The collector is a common species. Some have an acquisitive compulsion for baseballs, others for beer cans. Still others collect books; in my case it is quotations. In a fit of intellectual outsourcing, I am devoting this issue of Second Opinions to medical wisdom and related philosophical observations. This includes epigrams, aphorisms, anecdotes, all of which I regard as examples of consummate insight, studded with common sense. When reams of health information via Google become indigestible, a swallow of wisdom is a good antacid. Emerson once remarked, "Don't quote me; tell me what you know." But perhaps for once the sage of Concord was mistaken. Judge for yourself.

Etymology

The word "patient" comes form the Latin patior, to suffer. "Client" comes from the Latin cliens which is the term given to the vassals of a feudal lord for whom services, such as protections, were rendered in return for payment.

On Being a Physician

From inability to let well alone; from too much zeal for the new and contempt for what is old; from putting knowledge before wisdom, science before art and cleverness before common sense; from treating patients as cases; and from making the cure of the disease more grievous than the endurance of the same, Good Lord, deliver us.

And

It is unnecessary - perhaps dangerous - in medicine to be too clever.
            Sir Robert Hutchison

To throw open the mind's door and allow diseases to enter into consideration each time that we are called to a bed side is foolish in the attempt, and impossible in the performance. Each case should lead us to arrange before the mind's eye a selected group of reasonably probable causes for the symptoms complained of and for the signs discovered. What we select should depend upon the clues furnished us by the patient himself or by the results of our own examination.
            Richard C. Cabot, MD
            Differential Diagnosis, Philadelphia, WB Saunders, 1915

Each trade and profession "ridden by the routine of... craft." "The priest becomes a form; the attorney a statute-book; the mechanic a machine; the sailor a rope of the ship." (And the doctor an MRI scan?)
            Emerson in The American Scholar, comment by Cynthia Ozick

Go to the patient, because that's where the diagnosis is (à la Willie Sutton on why he robbed banks: "because that’s where the money is").
            William S. Dock, MD

New medicines and new methods of cure always work miracles for a while.
            William Heberden

Medicine is like a woman who changes with the fashions.
            Auguste Bier

Diagnosis is a system of more or less accurate guessing in which the end-point achieved is a name. These names applied to disease come to assume the importance of specific entities, whereas they are for the most part no more than insecure and therefore temporary conceptions.
            Sir Thomas Lewis, Reflections of Medical Education. The Lancet, 1944

He is the best physician who is the most ingenious inspirer of hope.
            Samuel Taylor Coleridge

On Being a Patient

Just because your doctor has a name for your condition doesn't mean he knows what it is.
            Six Principles for Patients, Murphy's Law, Book 2.

On meeting Disraeli, Oscar Wilde said, "I hope you are very well," only to have that eminence rejoin, "Is one ever very well, Mr. Wilde?"

I had four years of medicine at Hopkins, but it didn't help.
            Tony Tamburello, jazz pianist

To preserve one's health by too strict a regime is in itself a tedious malady.
            Duc Francois de La Rochefoucauld

For the nicely brought-up girl, there is something that is hard to reconcile with her genteel sensibilities about walking into the inner sanctum of a complete stranger, solemnly describing her symptoms, and at the end of her recital hearing the stranger say, "Will you please go into the next room and take off everything except your shoes and stockings?" It wouldn't seem so bad if it weren't for that shoes and stockings clause! To my impressionable mind it has always smacked of the more erotic refinements of Berlin during its decadence.
            Cornelia Otis Skinner – on seeing the gynecologist

When I was a transvestite, dressing up like this was fun. But now that I'm a woman, it's such a chore.
            Remark of a transvestite turned transsexual

Psychiatry, Depression, and Hypochondria

Samuel Beckett and a friend were taking a walk one bright spring Sunday morning in a London park. The friend could not restrain his enthusiasm and exclaimed, "What a glorious day to be alive." Beckett replied cautiously, "I wouldn't go that far."

I was in group analysis when I was younger, because I couldn't afford private. I was captain of the latent paranoid soft ball team. We used to play all the neurotics on Sunday mornings. The nail biters against the bed wetters. If you've never seen neurotics play softball, it's pretty funny. I used to steal second base, then felt guilty and go back.
            Woody Allen

In sentimentality there is repressed or unconscious hate, and this repression is unhealthy. Sooner or later the hate turns up.
            D.W.Winnicott (British psychoanalyst)

Psychoanalysis is confession without absolution.
            G.K. Chesterton

Alfred Adler in his early, more psychoanalytic days, would ask the patient at the end of the first consultation, "What would you do if you were cured?" The patient would answer, and then Adler would say, "Well, go and do it then."

The composer Alban Berg (1885-1935) is said to have refused a blood transfusion in the Vienna hospital because he was afraid that it might contain the blood of a composer of operettas.

Charles Revson, the founder of Revlon, whose aim was to live forever and a day, feared that cancer might defeat his objective He had a highly paid live-in physician who occupied a suite in his Park Avenue multi-floor apartment, who gave Charlie a daily check-up. It came as a shock to me, when I learned that Charlie died of stomach cancer, for he also had a live-in chef whose sole function was to prepare meals for Charlie that were altogether free of carcinogens. It must have come as an even greater shock to Revson.
            His patent attorney

On Sickness and Health

A healthy body is a guest chamber for the soul; a sick body is a prison.
            Francis Bacon

Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick.
            Susan Sontag (Illness as Metaphor)

Part of the secret of success in life is to eat what you like and let the food fight it out inside.

The only way to keep your health is to eat what you don't want, drink what you don't like, and do what you'd rather not.

Be careful about reading health books. You may die of a misprint.
            Mark Twain

The cardiologist's diet: If it tastes good...spit it out.
            Anonymous

Historians still wrangle as to whether Napoleon would have won at Waterloo if his hemorrhoids had not been killing him on June 18, 1815.

Medicine makes sick patients, for doctors imagine disease, as mathematics makes hypochondriacs and theology sinners.
            Martin Luther

Who lives medically lives miserably?
            Anonymous

Attention to health is the greatest hindrance to life.
            Plato

We're all of us ill in one way or another: We call it health when we find no symptom Of illness. Health is a relative term.
            T.S. Eliot

'Tis healthy to be sick sometimes.
            Thoreau

On Life, Aging, and Death

Millions long for immortality who do not know what to do with themselves on a rainy Sunday afternoon.
            Susan Ertz

Life is like going to the dentist. First you think you can't stand it, then suddenly it’s all over.
            Attributed to Bismarck

Life is a glorious cycle of song,
A medley of extemporania
And love is a thing that can never go wrong
And I am Marie of Rumania.
            Dorothy Parker

We could certainly slow the aging process down if it had to work its way through Congress.
            Mark Twain

The tragedy of man is what dies inside himself while he still lives.
            Albert Schweitzer

Men do not quit playing because they grow old; they grow old because they quit playing.
            Oliver Wendell Holmes

This is a business where people wish you well only if they know you are terminally ill.
            Ted Tanen, former head of both Paramount and Universal Pictures

Dying is an art like everything else.
            Sylvia Plath, shortly before she committed suicide.

I'd rather be well for a whole day than sick for an entire year.
            Professor Irwin Corey

He's a good doctor. If you die, you die of what he says you got.
            Anonymous

Death for us is what sex was for the Victorians: something that fascinates and frightens us, an inevitability that we do not speak of, a scandal that makes a mockery of our pretensions to grandeur, dignity, transcendence. To deal with its depredations, we developed the most elaborate rituals, whether in the depths of the jungle of Borneo or on the barbered sward of Forest Lawn.
            John Banville, N.Y. Times Book Review, Nov.12, 1995

Old Age is the most unexpected of all things that can happen to a man.
            Lev Davidovich (Bronstein) Trotskii

This is what we fear-no sight, no sound,
No touch or taste or smell,
Nothing to think with,
Nothing to love or link with,
The anesthetic from which none come round.
            Philip Larkin's "Audabe"

All the unprogrammed imperfections in life are indeed what make life meaningful: the unexpected, the incongruous, and the surprising simple events of everyday existence. Some tend to sacrifice everything for some unidentified or (programmed) abstraction. We use the term, "practice of religion", or "practice of medicine." We should understand the practice of Living. This is not a habit, which tends to be unconscious, but a practiced, Conscious awareness of existence.
            James D. Coane, Psychiatrist

A prerequisite for being happy is to want to exist in the first place (Spinoza):
Comment, The Lancet: "This is not as circular as it initially sounds. None of us, after all, had any real choice: we just tumbled into existence whether we liked it or not. We were never warned; nor were we consulted. It makes perfect sense that some of us will be unhappy about it."

And among my Favorites

Americans follow news of medical research as closely as sports or the stock market. We are particularly avid for new findings about the health effects of diet and life style, because we have come to believe that no one gets sick anymore just because of bad luck. Instead, we see health as largely a matter of doing the right things, with the corollary that illness is a failure of some sort.
            Marcia Angell, MD. Author, Former Editor, New England Journal of Medicine

Skepticism is the chastity of the mind. Do not surrender it to the first comer.
            Santayana

Martin F. Sturman, MD, FACP

Copyright 2005, Mathemedics, Inc.