Gillie Bolton's review continued:

The author quotes a wonderful piece of research which found that people are half as good at remembering a face in a photograph, if theyve tried to describe it when they first see it. If we only trust our innate and wordless ability to remember a face, we are twice as likely to remember it: a metaphor for general practice. Doctors are being constrained not to rely on their hard-won experience, knowledge and skill, their unarticulated sense of what needs to be done. But instead always to use their conscious brain function to work out a solution. Thus quite possibly reducing their effectiveness by half.

"I would say that evidence based medicine goes wrong when it stops trying to help, and starts trying to control. In other words, when it stops being a tool, and starts to become a master." (p105)

We are trapped in a culture in search of certainty, seeking to abolish uncertainty even. We are in a culture which attempts to deny and abolish the wonder and glory of chaos and serendipity and chance in the education of children, in the care of the sick. We are trained by the media, by our masters, to have zero tolerance of risk due to a belief that the end of uncertainty is in sight. This leads to the horror expressed by our masters that half of all doctors are of below average performance, and to their instruction that everyone and everything must show excellence. We need a few lessons in the use and abuse of the English language.

I would add: we are a culture which has lost its spiritual base, and is therefore trying to construct one out of shaky models. Those in control make models. They then constrain us to live and work within those models. The model becomes the master. Oh dear, Im getting as worked up as James does himself.

James writes in an inimitable everyday style, in keeping with his thesis. He embeds his arguments in stories of daily life: patients, colleagues, wife Lesley, encounters at conferences, when sailing. The reader is made to feel part of the inductive process which led to his arguments. Its so obvious: that if you control and constrain anything beyond the straightforward, it will be prevented from functioning properly. Especially the mystery of the human brain and the magic of medicine.

Contents: They'll want you to measure something * Surrounded by the madness * The nature of authority has changed * Making models: structure and reality * Modern life is even fuller than we think it is * The absolute, the new, change and entrapment * Elbowing into the spotlight (of shared experience) * Heralds of a new enlightenment * Grasping the nettle - the tough questions * The pathology of managerialism * Confronting the Utopian illusion * Understanding * Structure v. Freedom * OK, so what?  INDEX