One of the eXCltmg challenges of medicine has been the reaching of
decisions based on less than complete evidence. As undergraduates in
teaching hospitals future physicians are taught to think in clear and
absolute black and white terms. Diagnoses in teaching hospitals all are
based on supportive positive findings of in- vestigations. Treatment
follows logically on precise diagnosis. When patients die the causes of
death are confirmed at autopsy. How very different is real life in
clinical practice, and particularly in family medicine. By the very
nature of the common conditions that present diagnoses tend to be
imprecise and based on clinical assessment and interpretation. Much of
the management and treatment of patients is based on opinions of
individual physicians based on their personal expenences. Because of the
relative professional isolation offamily physicians within their own
practices, not unexpectedly divergent views and opinions are formed.
There is nothing wrong in such divergencies because there are no clear
absolute black and white decisions. General family practice functions in
grey areas of medicine where it is possible and quite correct to hold
polarized distinct opinions. The essence of good care must be eternal
flexibility and readiness to change long-held cherished opinions. To
demonstrate that with many issues in family medicine it is possible to
have more than one view I selected 10 clinical and II non -clinical
topics and invited colleagues and fellow-practitioners to enter into a
debate-in-print.
