Oxford Handbook of Clinical Specialties

Book Preface

This is the fi rst medical textbook to take the health of its readers seriously on the grounds that the health of one person (a patient) must not be bought at the expense of another (their doctor). It is an unsettling paradox that when we study medicine our own health goes out of the window (fig1), with long hours of coal-face working often without joy or sustenance as our health is shattered by the weight of an over-full curriculum (no doubt because there are too many organs and we know far too much about them).

What can a book do about this defenestration (fi g 1)? First of all the ideal book can (must!) be brief with a clear distinction between work and play. Secondly, such a book must furnish the mind: as we drill down into the minute structure of disease, there must be a corresponding search for the macroscopic, the human, and the universal. This book intends to make plain the idea that for every such spiral of down-drilling, there is a corresponding upward spiral (the swarf, fi g 2) towards the infinite—and we aim the help the reader fi nd the jumping-off point where these spirals intersect, so that the movement down (reductionism) is complemented
by a movement up (integrative medicine). Can this infl uence the heath of our readers? The answer lies in a single word: enlightenment.

The spiral illuminations at the beginning of each chapter (and scattered throughout the book) remind us to follow the movement up as well as the movement down. Follow the swarf! We should do this in our consultations, as well as in our reading. Never pass over an opportunity to widen the horizons of your patients, or to have your own horizons widened by your patient: what better way is there of reducing the size of their (and our) insoluble problems? Here, it is enough to point out that the well-furnished mind confers resilience to the body. We all know that stress brings on physical disease—and from this premise it is a short step to accept that a resilient mind is central to maintaining heath. We aim to find magnetic correspondences in the jumping-off points between the downward- drilling helix and the upward-spinning swarf-spirals using philosophy, literature, humour, and tinctures of hope. Ultimately we would like readers to develop their own methods, thereby converting passive acceptance of an overfull curriculum into wealth, life, and beauty.