Do not become confused during medical education.  The best teacher is the one who knows that his little dance is only a ritual to amuse and entertain those who are finding the truth, not the truth itself. Medicine is unteachable; equally, unlearnable.  Real medicine is learned in the interstices. Do not believe that everything is phony; there is a path there regardless; it is lonely.

The pride connected with knowing and sensing lies like a blinding fog over the eyes and senses of men, thus deceiving them concerning the value of existence.
For this pride contains within itself the most flattering estimation of the value of knowing. Deception is the most general effect of such pride, but even its most particular effects contain within themselves something of the same deceitful character.
Nietzsche
What needs to be learned?

First, the nature of the human being in all their existence, to learn the form of the human body. There are many aspects of this form – anatomy, physiology, neuroanatomy, obstetrics. To know the Form of the Human in Wellness and the Variations in Normal Humans – this is the thing that must absolutely be understood. Without a Platonic concept of the Well Form, one can go no further.
The second is the Seeing of the Patient – perhaps the hardest part. Symptomatology and semeiology – the old term for the Signs of Illness – are manifestations of the Doctor-Patient dialectic. The “history” and the “physical” are mythical separations of the same thing.
To listen. The Phaedrus teaches us that even the written word is an echo – a blinding fog. Learn how to listen – it is not taught anywhere in America. Properly, To Listen is an essential part of the examination; it must be learned for all interactions.
The patterns often seen in illness and disease. Wellness is Platonic, idealistic; illness is nominal. Illness is derangement; every derangement has its own form, although the manifestations may be similar. Do not become confused, and believe there is a Form of Disease – there is no such thing.
“What does man actually know about himself? Is he, indeed, ever able to perceive himself completely, as if laid out in a lighted display case? Does nature not conceal most things from him — even concerning his own body — in order to confine and lock him within a proud, deceptive consciousness, aloof from the coils of the bowels, the rapid flow of the blood stream, and the intricate quivering of the fibers! She threw away the key.” guess who.
Dia-gnosis means “seeing-through;” unfortunately, sometimes through the patient’s own nonsense and denial. That is what they ask you to do; it frequently infuriates them.
Things to ignore:
Deception, flattering, lying, deluding, talking behind the back, putting up a false front, living in borrowed splendor, wearing a mask, hiding behind convention, playing a role for others and for oneself — in short, a continuous fluttering around the solitary flame of vanity — is so much the rule and the law among men that there is almost nothing which is less comprehensible than how an honest and pure drive for truth could have arisen among them. They are deeply immersed in illusions and in dream images; their eyes merely glide over the surface of things and see “forms.”  Friedrich Nietzsche – On Truth and Lies in a Nonmoral Sense
It is amazing, but Friedrich Nietzsche never went to medical school.
To be continued.

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