Clinical Observations and Emerging Questions

Abstract

I must congratulate our Planning Committee for putting together an interesting and provocative group of people to open our session. Namely, using the format of informed, inquiring clinicians who face the reality of everyday life to pose the problems which they see, and challenge the scientists, including themselves (some of whom are also scientists), with the forced explanations which they are required to use in order to rationalize the basis for their therapy. One of our participants put it all in proper perspective when he described the continuum from fact to fantasy to fiction. I have elaborated on that by trying to understand the differences between fantasy and fiction, and came to the opinion that fantasy is speculation, and essentially what, in scientific terms, is hypothesis formulation. Fiction, on the other hand, is quite often what the clinician is forced to resort to in his efforts at explanation or rationalization, given the few facts he has. He also has the responsibility of applying those facts to a real-life clinical situation which he does not have the prerogative to walk away from--namely, the patient who presents with a real, acute problem.