Training to be a clinician is so much more than simply accumulating facts. It is easy to forget, for example, just how much time and energy we spend on learning to use our senses. Despite having served the owner well for 18 or more years, the senses of the “raw” student still need much honing if they are to be used as part of medicine, and learning to use them is very revealing.
How limited the sense of hearing proves when the medical student first tries to detect a foetal heart beat or distinguish the various heart murmurs (for me the early diastolic murmur of aortic incompetence was well nigh impossible); or the sense of touch when trying to feel a liver edge or the popliteal artery; or the sense of vision when detecting a fine rash or a hair-line fracture on an a radiograph. But gradually one’s senses develop and by the time of qualification, sensing physical signs has become almost second nature.
But there is yet another level of sensing. Over time, doctors develop a capacity to sense more profoundly what patients really want to tell them. Here a new sense develops in which clinicians detect (and integrate with findings from the history and examination) messages from the patient’s body language, from their behaviour and from what is left unsaid or said only obliquely (so in passing, or simply through hints). It has long been my belief that patients are burning to communicate their feelings, and doctors can only pick up the messages if they are observant, vigilant, and obviously, in a position to see. I fear for the patients of a doctor who never looks past the computer screen, whose view of the patient is obscured by a desk, or for whom the history is taken by a second doctor who then presents the ‘case’. In these circumstances it is inevitable that many a diagnosis will be missed.
It would be a shame if our “crude” senses were honed only to meet the needs of practicing medicine when there is so much more that they can offer. And for me, “enlightenment” began on a weekend stay with the late Professor Bryan Brooke, when I was his house officer. Apart from being a surgeon, Bryan was a potter, a carpenter and a painter; and a consummate lover of things natural. In just two days he showed this rather materialistic young man how enhancing it was to use one’s senses and to make use of them all and at every opportunity (indeed how not using them was a waste and sin); how by using them so much pleasure was to be had; and that gaining such pleasure was legitimate and (usually) free. After some discussion about life values, he took me to his wood store and using one particular piece of wood as an example convinced me of the enormous pleasure to be had from seeing, feeling and smelling a magnificent plank of planed oak. Then on to his pottery to learn the pleasures gained from kneading damp clay.
While the list of sensory pleasures must be endless, my current favourites are the smell of freshly crushed lavender, the fragrance of the sweet pea, the whiff of a bakery, the earthy smell of leather; the sight of a butterfly, of waves tumbling over themselves at the seaside, of an elegant Georgian Terrace, of the first crocus in spring; the taste of a lobster bisque, of summer pudding, of freshly cooked shrimps with a dab of mayonnaise; the sound of a happy baby or of a gurgling stream; the feel of cotton (especially of sheets dried in the wind), of slipping into a hot bath, of oak (of course), of a well-shaped china cup as I drink a good cuppa, and the soft warmth of skin (during an embrace).
Not surprisingly, there is a down side of becoming aware of ones senses and sometimes this can inconvenience. I will do anything to avoid drinking out of a plastic or paper cup and this may require either going without, or checking the drinking arrangements of several coffee bars till I find the real thing. Similarly I would much prefer to walk down a pretty street or corridor than down one that is bland or ugly, and this can add time. And, of course there is the expense: cotton on the whole costs more than nylon, china rather more than paper, wood more than plastic etc.
I rather suspect that that many of us, possibly men in particular, tend to ignore or under-use our senses, yet in so many ways they are invaluable (as in medicine) and in everyday life can add so much pleasure. Listening to others I expect that my usage is rather limited even though I am continually exploring and the possibilities are endless. Thank you Bryan.
Joe Collier is emeritus professor of medicines policy at St George’s, University of London