I ask most clinicians the same question. 'Tell me about the last patient who taught you something'. RH smiles a wry smile. Man hands on experience to man. He draws up a patient's notes, and together we read through the letters. The story emerges of a otherwise healthy middle-aged man who is fitted with a pacemaker. Every year thereafter we find a letter that reads; Pacemaker checked - normal operation The list continues for several years without excitement. Suddenly there is an aberration; frank, in black and white; Out of hours service. Your patient has died The next letter is the pathologist's report. Cause of death: tuberculous myocarditis I suck my teeth. 'So what do you think is the lesson here?' he asks. Turning the question around; an old trick. I smile a wry smile. 'Always be on the lookout for tuberculous myocarditis.' He says no, firmly but politely. He is right. The lesson is finer than that. We can no more be on the lookout for tuberculous...
Use your hand to pick something up. In a split-second your brain had to work out where to put your hand, where to position your fingertips, and how tightly to grip. Computers are smart – but it is not easy to teach a computer to do this. Your brain is much smarter than a computer. Your brain used a trick – it ran a simulation about the object. Before you picked it up, your brain thought ‘it’s this size, this shape, weighs so-and-so much…’ and so on. Another way of saying simulation is a practice run, which exists only inside your mind. Your brain is the fastest and most advanced simulation machine that has ever existed. How did your brain make this simulation? Partly from perception, which is what your senses told you. And partly from memory, which is what your past experience and learning told you. If you saw the object before you picked it up, your brain got a visual perception, and made some guesses based on how it looked. Also, your brain compared the image with your memory to work...
Our ward round was brought to a halt by a Portuguese patient who spoke no English. The interpreter would not be available until tomorrow, and we tried in vain to explain to him that he would need a coronary angiogram (a challenging mime). The consultant produced his smartphone and proudly declared that his translator app would save the day. ' Do you have any pain? ' he asked the machine. ' Do you have any pain? ' it asked the patient, in flawless Portuguese. ' You'll need a test called an angiogram ,' he told the machine. ' You'll need a testicular angiogram ,' it told the patient, without so much as a blush.
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