Problem-based learning is now established as the preferred method in clinical medicine. Although our own medical education may have led us to believe that a solid base of theoretical knowledge was needed on which to build our clinical knowledge, the evidence of the past 40 years supports the view that we learn best by doing, by experiencing real-life situations, either personally or vicariously through case histories. There is nothing new or startling about this; all this century and well before it, educators have been saying this and lamenting the relative paucity of problem-based learning in schools and universities.
Through Cautionary Tales, John Murtagh has provided another rich collection of case histories, which medical educators at both undergraduate and postgraduate levels will find invaluable in teaching and learning. These case histories are all the more valuable because they are enriched with the psychosocial elements that form part of almost every patient problem and every transaction between the patient and the doctor. Indeed these elements are so central, that to ignore them in favour of the purely physical is to often miss the point altogether. Medicine is still inclined to embrace the biomedical model, to which can be attributed countless advances in medicine during this century. But there are many phenomena that this limited model is unable to explain. An expanded biomedical model, which weaves the weft of psychological, social and environmental factors into the biomedical warp, will serve us and our patients much better. Cautionary Tales gives us many of the examples we need to illustrate and understand this expanded model.
The addition of ‘Discussion and lessons learned’ to each tale, and the use of the questioning format, further enhances the value of the tales. Drawn mostly from Professor Murtagh’s own practice in rural Victoria, where literally anything can and often does happen, they have an authenticity that the artificially created case history can never match.
Educators will find Cautionary Tales a source of excellent material for teaching and learning, and learners too will derive from them pleasure, insight and wisdom as well.
W. E. Fabb, AM, FRACGP, FRCGP
Foundation National Director of Education, Family Medicine Programme, Australia
Past Professor of Family Medicine, Chinese University of Hong Kong
Past CEO, World Organization of Family Doctors (Wonca)