Andrew Papanikitas is Deputy Editor of the BJGP.
Let me explain. Clifford Geertz’s concept of ‘making the familiar strange and the strange familiar’ emphasises the ethnographer’s role in understanding a culture by both stepping outside their own cultural assumptions and immersing themselves in the perspective of the people they study.1 Diagnosis is the way in which we recognise problematic strangeness. Diagnosis is the manner in which illness is seen and described. It determines the possibility and choice of medical intervention. Communicating what we diagnose and how we diagnose is key to medical education. But diagnosis (the sociologists tell us) also defines professional medicine. It provides structure to a narrative of dysfunction, or a picture of disarray, and imposes official order, sorting out the real from the imagined, the valid from the feigned, the significant from the insignificant. Diagnosis is a relational process with different parties confronting illness with different explanations, understandings, values, and beliefs.2 In Life and Times this month we aspire to make the strange more familiar and the familiar more strange!
Strange new worlds
Richard Armitage tells us that primary care has been identified as the stage in the skin cancer pathway with the greatest potential for the use of AI to increase early detection. As with any such technology, he advises we should reflect on its strengths, weaknesses, opportunities, and threats. Notably, AI analysis of images can see things that the human eye may miss, but still requires adequate conditions to operate and a human to guard against error.3 Alex Burrell takes us Yonder this month with a look at articles on screening for atrial fibrillation, antibiotics in care homes, hand, foot, and mouth disease, and asthma triple therapy.4
Diagnostic humanities
“In Life and Times this month we aspire to make the strange more familiar and the familiar more strange!”
If it is difficult to agree what exactly we mean by health; it is perhaps unsurprising that we also approach unhealth in a number of different ways. Ben Hoban reflects on the meanings of ‘unhealth’. He writes, ‘Disease is like a stone dropped into the pond of someone’s life, and illness and sickness are concentric ripples representing its effect on them personally and in their wider interactions …’ 5
How might we see or feel those ripples? Jens Foell brings us sharply to our senses by reflecting on the smell of poverty in Deep End general practice.6 Rebecca Quinn reviews Elizabeth is Missing by Emma Healey, a novel that situates a mystery in the protagonist’s progressing dementia.7 Annie Farrell reviews The Ghosts of A and E by Nicky Carter and reflects on how poetry speaks to us: ‘… this captures exactly how I feel before seeing a new patient. And the clinic is grim, and the room still doesn’t smell right!’ 8
Should we actively look for ‘invisible’ disability in our new colleagues? Adrian Hucks makes the ethical argument that we should be screening those who train as GPs for specific learning differences. Awareness can guide help.9
Pathology of social systems
A recent House of Lords report puts the blame for rising obesity squarely at the feet of the food industry, stating that marketing of unhealthy food products has created an ‘obesogenic’ food environment. Nada Khan investigates the report on our broken food system.10 Giles Dawnay extends the digital diabetes metaphor. He observes that, in the same way that there is an unsettling parallel in the rise of obesity and ultraprocessed food from the 1970s onwards, the rise of faster and more invasive digital technology seems to link with a decline in mental health. As with junk food, children are especially vulnerable.11
The struggle to promote health can also result in a fracturing or even splintering of patients’ health experience — Saul Miller brings this home to the consulting room with a cautionary tale that many of us will recognise.12
An intimate relationship with reality
It’s all strangely familiar! Seeing, naming, and thinking about what is troubling in and what is troubling for primary health care at the very least can reassure the reader that there can be a collective reality. I hope it also allows us to move from diagnosis to treatment, and perhaps, once in a while, even a shot at a cure.
References
1. Susen S. The interpretation of cultures: Geertz is still in town. Sociologica 2024; 18(1): 25–63.
2. Jutel A. Sociology of diagnosis: a preliminary review. Sociol Health Illn 2009; 31(2): 278–299.
3. Armitage R. Using AI to improve skin cancer detection in primary care: the vision and barriers. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X741177.
4. Burrell A. Yonder: Screening for atrial fibrillation, antibiotics in care homes, hand, foot, and mouth disease, and asthma triple therapy. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X741273.
5. Hoban B. Ripples on a pond. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X741201.
6. Foell J. Deep End: the scent of poverty. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X741225.
7. Quinn R. Books: Elizabeth is Missing. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X741261.
8. Farrell A. Books: The Ghosts of A and E. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X741249.
9. Hucks A. We should be offering GP registrars screening for specific learning differences. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X741213.
10. Khan N. Fixing our broken food health system. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X741237.
11. Dawnay G. Adolescent screening for digital diabetes. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X741189.
12. Miller S. A plague of opinion. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X741285.
Featured photo by Jackson Hendry on Unsplash.
