BMJ 5 July 2007

Having the great thinkers on your practice list can be a drag. The last time La Rochefoucauld came in, I happened to be reading a defence society magazine. “There is something, Monsieur, in the misfortune of other doctors which is not entirely unpleasant,” I observed. His eyes narrowing, he took out a little notebook, scribbled furiously for a few seconds, then nodded as if satisfied, before launching into yet another long story about his sinuses and how dry they were (he preferred them pleasantly moist).

Hippocrates had just legged it from a foam party in the Groves of Academe and left the whole place soaking wet, and when Nietzsche was here he wouldn’t wait in the queue like everyone else; we had to forcibly eject him by quoting Immanuel Kant at the tops of our voices. His complaint cited something about “ubermenschen” and creating his own morality and not suffering the consequences of his own actions; and besides, all he wanted was an antibiotic because he had an awful cold and he had been fighting it himself for a week and it wasn’t getting any better.

Darwin’s inability to book an appointment proved just a minor obstacle to someone who spent 15 years studying barnacles. I was stopped at the only set of traffic lights in the village, when there was a rap at the window. I ignored it, but Edgar Allen Poe knew what he was talking about and you can’t continue to ignore rapping evermore, plus the damn lights wouldn’t change.

I resignedly rolled down the window, observing with fatal satisfaction that the red turned to green right on cue, so I switched on the hazard lights to warn the cars stuck behind me that this was going to take some time.

“I am concerned,” said the great man, “about the direction of modern medicine. It is counterintuitive to the theory of evolution. You are perpetuating faulty genetic codes by artificial methods; maladaptive genes are being allowed to procreate; and the fitness of the human race is diminishing.”

“Maybe we are simply adapting rapidly to a new dynamic,” I replied, conscious of the honking horns and increasingly angry shouts behind me and trying to keep it brief, “Maybe fitness is a broader, more flexible concept.”

The deep brow furrowed, the honking and the clamour grew more frantic. In my rear view mirror I could see a herd of cows charging up the road and thundering into the melee, body parts flying everywhere, like Pamplona with more dung but without the Iberian charm.

I hopped out of the car. “Better run, Charles,” I said, “It’s survival of the fittest.”

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