Much of my academic life has been spent trying to bridge a credibility gap which I believe exists between medicine as it is practised and medicine as it is taught. The larger part of this effort has focused on trying to make teaching a more accurate and honest reflection of practice (using practice here in its wider meaning) believing as I do that many clinical actions are determined as much by behavioural or situational realities as by the nature of the underlying pathology. Thank goodness that some of these actions are taken, for they reflect what makes medicine an art which hopefully will always be deeper than the computer can describe. But some of the non-clinical determinants of clinical behaviour are less desirable or defendable; even if they too should be taught as being real, the eventual aim should be to understand their geneses and to remove them and whatever creates them.
KeywordsFatigue Expense Defend Ethos Burrows
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