The great conductors (Herbert von Karajan, Claudio Abbado, and Leonard Bernstein, for example) always seem to know instinctively what is important (), when to hurry up (presto! ), and when to slow down (). The symbols on the previous page (Symbols & abbreviations) perpetuate the myth that these instructions are easy to follow and to understand. When we first experience life on the ward or in consulting rooms, we marvel at how efficiently senior doctors dispatch their business. How will we ever aspire to this efficiency?—we ask ourselves, without pausing to ask what all this efficiency is for. We should be efficient so that we can canter through straightforward consultations, then slow down and spend time when we can make a real difference—to our patient's wellbeing, mental health, social functioning, or life in general. Too often, doctors remember the bit about cantering (or galloping) and forget the bit about slowing down. Every day we should dawdle, dilly-dally, and play—with each other and with our patients. This way we can pick up cues about what is really important to our fellows, and we can think up ingenious non-reductionist ways out of seemingly impossible muddles. The spiral is our symbol for this () because it comes from infinity and drills down to the infinitesimal. We need to enjoy juggling with both aspects, and move seamlessly from one to the other.
Almost whenever we ask colleagues about the management of certain diseases we get a mouthful of drugs and then a full stop. But really we should start with the full stop—to indicate a pause—hence our symbol—before launching into dangerous and sometimes unwanted drugs. These ideas can be rolled into a comprehensive treatment plan. This comes naturally to some doctors, although we were surprised to hear one such physician mutter “bastard!” under his breath when confronted by a difficult patient—surprised until he told us what he meant was “avoid doctor dependency”—ie Buy stuff over the counter; take Advice from grandmaet al; use Self-made remedies such as lemon-and-honey or sensible complementary therapies; Team up with other people with the same condition for mutual support; Augment your own mental health and resilience so that symptoms are less intrusive; Rest (or exercise); and eat a sensible Diet.
Two people may have the same symptom (backache, migraine, indigestion, etc): by adopting the principles above, one may shrug off his symptom and his doctor, while the other gets stuck in a cycle of prescription medicines, side-effects, and complications. To coin a phrase, we could describe this dependency on medicines as medlock. Have you freed anyone from medlock today? To do so, be it medlock or wedlock, think: “bastard”.
The foregoing is a little bit too neat. It suggests that two people can have identical symptoms, eg indigestion. This is as absurd as suggesting that two people can wear the same hat—identically the same hat. There is only room for one inside my pain. In the end, it's not so much the symptom that matters, or the exact hat, but the nonchalance with which we wear it. And on the tip of the coiled tongue inside our little symbol we can taste a hint of the jaunty insouciance we so admire in our long-suffering and indomitable patients.