Preface

To practise medicine is a privilege, to practise it well is a difficult challenge, but not to learn from one’s mistakes is unforgivable.

Cautionary Tales is a collection of authentic case histories encountered over 50 years of practising medicine, especially by John Murtagh and his wife, Jill Rosenblatt, during 10 years of intense yet wonderful, general practice in a country area of Victoria, Australia. It was their privilege to be the sole practitioners to a hard-working farming community of 2700 people. The practice was located in a small township with a twelve-bed Bush Nursing Hospital. The area, which was mountainous bushland with a snow resort, was popular with tourists. Many of the tales pertain to the experience of knowing their patients so well—both professionally and personally. They reflect the intensely human side of our calling and to share them is a special privilege. It is also appropriate to ponder on the humorous side of some of our experiences as well as the inevitable tragic outcomes for so many that we remember with sadness.

The concept of, and impetus for producing, a series of cautionary tales followed the obvious fascination of my medical students who considered they learned so much from them, especially when they realised they really happened and were certainly not apocryphal, however embellished in presentation.

Experience for doctors comes from the stories of our patients and, at times, our colleagues. As doctors, we are challenged by the atypical presentation of a common disease and the typical presentation of a rare disease. Each of the case histories in this book is a cautionary tale from which we can learn and observe the humanity of general practice.

We hope that sharing our experiences and messages is an important contribution to continuing medical education. In particular, the cautionary advice about so many pitfalls is extremely useful to the inexperienced doctor facing up to the vast challenge of general practice. There has been a focus on the medico-legal dimension of the tales, so that we can develop a healthy awareness of the pitfalls of our shortcomings, especially the missed diagnosis. This medico-legal commentary has been enhanced by the co-authorship of Sara Bird, who brings her special expertise and understanding to the editorial. Sara has also provided authentic case histories from her experience in medico-legal practice. We believe that the subject matter covered in this book is a reasonably accurate reflection of the common traps facing doctors in Western medicine. The tales are presented under headings that capture the nature of the message. Authoritative commentary on relevant medico-legal advice and pitfalls is provided using the case histories as a platform. The book concludes with an overview of a strategy that may help to keep the margin of diagnostic error to a minimum.

Good judgement is based on experience. Experience is based on poor judgement.

We trust that our shared experiences promote a certain wisdom, insight and better judgement.