Editor's Choice

A doctor's dilemma

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7566.0-f (Published 31 August 2006) Cite this as: BMJ 2006;333:0-f
  1. Fiona Godlee, editor (fgodlee{at}bmj.com)

    “Let us hope the medical profession can continue to learn from all the other worlds that surround it and which it ultimately serves,” writes David Connell in this week's journal (p 489). He's talking about the blues, but he may just as well be talking about sport, literature—or indeed the theatre. This year is the centenary of George Bernard Shaw's The Doctor's Dilemma, a play with even more to teach the medical profession today than when it was first written.

    James Sabin of Harvard Medical School has given a good account of what the play can tell us (www.amrep.org/past/doctor/charlatans.html). “The play revolves around what high school students refer to as ‘lifeboat ethics,’ the question of who should come first when there isn't enough to go around. The preface delineates a second quandary—no matter how we pay our doctors, we inevitably create destructive conflicts of interest. Finally, Shaw dramatises the clash between intellectual integrity and the fear of death. Integrity requires us to face facts. Fear prefers the consolation of fantasy.”

    Sir Muir Gray, the NHS's knowledge guru, has proposed a public reading of the play on 20 November, the date in 1906 when it was first performed. We're hoping Sir Mike Rawlins, the director of the UK National Institute for Health and Clinical Excellence (NICE), will read Sir Colenso Ridgeon, the doctor faced with the “lifeboat ethics” rationing dilemma, and that the BMA's chairman, Jim Johnson, will read Cutler Walpole, the surgeon whose answer to every ill is to remove the patient's nuciform sac.

    And why not also have a network of readings at hospitals and medical institutes around the world on that day? People might do it instead of the weekly grand round or journal club. If you're planning a reading, send us a rapid response, and we'll register your event on bmj.com. You could even send us a video.

    Back to this week's journal, Anthony J Pelosi and colleagues (p 491) explore the ramifications of a bitterly fought present day rationing dilemma, and one in which NICE made first an unpopular stand—that cholinesterase inhibitors should not be available on the NHS for people with dementia, and then a reluctant concession—that they should be restricted to people with moderate Alzheimer's disease. The authors contend that the drugs have diverted resources towards memory clinics whose main aim is to monitor patients' cognitive decline rather than providing effective multidisciplinary care. As patients and carers cry foul against NICE, Pelosi and colleagues write, “The tragedy is not the proposed restrictions, but the fact that the only currently available licensed medicines for this cruel illness have turned out to be of marginal benefit.”

    What would Shaw have made of all of this? In his preface to The Doctor's Dilemma, he suggested that it be “compulsory for a doctor using a brass plate to have inscribed on it, in addition to the letters indicating his qualifications, the words ‘Remember that I too am mortal.’”

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