EDITOR—As an orthopaedic surgeon specialising entirely in elbow and shoulder disorders I could not let the editor's choice on restoring the soul of medicine slip by without comment.1 Unlike the orthopaedic surgeon you refer to, I do read the BMJ each week (although I confess that my wife, a paediatrician, pays the subscription). I also note that in the editorial from the previous week on shoulder pain at work the one year prevalence of shoulder pain in the general population was estimated to be 20-50%, but only 40-50% of those affected consult a primary care physician, let alone an orthopaedic surgeon.2

Most musculoskeletal complaints are influenced, if not caused, by circumstances of daily life. This is not just physical activity but psychosocial factors, including job pressures and stress at home. The commonest elbow complaint is tennis elbow. It is a considerable problem to those who have it; symptoms are undoubtedly influenced by a range of factors, and it is eminently suited to an integrated management approach. Those affected should consider changing the pattern of their lives, reduce stress, and seek advice and help from complementary and conventional practitioners, and they may even benefit from seeing an orthopaedic surgeon. Orthopaedic surgeons should read the BMJ, but equally the BMJ should be aware that many orthopaedic surgeons do not think of patients just as malfunctioning elbows.