Author Malcolm Gladwell is a master of the fascinating factoid - which often gives an insight into, or is relevant to, the practice of medicine.

My sister just gave me ‘Blink’ - subtitled “the power of thinking without thinking”.

It’s all about how we make decisions about things, and particularly instant decisions - or “thin slicing” as he calls it. Some subliminal process is going on where we are thinking about, and making a judgment about, someone or something without realizing it.

He sites numerous examples of where this occurs - by art critics, by cops in arrest situations, in music auditions and many other situations. I think this may be the explanation for the little voice in my head that is telling me what is wrong with someone, or more particularly, that just pops the name of a medicine into my mind, for no apparent logical reason.

I will be sitting before a patient and suddenly the name Zoloft or Coreg or Topomax will suddenly come to mind - well before I have gone through the whole rigmarole of history and examination and then computing it all for the “assessment and plan”.

Another factoid he sites is how you can make a fairly good assessment of a person, not by meeting them, but by looking at their surroundings.

He sites a study where the personality of students was remarkably accurately assessed by looking at their rooms - if they are anything like some of the student rooms I have seen in my time, this could be a dangerous thing to do.

The relevance of this to the practice of medicine, is that it vindicates what is said about the benefit of the lost art of house calls. That you gather all sorts of information about the patient that you would not have if they just come to the office and you don’t see their home environment.

You see their wound infection’s not clearing up because of the unsanitary conditions. That they’re not getting any rest because they’re next to the interstate. That they’re fighting with their wife. The pile of pizza boxes and empty fridge indicate a crappy diet. That the garbage is cram full of beer cans. That there are numerous loose rugs and obstacles that will lead to falls - and so on, in your Sherlock Holms-ian way.

Finally he discusses the conundrum of how it’s not the degree of skill or how many mistakes a doctor makes that predicts if he/she will get sued.

He talks about a study of conversations between surgeons and patients - that were dickered with so that you couldn’t even hear the words - just the tone of voice.

It would appear it is the doctor who adopts a dominant tone that incites patients to sue him or her.

 Hot dogs are not considered as very desirable by anyone who has an interest in nutrition - full of fat and made from all the left-overs  (”lips and ass- holes” as Mrs.Gagg so delicately puts it).But they are a great American tradition, and no one could conceive of going to watch a ball game or having a cook out without them.

So the idea of redesigning them is kind of sacrilegious - but that’s what the American Academy of Pediatricians wants.

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 I guess I’m going to be cursed with bad luck.

Mrs.Gagg always claims that she’s cursed by Murphy (you know “anything that can go wrong will”) - and needs to kiss the Blarney stone to get cured (it’s on the itinerary). But I fear I am destined to the same for having failed to pass on an “Irish Luck” e-mail.

I didn’t realize it in my naivety, but it’s National Friendship Week, and some philanthropist somewhere sent me this opportunity to have a wish come true - within 3 hours if I send this to 20 other people. Together with some sound advice like “love like you’ve never been hurt” and “dance like nobody’s watching”.

But “you had better send it on” warns the anonymous presence. “If you delete this you will have one year of bad luck”.

This e-mail is a turgid, apocryphal story about how, as a boy, Alexander Fleming (the discoverer of penicillin) saved some other boy from a peat bog in Scotland. The boy he saved supposedly was Winston Churchill - and supposedly his farther (Lord Randolph Churchill) then paid for Fleming to go to medical school, so penicillin was invented - and then to cap the sentimentality, supposedly Winston’s life was saved by penicillin when he got pneumonia.

The problem  is that it is all pure bullshit. I just happen to be reading a detailed and  authoritative biography on Fleming (Penicillin Man by Kevin Brown). In reality, when Churchill got pneumonia after attending the conference in Tehran in 1943 to set up Operation Overlord, his physician, Lord Moran chickened out on using penicillin as it was not very well tried and tested at that stage. He was in fact saved by sulphonamides - but the newspapers, in their enthusiasm for penicillin mania “reported Churchill’s recovery, but claimed it was due to penicillin”

Those imaginative journalists also came up with the story of how Fleming had “twice saved the Prime Ministers’ life”, with “Fleming or his farther having saved Churchill from drowning as a boy”. “Neither story was true, but put together they made good copy, and like many good stories, live on as urban myth” notes Brown.

Mrs. Gagg, ever vigilant that I don’t put my foot in my mouth, tells me that the website ‘Snoops’ confirms that the story in the e-mail is not true.

The point of my comment is not to be a smart-ass about catching the error, but to ask who are the dorks sending out these hideously sentimental “Round Robin” e-mails that seem to arrive in my in box all too often - with their threats of misfortune if you den’t send them on?

Here’s a picture of a couple of fellowes who obviousely DID pass on the e-mail.