TY - JOUR T1 - Frailty as illness and the cultural landscape JF - British Journal of General Practice JO - Br J Gen Pract SP - 216 LP - 217 DO - 10.3399/bjgp17X690641 VL - 67 IS - 658 AU - William Mackintosh Y1 - 2017/05/01 UR - http://bjgp.org/content/67/658/216.abstract N2 - It is over 30 years since Susan Sontag famously denounced the use of illness as metaphor.1 Her work examined the dangers of the use of language we adopt in describing cancer, tuberculosis, and AIDs. Since the publication of her essay, the way we look after our patients has radically changed. We live in the age of frailty. First described as a clinical syndrome (or ‘phenotype’) in 2001,2 its definition remains loose and variable even among the medical profession. A recent summary of NICE guidance on multimorbidity in the BMJ suggests we consider frailty as a symptom complex.3 The challenges of looking after an ageing population living with multiple conditions are clear. Only when remembering what Sontag tells us about how we talk about diseases might we realise that the complexity of frailty is perhaps more than we bargained for.In West Wales we certainly have our challenges in caring for people who are frail and widely dispersed by the rural landscape. The people who live in our community have a strong sense of connection to the land and traditions of farming. The attachment is so strong that it is fairly usual for you to find the patient you are visiting out in the cowshed, even if they are in their eighth or ninth decade. The stoicism of my patients got me thinking that perhaps the idea of frailty as illness needed closer attention.Just as Sontag did in the 1970s, it is in the cultural landscape that we can look for reference points. This may help us better understand the implications of saying that our patients are frail. In doing so I could not help but immediately trip over Shakespeare’s Hamlet.4 In disgust at his mother’s marriage to Claudius after the death of his father, … ER -