“It is astonishing with how little reading a doctor can practice medicine, but it is not astonishing how badly he may do it.”
– Sir William Osler –
From Turkey Chick to Soaring Eagle
So concludes the first lesson in training your medical brain. We have met ‘the sieve’, a tool for working out the causes of diseases. We have discovered that in practice there are really only a few basic ‘classes’ of diseases, and if we think through them logically we can quickly develop a useful differential diagnosis. We have also briefly explored each part of the sieve and have touched on some of the fundamental history and philosophy that underpins the practice of medicine.
Remember to memorise the sieve presented in chapter 1.1 before you keep reading, and to begin applying it every time you think about diagnosis in medical practice.
Even today, the most powerful supercomputers performing countless calculations a second cannot reliably beat the best human chess minds. To perform such an incredible feat, chess Grandmasters have spent countless hours training their chess brains – none were born simply with the ability to play great chess. They had to start out as little ‘turkey chicks’ of the chess world, laboriously learning the rules, concepts and strategies of the game. Clumsily and slowly at first they applied these concepts, getting familiar with different possibilities and tactics. Soon, however, they found they no longer had to think about the rules – they just knew them… and later still they didn’t have to think much about the concepts or strategies either. It had all become an unconscious ability. While the computer mindlessly crunches through billions of possibilities, our Grandmaster ‘soars like an eagle’, unconsciously sums up the board, thinking through only a few of the best moves.
The same is true with medicine. This book presents a number of concepts – starting with the sieve. We start out as little turkey chicks struggling to use them. For a long time we flap awkwardly applying the principles slowly and clumsily. With dedicated perseverance, however, we too may reach the point of the Grandmaster: the unconscious integrator… soaring like an eagle.Initial AwarenessAwkward