Intended for healthcare professionals

Feature Christmas 2023: Marginal gains

Medicine: a performing art

BMJ 2023; 383 doi: (Published 11 December 2023) Cite this as: BMJ 2023;383:p2710
  1. Roger Kneebone, professor of surgical education and engagement science
  1. Faculty of Medicine, Imperial College London, London, UK
  1. r.kneebone{at}

Many clinical acts are performances—and we should think of that as a strength, not a weakness, writes Roger Kneebone

I think of medicine as a performing art, although to many people the word “performing” sounds suspect, almost insulting. It smacks of inauthenticity, of putting on a mask and presenting something that is not the “real you.” This is a fundamental misunderstanding. Whenever we engage with other people, we select from multiple authentic selves. Whether it is dinner with parents, an evening out with friends, a job interview, or a clinical consultation, we are constantly making choices about how we present ourselves and gauging how those choices are perceived. Within medicine, instead of asking “when are we performing?” clinicians might ask “when are we not performing?”

Theatre, music, dance, and public speaking—as with medicine—are rooted in a protracted grind of rehearsal, memorisation, and preparation. You spend endless hours in practice rooms and rehearsal spaces. You pluck up the courage to go out and do something in front of other people, putting your credibility on the line and taking responsibility for what happens next. You must connect with your audience, keep their attention, and remain vigilant in case things go off track. You learn to respond to the unexpected and to improvise. You develop courage and confidence to make radical decisions in the heat of the moment and cope with the consequences. If things go wrong, you do what you can to resolve the situation. Afterwards you “come down” as the adrenaline rush subsides. You may experience loneliness, isolation, and a sense of anticlimax. It is a relentless and demanding process that can lead to long term problems such as exhaustion and burnout, so you must find ways to sustain your energy and build resilience.

Clinicians experience these things too. I have …

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