The Doctor in Literature: Satisfaction or Resentment?

Abstract

Now that the humanities are joining the undergraduate medical syllabus, they can surely not be denied to us who struggle with continuing professional development and revalidation: how pleasant a prospect if seaside holiday reading might contribute to our good standing with the General Medical Council. Better still that physicians, a narcissistic group, might be able to earn brownie points by reading about themselves. (So, pack Ian McEwan's dazzling Saturday in your hand baggage to bone up on your neurosurgery.) Dr Posen, an Australian endocrinologist, has compiled his anthology from prose, poetry and plays that portray the doctor-patient relationship. The subtitle promises good and bad, but he has chosen to exemplify fictional interactions 'especially where these are unsatisfactory': would a collection of satisfactory ones be so thin as to be nugatory? He divides medical practice into eleven sections, starting with the doctor's fee and ending with the physician in court. On medicolegal matters he offers a brief dismissal of expert witnesses (noting that these tend to be third-raters at best) before moving on to litigation against doctors. In between come diagnosis, treatment, the bedside manner and the social status of the doctor. Posen draws on literature worldwide, ranging from the 14th to the 21st centuries: as a chauvinistic British reviewer, a child of the 20th century, I looked in vain for Waugh E or Powell A D but there was lots of Maugham and some Burgess, both of whom had a soft spot for the medical profession. In the 1950s the Doctor in The House books had, arguably, as great an influence in breaking down barriers between doctors and laity as television programmes such as Emergency Ward 10 (fictional) or Your Life in Their Hands (documentary) but Richard Gordon is not to be found. Perhaps Dr Posen found him too frivolous and positive about our relationships with patients. (Has this been our downfall? UK health policy seems focused on destruction of the personal doctor/patient relationship; would Tolstoy have written with such insight and sensitivity about a multidisciplinary team dealing with Ivan Illych? Does the medical establishment have no flanking move in its field manual—or is it colluding?). Russian, French and North American authors are well represented: the knowledge, skills and attitudes of the physician creations of Chekhov, Flaubert and Heller will satisfy their readers well into the 22nd century. But was it kind to overlook Joyce? Stately Buck Mulligan may have been, but his medical student behaviour did not suggest that relationships with patients would be smooth. Perhaps what comes over most powerfully is the paradox of the subtitle: it is often not one or the other but both satisfaction in resentment and vice versa. Shaw anatomized this vividly in The Doctors' Dilemma. A welcome book, this, to review and to commend. Beware: your reading list will become longer. Mine now runs through retirement and the grave to Elysium. My favourite medical book was given to me by the Arundel general practitioner who welcomed me as an undergraduate into his family, home, life and practice nearly 40 years ago; A Fortunate Man, about a general practitioner's relationship with patients, influences my practice still. The doctor John Berger portrayed as Sassall could perhaps not bear too much reality and ended his own life. Another Powell (J E) observed that all political careers end in failure: so do medical ones—don't they?