Book Review

Cautionary Tales: Authentic Case Histories from Medical Practice
By John Murtagh

Review by Dr Peter Thomas.

“The things we know best are the things we haven’t been taught.”  

“More things are missed by not looking than by not knowing.” 

John Murtagh, Emeritus Professor in the School of Primary Health Care at Monash University was recently called the JK Rowling of Australian medicine. This appellation is obviously fanciful but his influence on the practice of medicine, both domestic and international, through his writings and books is unarguable. His reputation was established with the publication of “Murtagh’s General Practice”, now in its fifth edition and coming in at over 1500 pages. It is considered the gold standard text for GPs and primary health care workers in this country and helped establish the general practice model for the new century.

With this new book, actually a second edition of one first published in 1992, John Murtagh explores the risks and pitfalls, joy and sadness of modern clinical medicine through the prism of his long experience. The title tells it all. It is not a textbook in the established sense of the word, rather a collection of case histories from general practice. He is ably assisted by a small group of contributors who provide cases from their own medical life. These medical anecdotes are written as they would unfold in the surgery. They are not written for the passive reader. Rather they demand that the reader does some work.

The book is divided into 24 chapters with names such as ‘Embarrassing Moments’, ‘Great Mimics’ and ‘Tales of the Unexpected’. Each chapter explores up to ten or more case histories on the theme. Many of these histories end with a section called ‘Discussion and Lessons Learned’. These are little nuggets of wisdom and insight presented in dot point form, and are the essence of the book.

Mistakes made are explored with commendable frankness and mea culpa. A book of this nature calls for nothing less. Recovering and learning from these situations is a measure of our medical maturity. One example from the book is telling. The author inadvertently gave a patient the wrong injection. When he discovered the error, he immediately admitted it and suffered no obloquy. The patient was a lawyer! The value of total transparency and communication in medicine, even of bad news, was proven again.

The classic medical paradigm of history, examination, investigation and treatment does not always work in an environment where social, cultural, psychological, addiction and many other factors can complicate the consultation process. The time-poor doctor has to think and work smarter in an ever-changing medical environment made dangerous by Government proscription and risk of litigation. The possibility that rare, unusual and forgotten diseases may present further complicates medical life. Thus, the last chapter offers a strategy for arriving at a ‘safe’ diagnosis, or “to help bring order to the jungle of general practice problems” as the author aptly puts it.

To pursue the JK Rowling analogy, if medicine was as easy as waving a Harry Potter wand to solve cases, books such as this would not be necessary. But medical practice is not easy and never will be. Professor Murtagh’s books provide advice, clarity and even comfort for the committed practitioner in an increasingly complex and challenging medical world. This new book is a worthy addition to his canon. It would be an act of forward-thinking altruism for a health agency or medical insurance company to give it as a gift to all new medical graduates in Australia.

In 2010, the President of the RACGP described John Murtagh as the most influential person in general practice in Australia. Few could disagree.