This is a bit of a rave – maybe the beginning of a conversation – where things haven’t been fully thought through. Your thoughts are appreciated.

“Goodness Andrew, could you not have used a thermometer to check her temperature?” This facebook comment came with a smiley face and a heart. It was a reference to the post ‘Back from The Grave’ in which I relate using my finger as a thermometer. 

About an hour ago, I was puffing and sweating my way up the Kauri Block hill in Coromandel Town, smiling about this comment. It had me thinking. Which world do we give most credence to; the mental with all its abstractions, the digital as it presents on our screens or the one we live in, the physical world of things, people and conversations.

Years ago I went to see a therapist when Tish, my wife, and I were having a spot of bother. I remember nothing about the session except the therapist’s final opinion. 

I was probably raving away about Tish, work, the stresses and strains of life and my self pitying struggles. I was almost certainly disconnected from what really matters and vanishing off into clouds of wishful thinking; hoping that Tish would change her ways. Then, of course, I’d be cured.

“I don’t usually give advice,” she said, “but I have some if you’d like to hear it?”

“Sure”.

“Go home and get your hands dirty”.

One of the best bits of advice I’ve had. My response was a good long belly laugh. Her arrow was well aimed.I didn’t bother with the garden. But I got her point. She could have said, ‘get out of your head and into reality.’ I might have resisted that.

These days we’ve added the digital world to the mental one of  abstractions to get lost in; and the poor old actual world, all too often, gets ignored.

There’s a bit of back story to what comes next but you don’t need to know it. I crashed through an airport car park barrier arm and well and truly bust it. I trundled over to a kiosk and told the woman there that I’d broken a barrier arm. 

“Hang on a minute,” she said. She turned to her computer. “No, all the barrier arms are okay”.

So I told her the arm was bent at 90 degrees.

“Let me check again”, she said. She took another peek at her computer. “No, it’s okay”.

I wandered off. Another human lost in the digital world thinking it’s a reliable indicator of the physical and totally ignoring a  person trying to tell her what was actual and real. 

Back to the use of a finger as a thermometer in a hypothermic patient. These days thermometers are digital. Back then, I am pretty sure they were still those good old, reliable, glass mercury jobs that are fading from view. Usually two were nearby, one for oral use the other for rectal. I think they had the same lower range of 35 degrees – not much use in the circumstances of hypothermia. There may have been a low range thermometer, unused for years, in a cupboard somewhere. 

A digital thermometer has a battery which could be flat or going flat. There’s a wee computer chip in it that might have corroded. A false reading could be the result. But hey! Stick a finger into a carton of ice cream and the result is immediate and undeniable. It’s freezing bloody cold.

When I was a paediatric SHO and we wanted a reliable reading, we always measured rectal temperatures with a good old fashioned mercury thermometer. These antiques can not develop software glitches. 

As for the digital thermometer used in ears, they are calibrated to take a reading from the ear drum. What if the ear has wax in it or the thermometer is placed in such a way that it doesn’t see the drum. Digital thermometers are further from actuality than say mercury thermometers; as the latter are from a finger. There’s a chance that like the woman in the carpark kiosk we forget this. There’s a chance a mother might miss a significant fever and think her child is okay when she or he isn’t. NB Infants may not develop a fever with infection!

Any device that measure skin temperature is unreliable. Skin can feel cold when the core temperature is up. It can feel cold when body temperature is normal. Here’s some information on measuring temperature. Here’s information on normal range – might surprise you.

During Tish’s fatal four weeks in hospital, Tish being my wife, she never had a full physical examination, as far as I know. She had many scans and millions of daily blood tests, very few really necessary. I witnessed several paltry attempts to examine her tummy. All who did, would have failed any medical exam I ever took. The team of five or so, each with an iPad, would arrive in Tish’s room, along with a mobile desktop.  What they examined was their screens. 

Maybe this modern way of doing things works well technically but, as a patient, I’d like to be examined properly, please. Here! Guys. I am over here not in your iPad. Get out of the digital world and meet me in the physical. The MRI scan you are looking at may be of someone else – an error in labelling. Check the scan findings with your examination of me. You might find something like a specific skin rash or lesion that points to a diagnosis. There could be a lump under my skin out of sight that gives the clue.

A good history and physical exam can save time, money and even anguish.  Here is a cardiologist’s story of a 20,000 dollar work up on his dad. By asking a few questions, taking a decent history, the diagnosis would have been easy peasy. I’d have made it in five minutes flat – one questions and a possible diagnosis is apparent. Can you make this pain happen? Yes. How? Bingo! 20,000 dollars saved. They thought he’d had a stroke!

If I take my car to the garage and the mechanic doesn’t take a history, I am off somewhere else, pronto. Because I know he’s going to cost me. He’s going to replace this and that till the car works! Or he’s going to base all his actions on what the computer tells him and maybe miss a simple and cheap remedy.

Back to rectal exams – finger up bottom! I was working as a locum in the Peak District of England many moons ago. I found myself in a situation where a rectal exam was required but the doctor, who I was working for, had supplied me with a doctor’s bag with no gloves. I was fifteen miles from the surgery. My dad, a rural gp, had told years before me what to do if I ever found myself without gloves. Scrape your index finger nail on a bar of soap. Fill the area behind the nail then go ahead. So this is what I did. Job done!

These politically correct days I could get hauled up before a commissioner for inappropriate sexual behaviour under section 5 clause 3b of some dreamt up madness for inappropriate use of a finger. Well I did but not for the use of a finger.

At 3am one morning, I asked a patient whether she had a vaginal vibrator. This was a spontaneous thought which I verbalised without considering its potential consequences. I now have an opinion on my records that I breached some sexual inappropriate code or other. I was told that if I had asked, do you have a pointed massage device all would have been okay. The idea behind my question was a good one and yes I could have expressed myself differently. It took three years for this complaint to be processed. It ended up in the legal system where the sexual aspect was dropped and I was censured for putting two nights worth of valium in an envelope instead of a a proper pill bottle. The complainant got an apology written by a lawyer years after the event. I ended up pissed off and resentful.

Once the legal system dropped the sexual aspect I asked the medical council to remove this adverse opinion from my records. They refused on the grounds of public safety! The opinion on my record was made by a person who never spoke with me – kangaroo court.

This could all have been sorted by the complainant and I being brought together. A sincere apology and explanation from me as to why I asked that question, would I am sure have brought an end to the whole sorry affair. It could all have been over in days or a week or so. Sexual abuse – for god’s sake no! Just a question asked in an ill considered and impolite way. We all make mistakes – all too easy at 3am. For me this is the kind of madness that can arise with careless use of abstractions. In this case it’s using a serious crime as a huge umbrella to include bad manners – nuts. I am 73 years old now and so I am free to say sod off or worse.

The digital world is fabulous, fun and useful. The abstract world is where creativity, amongst so much more, comes into play. But if we don’t relate the abstract and digital to the actual, we are heading for trouble.

Money was a physical thing like gold. Then it became paper backed by gold. Now it’s a beep in a computer somewhere, with no link to reality. The beep has value because of an agreement and government decree. It’s an abstraction. Like any other abstraction, when detached from reality and abused, madness is a possible outcome. What about Bitcoin?

When an ill considered question can be corralled as sexual abuse and an appointed government representative thinks it’s okay to do this, without even talking with the accused or applying normal rules of evidence, we are heading for looney tune times.

I am not arguing for the use of a finger instead of a thermometer. I am just suggesting that we should not forget the physical. The physical world is the ground of our existence. It behoves us to keep this in mind.

When in an argument with another and it’s all abstract, it pays to dig down into what our basic assumptions are – lay them out. When there is no objective ground to refer to and there is no way to reconcile these with reason and logic, what then. I am right and you are wrong – my tribe against yours – war.

We need to come back down to earth and get our hands dirty. Get as close to the source of what we assume and believe as we can. We need free speech even if it is offensive and mistaken. It’s essential to our survival as a species.