Although not particularly young, I'm a new GP. The umbilical cord with my trainers is freshly cut, and I'm only slowly getting to grips with the responsibilities laid on my shoulders. Because, really, about 30 or 40 people a day seek my advice, help or signature on anything from terminal cancer to a child's performance in grade 3. Obviously my head doesn't -and possibly can't- contain the science needed to deal with all of this. This is where the Art comes in, the Art that all old GP's speak of. 'It can't be taught, you've got to experience it', they said.

In my scientific enthousiasm I've always suspected the Art- proponents of simply not reading enough to keep up-to-date. One year down the line, I've joined the artists.

In no particular order, here's some observations and interpretations.

My heart always warms to the person with problem X, who thought it was probably something minor and would go away of it's own accord. Substance Y and therapy Z were tried, but despite this, X keeps getting worse. This person gets all my attention, knowledge, dedication and sympathy for less than a dollar a minute even if it runs into overtime.

In the less-than-young, I feel that facial lineage is of use. If one spends twenty years in relatively good cheer, the little crow's feet or gigantic emu paws as the case may be are archeological proof of a basically OK type person. They get the thumbs-up whatever the problem may be.

There are however those, whose wrinkles look as if their job involves the testing of lemons for acidity. Dark powers in the universe have also made them 'allergic' to a host of remedies. However prominent and solid they seem in the chair opposite you, their ailment tends to slip between diagnostic categories into the great cesspit of the Unknown.

My job is a filtering one. Allegedly, 86% of all consultations involve 'common, self-limiting illnesses' There must be a couple of percents too, which deal with a totally incurable problem. Evidently, whatever I do or forsake for these people is not going to affect outcomes.

So, possibly four people a day have something in which I can bend the disease's natural progression a couple of degrees in the direction of the better. For this, it's important to have some sort of a diagnosis. Once I have that, all the consultants in Perth, my bookshelf and the entire internet are full of helpful tips. The problem is, that I spend entire days of my life without making a diagnosis which will stand up to scientific scrutiny. It's all assumptions, impressions and free-floating theories with me. I know exactly what to do with a pneumonia, be it aspiration- community aquired- typical, or atypical. Piece of cake.
The problem is, that my patients don't so much have pneumonia's (pneumoniae?) of any type, but rather are iller for longer with a worse cough than I would expect of a head-cold. In fact, I think that in 10 years of medicine, I've seen about ten x-rays demonstrating a decent pneumonia in the ill coughers.

What to do, what to do....on the one hand I could give antibiotics 'just in case'....on the other hand, I don't want to see the person back four times a year with a cough requesting antibiotics. So the drawer of Management Plans is opened, and almost at whim, depending on mood, aura's, sunspot activity and my horoscope for the day, some get amoxy. Some get deferred amoxy 'if it gets worse'. Some get an x-ray and a week's delay until I get the report. Some get cough syrup. Some get a lecture outlining the borders of what I consider acceptable in coughing illnesses with the message to return should they cross any of them. Some get an x-ray, and a same-day appointment during which I'll have a look at the contents of their ribcage.

Now truly, where's the science in all this? I should mention that I used to be a teacher of physical diagnosis and although that's no guarantee of me being any good at it, I do take it seriously.

The analytic knife can cut in many ways. I haven't yet come across this particular division: there's patient's and doctor's diseases (DD's). Patient's diseases have a complaint, an ache, pain, inconvienience or missing limb which at that point in time ruins their potential happiness. The first port of call is to cure, remove the excess or add the deficit to restore the patient's usual sense of self. In this, anything goes. Polypharmacy, off-licence medication, advice to rock back-and forth, homeopathy, supplemental oxygen or SSRI's: the science lies in making the best guesses, the art lies in building rapport to make whatever work. After all, the patient will tell you what does and what doesn't. I don't need large trials for that.

Then there's doctor's diseases. High blood pressure, obesity, NIDDM, hypercholesterolaemia, pre-fracture osteoporosis. These people tend to be either as happy as Larry or at least totally unconcerned. In fact, no-one has a high blood pressure until I measure it. I create the disease. Now that's a bummer! You come for an itchy scalp and next thing you know, you have to avoid salt, join the Hash House Harriers, and forsake your only source of happiness: the bottle of plonk in front of the video.

Down the line, you're robbed of your proud perpendicularity by the beta-blockers, your legs swell up like skippy-balls on ca-antagonists and you decorate your bedroom with multicoloured pieces of lung tissue thanks to the ACEI. Your shoe-leather bill doubles from the expensive trips to your Friendly Family Doctor and your pharmacy bills put that V-8 hotrod on the back burner for a while. For your own good. You have to be cruel to be kind. Soft quacks make for stinking wounds.

The problem is, that treatment of the DD's have a very good basis in a statistical sense. Much better evidence that the lowering 160 whatevers to 120 thingies is good, than that hip-pain rating reductions from 9 to 6 have any use in this universe. So, I have to justify my actions. I used to do that with my Framingham models on computer, with relative and absolute risks. I filled sheaves of paper with normograms en went lyrical about the thiazides.

The above did not lead to the satisfied, 'consultation ended' facial expressions I so love to see.

Putting all the evidence in a couldron, with a bat's ear and the nose of blaspheming Jew, my educated advice has become that: 'You'll probably get a heart attack or stroke. If you get it at age 75, you may find solace in the fact that it would have happened at age 72 if you hadn't taken them tablets'. And: 'It's your body. Do with it what you will. On average, you'll benefit from a statin. But there's only one of you, so there's no guarantee'.

So, there you are. It'll be the mumbo-jumbo dances next.