Taking things out of context.

I don’t know if you know much about the Bible, but there was once a man, so the story goes, who used to daily read some of it. (Apparently G K Chesterton did,) One morning the reader in the possibly apocryphal story was in a hurry and he said ‘today I’m just going to, with my eyes closed, open the book and point with my finger to a spot’. He had thought that this would be God’s word to him for the day. Opening his eyes he read ‘Judas went out and hanged himself’. ‘God would never say that to me’, so he did the same thing a second time, only to read ‘Go thou and do likewise’.

He learnt to look at things in context after that.

I have often heard the saying ‘Jack of all trades, but master of none.’ It apparently came initially from Italy, but was made popular in English in the days when you had to be a member of a guild to get a position. Often very capable people were not admitted to the appropriate guild because of lack of family connections etc. There is another third phrase to the above. Maybe, it be would be better fully quoted with the third line. I like that very much but I couldn’t find who added it.

‘Jack of all trades, but master of none, yet often better than the master of one!’

The third phrase gives the saying a very different meaning. I knew several teachers who were doing an excellent job teaching in a primary school in Ethiopia. The requirement was put out from the USA’s Education committee, that if American teachers, teaching at a foreign school, were to maintain their USA accreditation all teachers in the school had to be accredited in an appropriate country. Three of their teachers, some of whom I knew personally, and were extremely good and loved by their pupils lost their jobs. Not to deny the need of accreditation, but…. maybe experience and even ‘grandparent’ clauses should be listened to, obviously with good backing evidence.

Several times I have had patients on whom I operated upon tell me that after I had spoken with them in a preoperative consultation they came into the hospital very happy for surgery. I always used to end my talk about potential complications by saying this occurs (for example) once in every five hundred operations but you realize that in your case it is either zero or one hundred percent of a chance. I can only assure you that I will seek for it not to happen to you. Postoperatively they occasionally told me that after a particular anaesthetist had spoken to them they almost cancelled and went home. Obviously he was not my favourite anaesthetist, but the way things are said makes a whole difference.

Just last week I had someone tell me that he had changed from surgery to radiotherapy, because some one told him that the operation was a lot of blood in a dark deep hole. His radiotherapy (which was a reasonable choice) left him with four years of a very significant complication. There is excellent lighting in Australian operating rooms. Blood loss is manageable by auto transfusion or simple transfusion. So I’m not saying that he made the wrong choice, but he made it on the wrong evidence and suffered one of those 1% or 100% complications. For him 100%.

Dominic Cartier.

3 thoughts on “Taking things out of context.

  1. You impart an important message here. How much is too much – and how little is too little – vis a vis a medical negligence claim. Over the past few years I have noticed that I am being given more and more information – is it the fear of the negligence charge, so provide overkill information to everyone to avoid the danger. An example, which made me grit my teeth was when I required a yellow fever vaccination when I was visiting Ethiopia, and was provided with a very graphic explanation of what could happen due to my age. A lesser being would have cancelled.

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    1. It is a lot to do with litigation. Some people are now video recording their discussions about potential complications to cover themselves in court. Recently I had a small tumour excised from my ear and had a six page document to sign!

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