There was a time when detailed case histories, including direct quotations from patients’ accounts of their own experiences, formed a significant part of the medical literature.
There was a time when detailed case histories, including direct quotations from patients’ accounts of their own experiences, formed a significant part of the medical literature. French doctors of the 19th century were particularly adept at writing such case histories; the lucidity of their prose, as of their thought, was exemplary. Indeed, French medical prose of the 19th century was often as good as that of Flaubert.
But the extended case history has gone out of medical fashion, as being too anecdotal and therefore unscientific. Now that we have so many diagnostic blood tests and imaging techniques, as well as powerful therapeutic procedures, the mere phenomenology of illness does not interest us very much; indeed it seems almost a waste of valuable time to elicit it. Yet a large percentage of avoidable medical mistakes are caused by doctors’ failure to take a proper history or to take much notice of what patients tell them.
There is therefore something rather old-fashioned about Oliver Sacks’s books, with their rich clinical material, use of patients’ words, and leisurely description of symptoms. Dr Sacks is clearly no technophobe or neurological Luddite who declines to take advantage of the startling technical progress of the last few years; but he is also not the kind of doctor whose first inclination is to put a patient straight away into the latest scanner in the hope that a diagnosis, prognosis and therapeutic regime will emerge all by itself, like a sausage out of a sausage machine. It is possible for technology to become a substitute for thought and a slayer of empathy.
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