A MINESTRONE MODEL OF MEDICINE - CLARIFYING THE SOUP

By Colin Brown
Contact the author by e-mail at christopher.johnstone@ntlworld.com

Marshall Marinker's Fulton Lecture was the anticipated tour-de-force of words, and illustrated his theme of the multiplicity of languages available to describe reality by playing us Mozart. After the audio technology of the Wolfson Lecture Theatre poured forth such pure music in classic synthesis of Art and Science, I was left musing on other languages, other world-views, other realities to help us cope with the ineluctable dissonance the lecture addressed: that of the patient-centred art of individual medicine with the public-health statistical mode of healthcare delivery. Could there be a third way?

So I reflected on how the deconstruction of Science shows it to be as socially and politically determined as are the Arts - and on food. Yes, of such dissonances are both stomachs and minds fed - and so allow me to whip up this after-Marinker conceit.

An alien discovering our civilisation from the TV emissions might infer that food is everything. It has an ontology - the ingredients that are - and a nosology - how they go together - and industrial-scale applications - think Heinz . Yet when applied on an individual scale, no two varieties of its products are alike, so it had craftsmen - Delia? - and artists - Floyd? It even has a goddess called Nigella.

Take minestrone soup as an example. In a backstreet trattoria - such as the one I still recall in Pisa in July 1970 - it may yet be heavenly, and each mouthful even from a single serving be different; but when doled out in a school lunch queue it's a grey sludge with bits in. And at home did you too have had little pasta alphanumeric shapes in the soup - and did you too arrange them on the edge of the plate? So the Idea of "minestrone" is pan-gastronomic - and like the Idea of general medical practice needs a wide gamut of language to describe it. For the managers of the public health, the cost of the ingredients is justified by the effectiveness, measured by the words and numbers that can be constructed from the floating pasta characters. And we can indulge them this "bean-counting" travesty on the edge of the plate, knowing that they leave behind the true broth, its richness and flavour and - perhaps - the unexpected magic such as the boiled-up heel of Parmesan cheese that I learned from Nigella to be a secret ingredient of the real thing.

So as I feed the IT beast with the ticks, crosses and numbers that will spell out the Q&O framework points, I will regard that task merely as if feeding it on those pasta shapes while the true nourishment is enjoyed from the rest of the broth.

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.