Monday, 11 July 2011

Black swans and yellow shorts

I saw this photo in the current issue of The Big Issue (ok ok bit of a name drop-alas I only buy it occasionally). These guys may have blended in to the Chicago scene when the photo was taken in 1975, but I think they would probably stand out somewhat if walking along Bedford High Street.

This photo comes from a collection taken by the street photographer Vivien Maier and which are about to go on show in London.

This week in our practice we saw a young child with Haemolytic Uraemic Syndrome, or rather I should say we saw a young child with some bloody diarrhoea. As a GP we see a lot of children with diarrhoea and very few of them are significantly unwell. At worst most will require simply oral re-hydration with appropriate fluids. Very seldom will hospital admission be required and then usually for the very young under 6 months of age.

What makes GP so fascinating and challenging is the ability to recognise the odd one out. So many symptoms in GP are common, be it headache, nausea, cough, diarrhoea or insomnia. But knowing when to  take more time with the patient, or to investigate further or review the next day or ask a colleague's advice- that takes time and experience and and a willingness to reflect upon one's practice.

Black Swan Theory is discussed in his rather formidably complicated book, The Black Swan, by Taleb who proposes a theory seeking to understand rare events, and indeed prepare for them. In summary he suggests:

  1. The event is a surprise (to the observer).
  2. The event has a major impact.
  3. After its first recording, the event is rationalized by hindsight, as if it could have been expected (e.g., the relevant data were available but not accounted for).
Now where are my tennis shorts?
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