We continue our series in which Consultant Interventionist Dr Michael Norell takes a sideways look at life in the cath lab…and beyond. In this column, he considers rules.
For UK healthcare professionals only
I was going to do a piece about how ridiculous it was to think for one moment that so-called ‘regular exercise’ might be achieved by wiring yourself up to a Wii machine and prancing around in the lounge in front of your HD compatible TV.
But then there was this news item, you see; something about the Department of Education planning to scrap (or ban, whichever is the more meaningful and permanent) the infamous spelling rule that most of us were brought up with, namely: ‘i’ before ‘e’ except after ‘c’. (You will notice that I took account of this instruction a couple of times in my first paragraph.)
This had always been part of our educational upbringing along with adverbs, gerundives and past participles. We had learned this by rote, along with the eight-times table and 1066, 1415, 1649, 1588, 1665, 1666, 1789, 1805, 1815, 1854, 1963 and 1969, in addition to loads of other dates and facts deemed later to be of dubious value. (The battle of Hastings, Agincourt, the execution of Charles 1st, the Spanish Armada, the Great Plague, The Great Fire of London, the French Revolution, Trafalgar, Waterloo, Balaclava, the Kennedy assassination and the first Moon landing, by the way.)
Exceptions to the rules
One of the first things we also learned was that there was always an exception to every rule… presumably including that one. So it seems typically heavy handed to advise that such a catchy phrase should not be taught simply because there are some circumstances in which its inherent truth does not apply.
The point is: it’s not a rule, it’s an aphorism.
Now, you may be asking, what’s the difference? Well, one is a rigid path along which you are required to proceed without deviation. The other, however, is more of a prompt or a maxim, designed to remind you to think about what you are doing and apply memory, judgement, common sense or even just good fortune in order to find a solution.
In medical school we were bombarded constantly by such statements, not because they should be followed unerringly, but because they sparked within us the notion that we could at least ponder as to what might be the right answer. Surgical textbooks are full of these reminders and tips, and the enjoyment of learning the subject was gleaned partly by being able to recite them.
For instance, I recall the more cautionary phrases such as “Beware the man with the glass eye and the big liver”, illustrating the rather gloomy natural history of malignant melanoma, and the well ingrained reminder about the importance of the rectal examination: “If you don’t put your finger in it, then one day you will put your foot in it”. “Nothing dies whiter, quicker than a ruptured aortic aneurysm”, also had its uses, although to make any difference to the outcome you would need to get your skates on.
You will not be surprised to learn that there are also plenty of websites in which these mottos are listed in their scores. In researching this article (yes; I think that is the right word to use) I was pleased to look through long lists of such sayings and thought that readers might also be interested in some of the more pithy examples.
Dr William Halstead is credited with the maxim we often employed when the solitary interventional device on our shelves was a stent: “If your only tool is a hammer, everything looks like a nail”. Similarly, the requirement for our patients to have at least some symptoms is encapsulated in his words: “The lesser the indication, the greater the complication”.
Quite rightly, we are cautioned not to focus unduly on the more exotic diseases. Hence, Dr Thomas E Woodward advised: “When you hear hooves, look for horses, not zebras”. Unfortunately, some of the best and most remembered sayings are not attributed. “The most important thing to remember about rare diseases is that they are rare”, is an example as is its corollary, “common things occur commonly”.
On the other hand, some characters notable for their remarks relevant to one subject, can also be found contributing to the medical field as well. The renowned film producer Samuel Goldwyn, famous for all manner of axioms, such as “a verbal contract is not worth the paper it’s written on”, is also credited for the observation that “a hospital is no place to be sick”.
It appears that one Erma Bombeck noted, “never go to a doctor whose office plants have died”, and of all people, it was Dr William J Mayo, apparently (yes, he of the clinic), who defined a specialist as “a person who knows more and more about less and less”.
Dr Kerr L White was the individual who said, “good judgement comes from experience; experience comes from bad judgement”, while, as you might expect, Sir William Osler produced his fair share of quotes of which one example is “the greater the ignorance, the greater the dogmatism”.
The golden rule
That last contribution seems quite apposite given the original motivation for this column. We should certainly hesitate before dispensing with any longstanding tradition, even if close analysis suggests that it may be, on occasions, flawed. The ‘i’ before ‘e’ business is an example of just that. I doubt it was ever suggested that this memorable rhyme supplies a definite and foolproof guarantee of correctness in every circumstance. It does, however, give reason for the writer to pause and think, “now is it ie or ei?”, and it adds yet another reason to that long list headed: “Why is our language so difficult to learn?”
I say, keep all these adages, axioms and aphorisms. Do not dispense with maxims and mottos, precepts and proverbs. They add colour to the richness of our heritage whether in learning the English Language or practising Medicine; just as long as they are not regarded as rules.
And I believe that, (or should it be beleive …?).