War gets a bad rap, but there’s a bright side; the poetry, the feature films, meeting babes at anti-war marches, and the wisdom gained from young men dying like flies for a pack of lies on the orders of evil callous old men and scarlet majors at the base.
These harsh lessons can help us navigate the minefield of family practice. Hold your friends close, and your enemies closer, said Sun Tzu in The Art of War, and I have always held Joe very closely indeed, so close that, most of the time, I’m actually behind him; on aesthetic grounds this is the preferred point of view, especially when Joe is (pre-examination) naked, although Joe is so hairy that when he is naked, it’s hard to tell that he actually is naked.
Not unusually in rural Ireland, there is an agricultural analogy; if Joe is left fallow for more than a month, he will generate a whole new set of complicated symptoms. The information now available on the internet can be considered a form of manure, and Joe will brood and brood and yea, verily, a veritable harvest will spring forth from his fecund loins.
The fertile ground of Joe’s imagination must be mown at least weekly, so that any new-sprouting sprigs of discontent and fabrication can be crushed mercilessly.
And it isn’t just symptoms; in the presence of a greenhorn, Joe can even mimic clinical signs plausibly. I’ve lost count of the number of times a locum has come out smirking with that wait-till-you-see-what-I’ve -just-diagnosed-how-could-you-have-missed-it-what-are-you-dumb look on his face, and says: ‘I think this chap has acromegaly.’
‘Really?’ I say, feigning astonishment. ‘Let’s check it out.’
We go back in and Joe is sitting there, looking impossibly normal and smug. The locum is nonplussed, completely baffled.
‘I can’t understand it,’ says the locum. ‘I could have sworn he had all the classic features; maybe it was a trick of the light.’
‘Yes,’ I say kindly, because I was always taught to humour simple people. ‘That’s it, it must have been the light, bad light often leads to a misdiagnosis of acromegaly.’
Love your enemies, said Nietzsche, because they bring out the best in you, but my best was used up long ago. Enthusiasm, sympathy, equanimity and diligence are historical curiosities only, and all I can manage now is a jumble of sarcasm and apathy.
In general practice, that’s what we call a result.