BMJ  2004;328 (10 January), doi:10.1136/bmj.328.7431.0-f

Editor's choice

Medicine's complexity: exhausting or inspiring?

The first 150 words of the full text of this article appear below.

The central fantasy of medicine is seductive. The patient who has suddenly become desperately sick needs the help of you, the lone doctor. Listening with the intelligence and attention of Sherlock Holmes you pick up an elusive clue and form a diagnosis. Remembering some recondite piece of anatomy, you make an examination that shows you're on the right track. Your examination through a microscope of a speck of urine confirms your highly unusual diagnosis. An injection, and the patient is cured. She smiles beautifully, thanks you profusely, and the next day leaves you a brace of pheasant, a bottle of your favourite whisky, and an invitation to her island retreat in the Caribbean.

The BMJ—perhaps sadly—deals in messy, complex reality, which is ultimately, I suggest from my ivory tower, much more interesting. Consider the patient who wants a sickness certificate. He looks fine to you—in fact a lot better . . . [Full text of this article]

(rsmith@bmj.com)

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