Liam Farrell: Believe nothing you read, it is not true to life

I love the theatre, especially when there's nothing good on TV. A good friend of mine is a talented, if brittle, actress and I went to see her play the title role in Agnes of God. The eponymous heroine is required to go into labour on stage and her writhing and moaning was more realistic than any 'real' delivery I've ever witnessed.

She was unencumbered by any drips or tubes, she had not got 20 pounds of fluid holding her down and she was a total and absolute show-off, so it was no surprise that her imitation was vastly more real than the real thing itself. In fact, she was so stunningly life-like that I was almost going to stand up and shout to the rest of the audience: 'Omigod, look. She really is having a baby.'

Great minds think alike, and G K Chesterton made the same observation in The Man Who Was Thursday, where a spy infiltrates the anarchists by assuming the identity of a crippled professor. When the real professor turns up, no one believes him, as the fake cripple is much more authentic.

The fake, the simulator, has the freedom of movement and imagination.

An old man in poor health could not be expected to be so impressively feeble as a young actor in the prime of his life. Artifice is a distinctive mark of the human genius.

Our medical textbooks are similarly unfettered by reality. In textbook fantasy-land the chest pain in MI will be central, crushing and conveniently radiate down the left arm. The pulmonary embolus will have pleuritic chest pain and haemoptysis; the appendicitis will start with periumbilical pain gradually moving to the right iliac fossa, elegantly accompanied by vomiting six hours later.

But in general practice, real life rears its dead hand; we see so much stuff, and at such an early and undefined stage, that accepted dogma is unreliable. The so-called classical features are an unchallenged part of medical folklore, seemingly handed down from generation to generation as part of a glorious oral tradition, like barbarians squatting round a camp-fire, written in stone.

As an article by Will Muirhead, an unusually perceptive intern, in the BMJ recently observed, Macleod's famous Clinical Examination must be the only definitive medical reference not to have any references.

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