Body of Art is a book the colour and size of a breeze block that could break your coffee table. Don't fret; there is much of interest in this rich collection of art for health professionals. The images comprehensively span humanity's take on our own form, going from the tubby Venus of Willendorf made around 24 000 BB (before bariatric) to Ryan Trecartin's frenzied video Center Jenny (2013) of American youth and their aspirations for physical perfection.

Fine-needle aspiration (FNA) has revolutionised the care of patients with thyroid nodules and is the initial investigation of choice. However, as a result of nondiagnostic (Thy1) and nonneoplastic (Thy2) specimens, it remains an imperfect sole solution with a range of sensitivities and a high inadequate ratio. Therefore the British Thyroid Association (BTA) guidelines recommend a second FNA immediately for Thy1 specimens and 3–6 months later for Thy2 specimens. Patients must be followed up to exclude malignancy. In this study we assessed the performance of MIBI scintigraphy for diagnosing thyroid malignancy and the cost-effectiveness of a combined FNA/MIBI investigative strategy for the management of thyroid nodules.

Recently in a lecture hall during a humanities session I asked (ill-advisedly) some medical students to name an artist that they liked. A silence as lengthy as that “composed” by John Cage threatened. Tastes vary of course—no-one risked ridicule. I quickly changed tack and said “ok—name me some art you don't like”. To which the eternal figure at the back shouted out—“everything in Tate Modern”. That mocking voice recalling Evelyn Waugh at his most blimpish seems to be always with us, the opinion that labels anything new as threatening. But hang on; maybe we are all guilty of that at times. So here we are in Tate Modern with meek Herr Klee. Surely he couldn't upset a soul these days? Perhaps the most famous of his works is not on display. Angelus Novus (1920) is a print once owned by the critic Walter Benjamin that shows an angel staring out at us with wild eyes. Benjamin, spookily anticipating his own fate, considered this the angel of history, face turned upon the past to see “one single catastrophe which keeps piling wreckage upon wreckage and hurls it in front of his feet”. Contemplating my own trivial history with ignominy I recall a visit to the last Klee retrospective in London a decade or so ago in the company of what the newspapers still oddly call a “Young British Artist”. I was daftly dismissive of the show saying something to the effect that Klee was an old hippy. Ill-judged conclusions are nothing new. Infamously the Nazis didn't like him: they called his work entartete Kunst—degenerate art. His career is told here with clockwork precision, the works go tick-tock with Swiss rectitude. There is much to like; the biomorphic forms that resemble invented plankton or the fugue-like patterning as with the watercolour Pottery (1921). Then there's Seaside Resort in the South of France (1927) where the pious rigidities of Piet Mondrian incongruously meld with the Mediterranean luxuries of a Raoul Dufy. Or again his aquatic tropisms like the frivolous piscine picture Fish Magic (1925). Ever the transcendentalist Klee's world is one where the ground beneath your feet begins to crumble. His fluid and florid romanticism allied to a transformative vision inspires many, but realists may find themselves craving the concrete with Klee. They may frown at the noodling of Hieroglyph with the Parasol (1917) with its whiff of school jotter doodling. It is not difficult to construct an ennobling tale of suffering with Klee akin to that of Beethoven's deafness. A painter whose hands with their toughened contracting skin need constant moisture. He was diagnosed with scleroderma in 1935 and made only 25 works in 1936. Klee's philosophy thereafter was nulla dies sine linea—no day without a line—and in 1939 incredibly he made over 1000 works. Looking at Klee's Outbreak of Fear III (1939) with its yelping Munch-like mouth it is easy to see this disembodied figure as a depiction of the traumas of scleroderma, that apoptotic nightmare of a condition. Driven in the leap year of 1940 he created 366 compositions, the year of his death. The star late work is Rich Harbour (1938). In size, in horizontality, in its all over playful marking it prefigures Jackson Pollock and even further into the future the ludic stick figures of Keith Haring or A R Penck. Earlier this year in the German city Dessau, I met an elderly Japanese academic whose face fell when he realised that the house where Klee lived and worked for the Bauhaus was closed for renovation. That Klee is much loved is beyond dispute, the crowds at this exhibition testify to this, but sadly this viewer has a persistent scotoma for some of his output. The much-vaunted colouring seems muted now, as faded as an old rug. It is no fault of Klee's that his designs have been appropriated by much carpet patterning in the past century but after seeing canvas after canvas of scuffed rectangles and parallelograms one feels a tad shaken and vacuous. To paraphrase Klee's epitaph one feels after this show somewhat closer to the heart of the man but far from close enough.

One day he gives us diamonds, next day stones. This accusation thrown at Shakespeare's Timon of Athens sounds all too pertinent in these dark cash-strapped days of a once solvent British National Health Service (NHS). It seems to me that faceless creditors are now asset stripping this once generous and caring colossus, and so threaten a descent into an Elizabethan horror show of misanthropic madness. But it wasn't always this way. Let's go back to the halcyon days of 1984 when a doctor's working week began with an opening snap, where all your troubles were “character building”, and there was no Big Brother watching us as now. That year British cardiologist David Mendel (1922–2007) first published his vade mecum of how to do the doctor bit right and proper. Mendel was born in east London, avoided his father's millinery business, contracted tuberculosis as a houseman, and then became a heart specialist at St Thomas' Hospital and took to writing having “done” cardiology. The “caring jazz”, as an old teacher of mine would have it, was his subject. Forget the whines about a 100-hour working week, for Mendel it was a joy just to turn up on the ward. In Proper Doctoring: A Book for Patients and their Doctors Mendel's style was aphoristic, bracing, clipped, and challenging. For many his truths will, in Thomas Jefferson's words, be self-evident. Mendel took impish delight though in wielding a scythe into the collective medical ego with assertions like “medicine is not a very intellectual subject; most of its concepts are simple”. Or “there is nothing clever about being clever. It comes entirely without any effort on your part and is not correlated at all with niceness or humanity or good citizenship.” Exclusivity as regards entry into medical education was not justified for Mendel. He insisted that “no ‘gifts’ are required and this puts the job within the range of the well-motivated average student”. And for new medical students he offered this frightful suggestion: “it is a pity that getting all the diseases cannot be made part of the medical training”. The duly qualified do not escape censure—“we all start off thinking that we are the centre of the universe and one of the great advantages of not having any talent is that you are forced to realize your insignificance at an early age”. As for dress code Mendel is rigorously conservative, advising “if you need a model, try and dress like a bank manager”. That'll be my cravat out then. Links etiquette, as with Stephen Potter's One-Upmanship, is unsurprisingly held up as a comparator—“as in golf, each stroke counts and you don't get a chance to play it again. If you want to get round in par for the course, you cannot afford to muff a single shot.” Sad that we make do these days with half sets and obsolete tools, the medical equivalents of a mashie niblick. Even watching physicians at the top of their game can leave Mendel unimpressed; he observed that “all the truly great men and women I have ever met have been nice, but we do not have many true greats in medicine. The medium-greats are often not so nice. Perhaps they feel that careless arrogance and evident superiority will make them appear truly great.” He is prophetic too—“as the climate of unashamed self-interest mounts, it must be difficult for new generations of students to act up to the doctor's role than it was for earlier generations who were brought up to believe in duty and service, and that privilege involved responsibility”. Mendel acknowledges that these are “increasingly unfashionable concepts”. There is something of J P Donleavy's pithy Unexpurgated Code: a Complete Manual of Survival and Manners in such perhaps unintentional hilarities as with “it is particularly offensive to call the patient ‘Dad’ or ‘Mother’”. There are unavoidable archaisms, of course, such as Mendel's references to vagotomy and ulcers. And some dodgy tips on receiving presents—“however large or small it is you should accept it gratefully no matter how you feel about taking it”. Today that “large” would worry your medical director. Mendel as doctor behaved like the born writer he was, on the bus, on the train. Witness “all doctors should be ‘good lookers’, and they should practice on everyone they see”. There is rationed use here of medical metaphor as with “the good doctor works with a tidal air of information which bears little relation to the vital capacity”. There are attempts at Chekhovian profundity—“the proper study of physicians is man”. This centring of the patient, the overriding importance of the interests of the sufferer, makes Mendel's book of universal appeal. Mendel was an Italianist and friend of Primo Levi and his insightful book is now happily published as an NYRB Classics in the hallowed company of Alberto Moravia, Leonardo Sciascia, and Curzio Malaparte. Diamonds like this book are forever.

The co-existence of diabetes mellitus and HIV infection poses significant challenges for both patient and physician. This article reviews the clinical problems, the implications for treatment plans and potential confusions that can arise when managing patients who have both conditions.

Erectile dysfunction (ED) affects millions of men worldwide with implications that go far beyond sexual activity. ED is now recognised as an early marker of cardiovascular disease, diabetes mellitus (DM) and depression. The risk factors that are associated with ED (sedentary lifestyle, obesity, smoking, hypercholesterolaemia and the metabolic syndrome) are very similar to those for cardiovascular disease (CVD). Arguably, the awareness of ED as a symptomatic entity in the post-Viagra™ age is on the rise. Nevertheless, ED is commonly missed when evaluating patients in the hospital setting, either because of lack of consideration or awareness, or through simple embarrassment (of both clinician and patient). This article provides an overview of the aetiology, assessment and importance of ED and hopes to promote its consideration in day-to-day clinical practice.

Elton John, that well known pugilist, once insisted that “Saturday night’s alright for fighting.” Now it may well be for bespectacled neds up for a ruck. But most doctor types prefer a quiet night at home enduring X Factor while wrestling with a barrel load of SurveyMonkeys. We crave a gentler life. But wait! Here’s another cuddly albeit cunningly cutting old fuddy duddy—John Betjeman—writing a poem he called “Five O’Clock Shadow.” Betjeman speaks for patients that this is the “time of the day when we feel betrayed” in the men’s ward—a time when “a doctors’ foursome out of the links is played.” Well that was back in the days when consultants could rely on the dogged Dr Finlay and his ilk doing the community cover, who worked all the hours that Tannochbrae or wherever gave them. Consultant physicians in particular back then could instruct troubled juniors down the phone. Faced with an intractable supraventricular tachycardia they might urge …

Late afternoon in a quiet central European bar, and I’m thinking, “How come only about 10% of consultants in certain hospital specialties are women?” As you do. At a neighbouring table sit two American businessmen and an elegant elderly lady. You recognise her voice. Yoko. It’s Yoko Ono! And so, excited, you think of what you might say to the queen of conceptual art, that paragon of second wave feminism. You think of all the women you’ve worked with and admired and conclude that you should say something, anything, to her. Maybe she’ll trip off some koan that will inspire hardworking female colleagues who are up against …

It’s only rock ’n’ roll, but you will like academia, reckons John Quin

John Quin lets rip about some of the everyday aspects of working in a hospital that drive him to distraction

An issue in the practice of oncology is the patient with a rare malignancy, where the challenge to the clinician is to rapidly understand the diagnosis and prioritise the best management approach. We present the case of a patient who was initially thought to have a malignant sarcoma and was eventually found to have an unusual, aggressive neuroendocrine tumour. This case stresses the importance of multi-disciplinary team (MDT) working and good communication and raises the pertinent issue of risk analysis in such settings. The case has greater relevance as it has led to a re-evaluation of how such cases are handled and heralded the introduction of a system of internal peer review.

Medical school didn’t prepare the young doctor-author of this book for the death of his brother in the south Asian tsunami of 2004, notes John Quin

AimsUsing psychological and quality of life assessment tools, we prospectively studied changes in health-related quality of life and emotional well-being in patients who had commenced GLP-1 analogue therapy (exenatide) and compared them with new insulin starters.MethodsTwo matched groups of patients with type 2 diabetes who had suboptimal glycaemic control on oral medication were assessed using a battery of well-validated psychological and quality of life tests at baseline, prior to commencement of treatment and then again after 6 months of continuous therapy, along with body mass index (BMI) and hemoglobin A1c (HbA1c) measurements.ResultsIn the exenatide-treated patient group (n=71), treatment satisfaction was greater (P<.05), as was the well-being score, at 6 months (P<.05), and the Hospital Anxiety and Depression Scale scores were significantly reduced (P<.05) when compared with the insulin-treated group (n=67). This was also found to be independent of changes in BMI in an analysis of covariance calculation. The effect size (using Cohen's d) of these changes was however relatively small.ConclusionsAlthough exenatide and insulin appear to have similar efficacy for the treatment of type 2 diabetes mellitus, there are several differences between them that could influence outcomes from a patient's perspective. Exenatide affects both physiological and psychological parameters. ‘Well-being’ generally tends to improve in exenatide-treated patients and could be used as an adjunctive therapy for depression in the context of diabetes. A larger study is required to confirm these interesting findings.

There’s a crisis in casualty, says John Quin