a zebra (unless you're practicing in the Serengeti).

Sick people are anxious and insecure; cheer them up by playing a tune on the banjo.

It's a great privilege to be able to be good to people.

You can do nothing without a form.

Every specialist fondly believes, in their hearts, that their specialty is the only important one.

Always do the unexpected; never let the enemy know what you are thinking.

There's nothing worse than a smiling bastard.

It is our vocation to care for everybody, no matter how needy or deluded or repulsive.

Drug reps are very friendly; they are paid to be your friend.

Over the years cultivate a tranquil demeanour, which the casual observer might misinterpret as apathy.

Introduce yourself as a doctor at an emergency, and everyone else will immediately think, 'great, it's his problem now.'

'Could you do me a favour?' Always a bad sign, implies something beyond the eternal dance of doctor and patient.

Dissimulation is a skill every doctor must learn to blithely apply.

There's no such thing as someone who's well, just someone who hasn't been investigated enough.

If you can fake empathy, you've got it made.

A symptom's absence may sometimes be as telling as its presence.

To speed up a clinic, hide the patient’s chair behind the sharps box, so if they do try to sit down, they risk a nasty prick.

How to cheer up patients; 'You're not chronically ill, you're medically interesting.'

Often the best thing to do is let the hare sit.

Avoid the annual Christmas party for the elderly, which usually turns into a vodka-fueled orgy of gargantuan proportions.

The more uncertainty there is about a diagnosis, the more certainty with which it needs to be delivered.

Artifice is the ultimate expression of human genius; someone really sick never looks as sick as someone pretending be sick.

Confirming death can be easy, like when there’s no head, but sometimes can be a tough call.

Forget bacteria, trauma, auto-immunity etc, what really screws up people is relationships.

If you have nothing to say, say it.

Be a lover, not a fighter.

To paraphrase the Fat Man; in any emergency, first thing to do is take your own pulse.

On home visits, always wear a stethoscope, so you won't be mistaken for the TV licence man .

If patient is convulsing, but still tweeting or texting, diagnose a pseudoseizure.

And finally, above all, be kind; can't be be seen or touched or counted, but it’s very real; many important things are like that.

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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