On The Case

Doctors, detectives, and common sense

BMJ 2005; 331 doi: http://dx.doi.org/10.1136/bmj.331.7531.1495 (Published 22 December 2005) Cite this as: BMJ 2005;331:1495
  1. Alexander McCall Smith (jan.ppw{at}blueyonder.co.uk), emeritus professor of medical law1
  1. 1University of Edinburgh, Old College, South Bridge, Edinburgh EH8 9YL

    A detective story by the former chairman of the BMJ ethics committee, now a well known novelist

    Mma Ramotswe, only begetter and proprietrix of the No 1 Ladies' Detective Agency, Botswana's only private detective agency for the problems of ladies (and others), rarely had cause to consult her general practitioner. This doctor was called Dr Leonard Modisapodi, a man of modest tastes and quiet demeanour, who lived in a small house just off the Gaborone end of the Tlokweng Road. Mma Ramotswe attributed her robust health—and the resultant infrequent contact with Dr Modisapodi—to her good fortune in coming from a line of long lived women. Even though her mother had died at an early age, that tragedy had been the result of an accident involving the Francistown train and was nothing to do with her genes. These genes were good: her aunts, of which she had several, were all in their eighties or, in one or two cases, beyond. Precious Ramotswe realised, of course, that one could count on nothing in this respect, but she had always enjoyed good health and saw no reason to assume that she would not continue to do so. So, the only time that she saw Dr Modisapodi—other than those occasions when she spotted him walking about town on Saturday mornings with his two young sons—was when his receptionist summoned her to his surgery for the annual check-up that he gave all his patients.

    This examination was the cause of mild stress—or irritation, perhaps—for Mma Ramotswe. Ever since Dr Modisapodi had instituted these appointments, she had been obliged to endure the ordeal of standing on the scales that he produced from under his consulting couch. And every time that she had stepped on to their unforgiving platform, the doctor would draw in his breath sharply, as one might do on opening and reading a large and unexpected bill. This sound annoyed her, and it seemed to Mma Ramotswe that it was distinctly unprofessional to make such a noise. She herself never drew in her breath or shook her head in disapproval when one of her clients revealed something shocking. She just sat there and noted down the details, impassionately, as she had learned to do from her reading of The Principles of Private Detection by Clovis Andersen.

    Then Dr Modisapodi—and this happened every year—would look at her over the rim of his halfmoon spectacles and intone, “Now then, Mma Ramotswe, we are going to have to lose some weight, aren't we?” And she would say: “Dr Modisapodi, I am a traditionally shaped lady, that's what I am. Not everybody needs to be thin.” And he would frown and make a sound that was difficult to interpret, but which sounded like deep disapproval, and the matter would be left until the next year.

    This year Mma Ramotswe was due to see the doctor at eleven o'clock in the morning on a rather hot day in late November. At ten o'clock she called at an office near the surgery, hoping to see somebody she needed to interview in connection with a matter under investigation. This person was not in when Mma Ramotswe called, so she decided that it would be more comfortable to spend the hour in the waiting room of the surgery nearby, which would be considerably cooler than parking her tiny white van and waiting in the driver's seat, even if she were to park in the shade of an acacia tree. And there was always the chance that Dr Modisapodi would see her early if there were not many patients waiting to consult him.

    She entered the surgery and saw at once from the number of people present that there would be little chance of her wait being a short one. There were magazines, however, and Mma Ramotswe liked the idea of paging through these for an hour or so. Picking an empty seat near the receptionist's desk, she sat herself down with an out of date magazine and cast an eye over her fellow patients. There was nobody she knew, and that, for Mma Ramotswe was something of a challenge. “Always work out who's who and what's what,” counselled Clovis Andersen in his book. “You can do that just by looking. And you can find out just about everything you need to know without asking a single question—not one!”

    Shortly after eleven, when the rest of the patients had been seen and had left, Mma Ramotswe was ushered into the consulting room by the receptionist. Dr Modisapodi was writing something on a piece of card when she entered but he looked up and smiled at her, gesturing to a chair at the side of his desk.



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    “There now,” he said, slipping the card into a brown folder. “So, Mma Ramotswe, here you are. I'm sorry that you've been kept waiting. I saw you sitting there. You must have been very early.”

    “It did not matter,” she said. “I had plenty to look at. And I had lots to think about.”

    Dr Modisapodi raised an eyebrow. “But there's not very much that happens in my waiting room.”

    Mma Ramotswe laughed. “There is, you know. I was able to work out exactly who everybody was. That's what I did. And I was able to see what was wrong with each of them.”

    Dr Modisapodi looked at her in surprise. “I see,” he said. “So you could do my job, do you think, Mma?”

    Mma Ramotswe shook her head. “No, I would never say that. But maybe I could do a bit of it, and you could do a bit of mine. You see, doctors are detectives, are they not, Rra? You look for clues. I do too.”

    “Well, it's not always as simple as that. Maybe…”

    “So,” interjected Mma Ramotswe. “Let me think of the patients you've just seen. How many were there? Five, yes, five. And would you like me to tell you all about them?”

    Dr Modisapodi sat back in his chair. It was the end of his morning surgery and he could spare the time for Mma Ramotswe. After all, his examination of her could be fairly perfunctory. Her blood pressure was always remarkably controlled for a woman of her size and all he needed to do was to try to persuade her to lose a bit of weight, not that she listened to him, of course. “Very well, Mrs Detective,” he said good naturedly. “You tell me.”

    “I came in just a little bit after ten,” she began. “There were three people waiting then. Another two came in after I arrived, but they were booked in before me.”

    “Yes, yes,” said Dr Modisapodi. “You would not have to be a detective to work all that out, Mma.”

    Mma Ramotswe agreed. “Yes, that is true. But I was about to start, doctor. I was just going to tell you about the butcher. He was the first one to go in.”



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    Dr Modisapodi nodded. “That man is a butcher, yes.” He paused. “You probably go to his store. I imagine that's how you know.”

    “No, I do not,” said Mma Ramotswe. “I have never seen him before. But I could tell that he was a butcher. He had lost half a finger on his left hand, you see. That is often a sign of a butcher. Not always, but often.” She paused, watching his reaction. He was listening to her attentively. “He had come about a skin problem, I think,” went on Mma Ramotswe. “Now I know that you can't tell me whether I'm right because you can't speak about what your patients tell you. I know that because it's the same with me. What people say to me is confidential. But I was watching that poor man scratching away.”

    She paused. “Of course, you probably know this already, Dr Modisapodi, but skin conditions often respond very well to redbush tea. You know that tea, Rra? I'm sure that you do.”

    Dr Modisapodi pursed his lips. She was right about the butcher, of course, but he could not confirm it. “And then, Mma?”

    Mma Ramotswe looked out of the window. The sky was almost white from the heat. They needed rain to get the temperature down and to bring some life back to the land. Even at night it was oppressively hot; not a good time to be sleepless, as the next patient had been.

    “The next patient,” she said evenly, “was a lady who is having difficulty sleeping. I felt sorry for that poor woman. And it was her baby, of course, that was causing it. A colicky baby.”

    Mma Ramotswe noticed the doctor give a start, but she refrained from saying anything. Of course he is surprised that I knew what the trouble was, she thought, but it was perfectly obvious. That poor woman actually nodded off while she was sitting there and the receptionist had to wake her up when it was her turn to go in. And it was obvious that she had been holding a baby over her shoulder because of the milk stains that she had sponged off her blouse but which could still be seen. Any detective would have noticed that, Mma Ramotswe said to herself. But not every detective would know the solution to this poor woman's problem. Babies, especially colicky babies, were known to respond very well to redbush tea.

    “Of course I'm not going to tell you how to do your job, Dr Modisapodi,” she continued, “but colicky babies are much easier to deal with if you give them redbush tea. But of course you know that, don't you?”

    Dr Modisapodi gave no sign of knowing, or absorbing this information. “And the next patient?” he asked quickly.

    Mma Ramotswe folded her hands on her lap. “She was a very unhappy lady, that one,” she said. “I imagine that she came to ask you for a pill to make her feel better.” She paused. “And you decided, quite rightly, that she was not depressed and did not give her anything.”

    Dr Modisapodi's eyes widened. “And how did you work that out?” he asked.

    Mma Ramotswe kept her eyes on her hands. She was enjoying this. “Because she sat there knitting,” she said. “All the time she was sitting in the waiting room she was knitting. She never stopped.” She paused. “And you wouldn't find a depressed person doing that, would you? She was a very busy lady; very unhappy, but very busy.”

    Dr Modispodi shook his head. ‘You are a very clever lady, Mma Ramotswe,’ he said after a while. “I don't think that I'm giving too much away if I say that you're right.”



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    Mma Ramotswe took the praise in her stride.

    “And I suppose that you're going to say…” Dr Modisapodi began.

    “Yes,” said Mma Ramotswe. “Redbush tea. That is the best thing for one who is unhappy, Rra. Redbush tea raises the spirits.”

    Dr Modisapodi stared at his patient. She is a very unusual woman, he thought; what they say about her is correct; very unusual. “I am very surprised,” he said. “You seem to know everything, Mma Ramotswe; you really do.”

    Mma Ramotswe smiled. “But anybody can tell what I can,” she said. “One learns about people by watching them, Rra. And people are very predictable; they always do and say the same things.”

    Dr Modisapodi looked down at his desk. “So I suppose you know exactly what I'm going to say, Mma Ramotswe?”

    She laughed. “You're going to tell me to lose weight, and…”

    “And you won't do it,” said Dr Modisapodi.

    Mma Ramotswe shook her head. “I would like to try,” she said. “But somehow… Well, Rra, I am a traditionally built woman.”

    “Of course you are.”

    There was silence. Then Dr Modisapodi spoke again.

    “Of course, it's doughnuts that are the problem, aren't they?” he said quietly.

    Mma Ramotswe sat up in her seat. “How do you know that, Rra?” she asked.

    The doctor smiled. “Because I can see some sugar on the front of your dress, Mma. Doughnuts are coated in sugar, aren't they, especially those from the stall near your office.”

    Mma Ramotswe's face broke into a grin. “You're learning,” she said.

    “But I've always known,” he said.

    “Most doctors do.”

    “So you could do my job?” asked Mma Ramotswe.

    Dr Modisapodi looked thoughtful. He had made a guess about the doughnuts; there had been no sugar. Should he tell her?

    He looked out of the window. It was hard being a doctor sometimes.

    Footnotes

    • Competing interests AMcCS has no interest in any companies producing redbush tea, but has a small shareholding in supermarkets that sell it.