Liam Farrell: The only real certainty is uncertainty

The great physicists can be a drag. Planck was constantly complaining; Galileo had a persecution complex (something about the Pope and thumbscrews and red-hot pokers, obviously all made up).

And then Heisenberg came to see me; or did he? It was disconcerting; by the time the light had travelled from him to me and I could see where he was, he had changed position. This made eye contact difficult and counselling even more useless than usual; he was moving too quickly to allow me to pat him on the knee and say: 'There, there.'

His history was fittingly ambiguous.

'How often do you get the pain?' I asked.

'Now and then,' he replied.

'Where is the pain?'

'Here and there.'

'What do you work at?' I asked, by this stage pretty sure of the answer I'd get.

'This and that,' he dead-panned.

The Uncertainty Principle can be a bit of a Bohr, but in general practice, uncertainty is not an ignoble state; managing uncertainty is one of its great challenges. We are compelled to make the marginal call every day, based on experience and intuition; as WB Yeats said: 'We are closed in, and the key turned/On our uncertainty'.

We know that every kid with a URTI can turn out to be meningitis a few hours later; every minor chest pain or indigestion can suffer an infarct after walking out the door, marshalled by our reassurance; and that an obvious case of gastroenteritis can become a florid acute appendicitis.

But we can't play safe all the time. We can't admit them all to hospital for observation - the system would come crashing down in flames. We are the thin red line, protecting our hospitals from the barbarians at the gate. Referring is easy; deciding not to refer is the hard decision, a decision we know can end in tragedy.

We can't pass the buck, we have to make the call, and when we get it wrong, as will inevitably happen, we will get the blame.

Certainly, there's no uncertainty about that.

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

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

HRT prescriptions lower in most deprived areas of England, study finds

HRT prescriptions lower in most deprived areas of England, study finds

Prescriptions for HRT are 29% lower in GP practices in England's most deprived areas...

Map: Which parts of England are most reliant on GPs aged over 55?

Map: Which parts of England are most reliant on GPs aged over 55?

More than two-fifths of the full-time equivalent (FTE) GP workforce is aged over...

Government outlines PPE supply plans as GPs remain in dark over reimbursement

Government outlines PPE supply plans as GPs remain in dark over reimbursement

The government has outlined plans to provide 'an uninterrupted supply' of PPE during...

Four in five GPs report heavy workload as COVID-19 second wave builds

Four in five GPs report heavy workload as COVID-19 second wave builds

Four in five GPs say their practice is currently facing levels of workload that are...

Medeconomics Live: Bringing you the latest in practice management thinking

Medeconomics Live: Bringing you the latest in practice management thinking

The one-day, virtual Medeconomics Live conference aims to provide essential insights...

First COVID-19 jabs to target care home residents and staff under new JCVI advice

First COVID-19 jabs to target care home residents and staff under new JCVI advice

Older adults living in care homes and staff working there will be first to receive...