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.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

Refugee doctors and international medical graduates set to help NHS in coronavirus outbreak

Refugee doctors and international medical graduates set to help NHS in coronavirus outbreak

Hundreds of unregistered refugee doctors and international medical graduates will...

Practices offered less than average locum rate for bank holiday opening

Practices offered less than average locum rate for bank holiday opening

Practices in England will be reimbursed a maximum of just £62.50 an hour for locum...

Cumbrian GP's bright idea sparks production of thousands of items of PPE

Cumbrian GP's bright idea sparks production of thousands of items of PPE

A Cumbrian GP's call for help to provide local practices with eye protection in the...

NHS England launches mental health hotline to support staff during pandemic

NHS England launches mental health hotline to support staff during pandemic

GPs and other NHS staff can now access a new mental health hotline offering support...

Split staff to handle patients with and without COVID-19 symptoms, GPs told

Split staff to handle patients with and without COVID-19 symptoms, GPs told

GPs and practice staff should be allocated to manage either patients with COVID-19...

Coronavirus: Key guidance GPs need to know about COVID-19

Coronavirus: Key guidance GPs need to know about COVID-19

GPonline provides an overview of the key guidance relating to coronavirus, including...