Preface

To practise medicine is a privilege, to practise it well is a difficult challenge, but not to learn from one’s mistakes is unforgivable.

Cautionary Tales is a collection of authentic case histories encountered over 44 years of practising medicine, especially during 10 years of intense yet wonderful general practice in a country area of Victoria, Australia. During this time in practice with my wife, Dr Jill Rosenblatt, it was our privilege to be the sole practitioners to a hard-working farming community of 2700 people. The practice was located in a small township with a twelve-bed Bush Nursing Hospital. The area, which was mountainous bushland with a snow resort, was popular with tourists. Many of the tales pertain to my experiences in this community where we came to know our patients so well—both professionally and personally. They refl ect the intensely human side of our calling and to share them is a special privilege. It is also appropriate to ponder on the humorous side of some of our experiences as well as the inevitable tragic outcomes for so many that we remember with sadness.

The concept of, and impetus for producing, a series of cautionary tales followed the obvious fascination of my medical students who considered they learned so much from them, especially when they realised they really happened and were certainly not apocryphal however embellished in presentation. With the encouragement of some colleagues I decided to publish them regularly in Australian Family Physician, the official journal of the Royal Australian College of General Practitioners. The series has become immensely popular and many practitioners have contributed their own cautionary tales over many years. Several of their interesting tales are included in this book.

Writing these histories (which probably represents some type of catharsis for the writers) for general consumption has its risks, but we feel that sharing our experiences and messages is an important contribution to continuing medical education. In particular, the cautionary advice about so many pitfalls is extremely useful to the inexperienced doctor facing up to the vast challenge of general practice. There has been a focus on the medico-legal dimension of the tales, so that we can develop a healthy awareness of the pitfalls of our shortcomings, especially the missed diagnosis. I believe that the subject matter covered in this book is a reasonably accurate refl ection of the common traps facing doctors in Western medicine. The tales are presented under headings that capture the nature of the message. The book concludes with an overview of a strategy that may help to keep the margin of error to a minimum.

Good judgement is based on experience. Experience is based on poor judgement.

I trust that our shared experiences promote a certain wisdom and better judgement.