Intended for healthcare professionals


Looking sideways

BMJ 2005; 331 doi: (Published 18 August 2005) Cite this as: BMJ 2005;331:463
  1. George Dunea, attending physician
  1. Cook County Hospital, Chicago, USA

    Joseph Vissarionovich Stalin, the theology student turned dictator, once said that “a man's eyes ought to be torn out if he can only see the past.” I note, therefore, with some trepidation, that this is my 300th column in this journal. Many of my middle aged readers have retired—some enjoying the felicity of the Victorian novelist George Gissing's Henry Ryecroft, who was enabled, by an unexpected legacy, to escape from a life of drudgery; others getting under their spouses' feet and brooding that “I married you for better or worse but not for lunch.”

    Now, as in 1975, we worry about high medical costs and the malpractice crisis, and argue about abortion and “death with dignity.” But there have also been dramatic changes: at the time we had no mobile phones, no email, no computers, not even fax machines. Manuscripts were typed interminably and sent off by snail mail, as were the galley proofs. And since my first “Letter from Chicago” this city has grown into a wonderful metropolis, with music, theatre, and flowers lining the streets, and Michigan Avenue with its Millennium Park attracting multitudes.

    Stalin's regime survived almost a century. Nobody knows how long our infatuation with targets, audits, evidence, outcome studies, peer review, and meta-analyses will last. Margaret Thatcher thought that “nothing is more obstinate than a fashionable consensus”; Hughlings Jackson that it took 50 years to get a wrong idea out of medicine; and Albert Einstein that it was easier to split the atom than a prejudice.

    One thing is certain: in diagnosis, as in other ways of life, mistakes are inevitable. Napoleon said he had been mistaken so often that he no longer blushed for it; and Ella Wheeler Wilcox once wrote a poem called “God sent us here to make mistakes.” But a recent US law allows doctors to report their mistakes without the risk of the information being used against them, so we can all learn from such mistakes.

    The old extol the virtues of the past, the young those of the future, a difference in perspective that may only be relative. Einstein, at least, thought that the distinction between past, present, and future was only an illusion; and Saint Augustine that “time comes from the future, which does not yet exist, into the present, which has no duration, and which goes into the past, which has ceased to exist.”

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