I'm not really all that mysterious

clinical medicine

That is most of it, being a physician—listening and seeing. The rest is technique.

adapted from a quote by Schmendrick the Magician from The Last Unicorn, with apologies to Peter S Beagle.

I’ve continued plodding on in my re-read of Gödel, Escher, Bach by Douglas Hofstatder (interspersed with Little Dorrit by Charles Dickens, as well as The End of Time by Julian Barbour.

One of the things that struck me about Gödel’s Incompleteness Theorems is the resultant stratification of all human knowledge

  1. true things that can be proven true
  2. true things that can’t be proven true
  3. false things that can be proven false
  4. false things that can’t be proven false

One way to simplify this is (1) fact (2) instinct (3) lies (4) nonsense

Or perhaps (3) can be error, because it can happen unintentionally, too.

The point being, no matter how much any of these realms of knowledge expand, the basis of clinical medicine will always be the same: history-taking and physical-exam. The rough estimate is that at least 60% and up to 90% of the diagnosis can be derived from history alone. A good physical exam can probably narrow the gap by another 5-10%. Leaving lab tests and imaging to determine the last 5-10%.

So the skills to being a good clinician are exactly what Schmendrick says makes a good wizard. Being a good listener enables one to be a good history-taker. Always looking enables one to hone their physical exam skills. Everything else is mere technique, which can be easily overturned by adequately large clinical trials.

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