This thought-provoking book exposes and challenges the hidden assumptions of modern medicine, encouraging readers to reconsider how they think about health and healthcare systems. Through vivid analogies and stand-alone articles, it helps clinicians understand how to better look after patients, themselves, and each other.
This thought-provoking book exposes and challenges the hidden assumptions of modern medicine: the body is a kind of machine, symptoms must be caused by disease, health depends on healthcare, prevention is better than cure, things that can be measured are more real than those that cannot, how we see things is how they are, relationships are peripheral to medical care, and proper doctors just keep going. It encourages readers to reconsider how they think about health and the wider healthcare system, and how to look after patients, themselves and each other as clinicians.
Recognising that many of the problems in the NHS and other healthcare systems are complex and not just due to overwhelming demand or staff shortage, the pieces of writing in this collection draw attention to the gap between our understanding of these issues and our everyday experience. Using vivid analogies and colourful characters, the author invites readers to fit the pieces together and look at the bigger picture that emerges.
This book is intended as a tonic for clinically active GPs in training and beyond who deal with the consequences of small-picture thinking on a daily basis. It will also be of interest to GP trainers, including course organisers and those involved in curriculum development, and other primary care health professionals and administrators.
Part 1: How We Think About Things
1. Naming
2. Learning to Live with
Cognitive Bias
3. Making it Real
4. Telling a Good Story
5. Seeing the Tiger
6. A Tyranny of Nouns
7. Timber, Trees and Sawdust
8. Codes
9. Beware of
Little Worlds
10. Avoiding Death
11. How to Make a Decision
12. Narrative and
Numbers
13. Illusions of Control
14. Swiss Cheese and the Power of Saying
Sorry
15. The Cliff and the Bog
16. Imaginary Medical Solutions Part 2: How
the System Works
17. The USP of General Practice
18. Hummingbirds and Foxes
19. One Big Thing
20. Facing Both Ways
21. Looking In and Looking Out
22.
Living in the Third Age of Medicine
23. Networks, Nodes and Equilibrium
24.
Efficiency, Effectiveness and Communities of Practice
25. Imagining the
Future
26. Not Just a Theory
27. Diverging at the Horizon
28. Health
Perception
29. Wagging the Dog
30. Cautionary Tales
31. A Poisoned Chalice
32. The Deal Part 3: How We Look After Patients
33. Heroes with Bifocals
34.
Flag-Waving and Learning to Dance
35. Falling Off the Swing
36. Getting On
with Strangers
37. Kobayashi Maru
38. Hyper-Burgers, Hyper-Medicine, and
Making Sense of It All
39. Sick Notes and Culture
40. Seeing and Hearing
41.
Scientists After All
42. Retrospectoscopy
43. Relational Care
44.
Uncertainty, Placebos, and Travelling with Confidence
45. Medically Explained
Symptoms
46. Eating the Elephant or Riding It
47. Ripples on a Pond
48.
Having Mental Health
49. Irresistible and Immovable Values
50. Archery,
Noodles, and General Practice
51. Narrative Failure Part 4: How We Look After
Ourselves and Each Other
52. Keeping Behind the Curve
53. Rethinking
Continuity
54. Professionalism, Kindness, and Going the Extra Mile
55. Being
Human
56. Overcoming the Monster
57. Making It Look Easy
58. Pulp Fiction:
Resilience, or Something Else
Ben Hoban has been a GP at Wonford Green Surgery in Exeter since 2001. He is a GP trainer, appraiser, and mentor, and the winner of the 2025 Kieran Sweeney Prize for medical writing.
