mahiwaga

I’ve continued plodding on in my re-read of Gödel, Escher, Bach by Douglas Hofstatder (interspersed with Little Dorrit by Charles Dickens, as well as The End of Time by Julian Barbour.

One of the things that struck me about Gödel’s Incompleteness Theorems is the resultant stratification of all human knowledge

1. true things that can be proven true
2. true things that can’t be proven true
3. false things that can be proven false
4. false things that can’t be proven false

One way to simplify this is (1) fact (2) instinct (3) lies (4) nonsense

Or perhaps (3) can be error, because it can happen unintentionally, too.

The point being, no matter how much any of these realms of knowledge expand, the basis of clinical medicine will always be the same: history-taking and physical-exam. The rough estimate is that at least 60% and up to 90% of the diagnosis can be derived from history alone. A good physical exam can probably narrow the gap by another 5-10%. Leaving lab tests and imaging to determine the last 5-10%.

So the skills to being a good clinician are exactly what Schmendrick says makes a good wizard. Being a good listener enables one to be a good history-taker. Always looking enables one to hone their physical exam skills. Everything else is mere technique, which can be easily overturned by adequately large clinical trials.

Even this late out into the game, I find myself still hoping for a reprieve from a life devoid of tender companionship, a life destined to loneliness and continued struggle.

I mean, c’mon, even Jesus Christ asked God to see if he could somehow defer crucifixion.

Despite what all the novels and movies say, the three magic words don’t do as much as you think they do. It’s the actions behind them that count.

And while I’m starting to recognize that I’m totally falling in love with her, I am frightened.

Frightened that I won’t do the right things, and that I’ll drive her away. Either I will go too quickly, or move too slowly. I’m frightened that, in the end, she’ll flee from me, and we won’t even be friends at that point.

Let me tell you, experience is a painful teacher.

But despite the current odds, I still hope. We’ll just have to see