Foreword

Problem-based learning is now established as the preferred method in clinical medicine. Although our own medical education may have led us to believe that a solid base of theoretical knowledge was needed on which to build our clinical knowledge, the evidence of the past 50 years supports the view that we learn best by doing, by experiencing real-life situations, either personally or vicariously through case histories. There is nothing new or startling about this. All this century and well before it, educators have been saying this and lamenting the relative paucity of problem-based learning in schools and universities.

In the first two editions of Cautionary Tales, John Murtagh provided a rich collection of case histories, which medical educators at both graduate and undergraduate levels have found invaluable in teaching and learning. These case histories are all the more valuable because they are enriched with the psychosocial elements that form part of almost every patient problem and every transaction between the patient and the doctor. Indeed, these elements are so central that to ignore them in favour of the purely physical is to often miss the point altogether. Medicine is still inclined to embrace the biomedical model, to which can be attributed countless advances in medicine during this century. But there are many phenomena that this limited model is unable to explain. An expanded biomedical model that weaves the web of psychological, social and environmental factors into the biomedical warp, serves us and our patients much better. Cautionary Tales provides many of the examples we need to illustrate this expanded model.

This considerably revised third edition has been enhanced by the addition of Dr Sara Bird as John’s co-author. Sara, who has an experienced background in general practice in Sydney, has added a significant complement of real-life cases that she has encountered in her experience as Manager Medico-legal and Advisory Services, MDA National. Over the past 20 years, Sara has worked in the role of assisting general practitioners and their staff in dealing with a variety of medico-legal issues which arise in general practice, including medical negligence claims, complaints, Coronial enquiries and other investigations. She is also the author of the Medico-legal Handbook for General Practice. Sara provides an expert commentary on the previous and new case histories.

The addition of the feature ‘Discussion and lessons learned’ to each tale, the use of the questioning format and Sara’s medico-legal commentary, further enhances the value of the tales. Drawn mostly from Professor Murtagh’s own practice in rural Victoria, where literally anything can and often does happen, they have an authenticity that the artificially created case history can never match.

Educators will find Cautionary Tales a source of excellent material for teaching and learning, and learners too will derive from them pleasure, insight, and wisdom as well.

W. E. FABB, AM, FRACGP, FRCGP

Foundation National Director of Education, Family Medicine Programme, Australia

Past Professor of Family Medicine, Chinese University of Hong Kong

Past CEO, World Organisation of Family Doctors (Wonca)