John Launer: All’s well that ends well?BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p104 (Published 17 January 2023) Cite this as: BMJ 2023;380:p104
- John Launer, GP educator and writer
Follow John on Twitter @johnlauner
The relationship between doctors and their rulers has often been uneasy. The problem, as Marx might have pointed out, is largely one of social class. Members of the ruling class have generally held on to power through careers in politics, the military, and the exploitation of land and labour. By contrast, medicine has often been a route to social advancement for people from the middle classes (including immigrants), but it then gives practitioners power over vulnerable bodies. It’s a power that everyone including rulers may find unnerving.
If you really want to understand this relationship, however, you might want to read Shakespeare rather than Marx. To most people’s surprise, one of his plays is a drama about the love-hate relationship between medicine and the aristocracy. It sits awkwardly in the canon, being neither a comedy nor a tragedy but having elements of both. As such, All’s Well that Ends Well portrays almost every shade of the ambivalence that doctors and the establishment feel for each other.
The play is set in France. Its hero is an arrogant young toff called Bertram. From the things he says and does, he would probably receive a warm welcome in the Bullingdon Club (the notorious private male dining club for Oxford University students). The heroine, Helen, is desperately in love with him but has the misfortune to be—of all rotten fates—the daughter of a doctor, albeit a distinguished one.
As the play unfolds, we discover that Helen has one thing going for her. She has inherited the instructions for various remedies from her late father, including the treatment for a beastly condition that threatens the King’s life—a fistula, since you ask. (Shakespeare is vague about its anatomical site.) She cures him. The King then offers Helen anything she wishes. Predictably, she asks for Bertram’s hand in marriage. Bertram is aghast. “A poor physician’s daughter my wife?” he asks the King in horror. Yes, says the King. Bertram refuses to consummate the marriage and runs away to fight in a pointless war in Italy.
As the title suggests, the play ends happily, at least on the surface. Helen follows Bertram to Italy. Through an elaborate “bed trick,” she impersonates another woman and gets herself pregnant by him. Back in France, she reveals this. Bertram instantly expresses remorse and promises everyone, “I’ll love her dearly, ever, ever dearly.” Unless played by a world class actor, this is about as convincing as Boris Johnson clapping for the NHS.
There’s a lot of other entertaining stuff in the play, including some very rude Elizabethan jokes and a parallel plot that exposes Bertram’s best friend as a military coward, just as Bertram has been a romantic one. As far as the main story goes, however, the play turns out to be the best parable ever written about how medical and ruling dynasties relate to each other.
As a politically active colleague and dear friend of mine used to explain to me, the ruling class would prefer not to live with doctors but cannot live without us.
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.