Views & Reviews Personal View

The demise of cultured doctors is bad for everyone

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d3649 (Published 22 June 2011) Cite this as: BMJ 2011;342:d3649
  1. Theodore Dalrymple, writer and retired doctor

Many doctors have been famous writers, many famous writers had a medical parent, and many doctors appear as characters in novels and plays: but this is not enough to establish a special connection between medicine and literature, at least for those pedants who will not countenance a statement without the strongest possible evidence in its favour. Before a connection can be honestly asserted, our pedant will say, we need to know that there have been more doctors who were writers, more writers with a medical parent, and more doctors as characters in literature than could be expected by chance.

There are obviously problems here with both numerator and denominator. Who is to count as a writer? Any doctor who has published a book in any literary form or on any literary subject? Even more difficult is the question of who doctors are properly to be compared with. The whole of humanity? Bricklayers? Fishmongers? Lawyers? These difficulties notwithstanding, I am convinced that the connection between medicine and literature is and has been a real one. But will it survive?

In the past, the connection between medicine and literature was spontaneous or natural, arising from the general education that all doctors had received, combined with their experience of human existence, an experience that was necessarily wider, deeper, and more varied than that of most people. Doctors are privy, after all, to their patients’ deepest secrets, but at the same time retain an attitude of objectivity. No situation could be more propitious for a writer.

However, with the increasing technical demands made upon medical students, it is possible that they are more narrowly educated than their predecessors were. Some medical schools now attempt to remedy this putative narrowness by teaching medical humanities as part of the course. But the spontaneous link between medicine and literature has been broken.

Does this matter? Is there any evidence that broadly educated doctors are better doctors precisely because of the breadth of their education? I suspect that there is not. In any case, it is clear that high artistic and literary cultivation does not by itself necessarily translate into fine moral qualities. For example, in his famous wartime memoir Kaputt, the Italian journalist and writer Curzio Malaparte describes a man who speaks perfect Italian though it is not his native tongue; discourses learnedly on Plato and Marsilio Ficino; has spent days and days studying the paintings in the Pitti Palace and the Uffizi; loves Chopin and Brahms; and plays the piano “divinely.” This man is none other than Hans Frank, head of the general government of Poland at a time when some of the worst atrocities in the history of the world were committed there, a man in short who was among the very worst of the very worst. His intellectual and aesthetic refinement did not prevent him from believing that the Führer’s will was the highest source of law or from seeing nothing wrong with the mass extermination of his fellow beings.

Furthermore, there is no reason why a doctor should not be highly accomplished in a severely technical discipline without being cultivated in any other sense. A doctor who can discourse beautifully on the sonnets of Shakespeare but who cannot operate is no use to someone with a surgical condition. And because medicine seems destined to become ever more technical, with knowledge and technical procedures increasing exponentially, there is no reason to suppose that our eminent doctors of the future either can or ought to be like eminent figures of the past, such as Geoffrey Keynes and Russell Brain, who were able to straddle the two worlds with almost equal distinction.

For all this, I cannot rid myself entirely of the idea that doctors should be broadly educated. The time is surely still far in the future when doctors will have to be technicians and nothing else; and it does not follow from the fact that not every doctor needs to be broadly educated that no doctor does, any more than it follows from the fact that not every doctor needs to know intimately the biochemistry of hepatolenticular degeneration means that no doctor does. Yet I remain bothered by the still small voice of my inner pedant, who demands evidence that even in the non-technical sphere of medicine the broadly educated doctor is better than the narrowly educated one.

Perhaps things should be approached differently. Let us grant for a moment that it is not necessary for a doctor to be broadly educated or cultivated in any way. If it is true of doctors, it is likely to be true of every other group you can think of: lawyers, accountants, teachers, engineers, and so forth. In other words, there is no need for anyone to be broadly educated or cultivated.

But if no one is broadly educated or cultivated, that is the end of broad education and cultivation itself. We will be reduced to a society of technocrats, each absorbed in their own narrow specialism. Notwithstanding the horrible example of Hans Frank, this is not a state of society to which I look forward. Apart from anything else, some among us will be specialists in the exercise of power, against whom the rest of us will be defenceless.

Notes

Cite this as: BMJ 2011;342:d3649

Footnotes

  • Competing interests: None declared.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

    This is an extract from a lecture given by Dr Dalrymple at the Royal Society of Medicine on 4 May 2011