True or False?

Who said, “All professions are conspiracies against the laity”?

A  Oscar Wilde

B  George Bernard Shaw

C  Rudyard Kipling

D  John Maynard Keynes

E  Groucho Marx

(Answer supplied at the end of this blog.)

Click, Double-Click is full of games.  It even has a multi-choice question.  Who has not had to grapple with five-stem posers at school or uni?  Select the best answer from the five on offer, is the instruction.  Notice they don’t say, select the right answer.  That is because life is full of fuzziness.  Maybe Oscar, George, Rudy, Maynard, and Groucho all said it, quoting somebody else.  If you’re pedantic enough, you can usually pick holes in an MCQ.  But it won’t help you pass the exam.  You’ve got to play ball.

The agony of the MCQ is that you can usually whittle the choices down to two.  Then you become distracted and, half way through an exam, contemplate a career change.  But it could be worse.  In the bad old days of undergraduate medicine each of the five stems could be either true or false, there was negative marking (points docked for wrong answers) and a pass mark of 60%.  This meant that if you answered all the questions and got an average of 4 out of 5 right, you could scrape a pass – just.  How best to undergo such an ordeal?  There were two philosophical schools.  If you don’t know, don’t answer.  Or, if you don’t know, guess.  Your right and wrong answers will cancel one another out, and if your gut instinct has any value, you should come out ahead.

The best way to prepare for an MCQ exam – aside from acquiring the necessary knowledge – was to rehearse.  The examiners knew this, and guarded their question bank jealously.  You weren’t allowed to take the exam paper out of the exam hall.  We got around that by allotting a single numbered question to each candidate which you were required to memorize.  As soon as you left the exam you wrote the question down before you forgot it.  Thus the exam paper was reconstructed.  This was of no use to us (unless we failed and had to resit), but was done for the benefit of our junior colleagues at the next diet.

I wonder about MCQs.  Their utility is that they are labour saving in that they can be marked electronically.  And they are completely unbiased and objective.  Their downside is that they hardly prepare you for the messy hurly-burly of real life.  Life isn’t remotely like an MCQ exam.  MCQs are constructed on a platonic plane, where every statement is either true or false.  Bertrand Russell once wrote on a piece of paper, “The statement on the other side of this sheet of paper is true”.  Then he turned the sheet over and wrote, “The statement on the other side of this sheet of paper is false”.  Then he sat and stared at the sheet of paper, in silence, for eighteen months.

Increasingly, we live in a binary world.  I have this notion that the dystopia we are currently creating resembles the nightmare of a multiple choice exam.  Everything is templated.  If you are ordering something on line, booking a flight, fixing a holiday, filling out the feedback form for the bank, or the computer help desk, everything goes swimmingly as long as you tick the boxes.  Once you embark on free text, the system crashes.  Maybe this is why children are so adept with IT.  They are happy to live in the binary world.  In Medicine, you can have a conversation with an 8 year old child that goes like this:

“Do you have a pain in your tummy?”


“Is it bad?”


The same conversation with an adult goes like this:

“Do you have a pain in your tummy?”

“Well, doctor, I wouldn’t really call it a pain…”

“Is it bad?”

“Well, it comes and goes.  You see, doctor, to let you understand…”

They didn’t warn me about this at Med School.  They told me everything would be either yes or no.

Which reminds me: the “best” answer is B.

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