PROLOGUE – INTRODUCTION

I’m no prophet. My job is making windows where there were once walls. [Foucault]

At medical school our timetable is dominated by lectures, PBL and tutorials, all revolving around medical science and clinical skills. Whilst acquiring a plethora of medical knowledge is clearly a pre-requisite of good medical practice, it is widely acknowledged by doctors, the GMC, and in particular by patients, that being a good doctor goes beyond possessing an encyclopaedic knowledge of the body. Throughout their work, doctors must navigate ethical dilemmas, cultivate compassionate and respectful relationships with their patients, and maintain an awareness of their own shortcomings. Achieving this revolves around one thing; insight. As medical students, the demands of a timetable dominated by lectures, PBL and tutorials can leave little room for insight and exploration of the questions we have about a lifetime of working as a doctor. What will be expected of us as doctors? Are we aware of the power we will have? Where does that lead us in appreciating our responsibilities? Will we act ethically? Will we cope? Will the reason we went into medicine sustain us throughout a career?

As a group we were interested in the way literature can provide us, as medical students, with a way of exploring these disparate questions. In the way that we examine and probe specimens in anatomy classes in the hope that we might understand the course of the cranial nerves, we can dissect fictional doctors in order to understand what it is about them that makes them ‘good doctors’ or otherwise.

Throughout our reading and ensuing discussions, several themes emerged from the texts that we believe are intrinsic to answering the question “what makes a good doctor’?”

attitudes towards patients,
power dynamics in medicine,
confidence in one’s abilities,
the ethics of medical practice,
what motivates doctors,
the future of medicine

These interrelated themes, and their implications for medical practice, are explored in this website.

Whilst we didn’t expect our reading to give us absolute answers to the questions posed earlier, we do hope that we now see windows where there were once walls.

Total Website Word count: XXX

Word count minus contributions page, references page, information search report, word version appendix: XXX

This site was made by a group  of University of Edinburgh medical students who studied this subject over 10 weeks as part of the SSC.

This website has not been peer reviewed. We certify that this website is our own work and that we have authorisation to use all the content used in this website

We would like to thank our brilliant tutors, Dr Ally Crockford, Dr Lena Wånggren and Dr Iain McClure for all their help.

CHAPTER 1 – ATTITUDES TO PATIENTS

As ‘doctors in training’ our heads have been filled with medical data for which we have no delete button. This may be considered a gift as we now have the ability to help our fellow human beings. On the other hand perhaps it is a curse; have we been dehumanised into seeing others as a collection of walking organs?

A thought-provoking place to begin is the doctor’s reaction towards physical appearance. We may presuppose that doctors who have been trained in all things science will see past the outer exterior and regard physical abnormality as a manifestation of the internal.  However, the disgust with which Treves (a man of science) acts towards John Merrick in ‘The Elephant Man’ suggests doctors may still experience that visceral reaction we all know when confronted with something out of the ordinary. In Treves’ eyes Merrick is a ‘perverted version of a human’ (Treves 3) rather than a body with tumours and gross masses.  Despite getting to know him to be a ‘sensitive and intelligent man’ (17), Treves still refers to him as a ‘primitive creature’ (18) illustrating the struggle to equivalate the physically abnormal with the mentally normal. This is likewise explored in ‘Frankenstein’ in which the monster – a supernatural perversion of humanity – is rejected for his physical appearance (50) despite later being divulged to be a being of intellect and emotion (Shelley 139-143). The notion is raised that somehow our physical normality and attractiveness denotes our level of humanity and ability to feel and think as others do. As future doctors trained in reason are we afforded the liberty of such illogical yet typical preconceptions? Can we help it?

 Perhaps we should shut off the emotional altogether and dehumanise our patients to the simple physiology they are made up of.  ‘The Practice’ suggests that in diagnosing a patient ‘the hunt was on’ (Williams 357) and has the connotation that the patient is no longer human – they are devoid of thought or feeling, they are a riddle to be solved and the faster you do it the better you are at the game.  Maybe this is the most efficient way of successfully treating patients and is needed in certain circumstances. Interestingly in the poem ‘The Surgeon at 2am’, the body on the operating table today is a collection of organs but tomorrow, when the surgery is done, they become a patient. Perhaps there is a need for surgeons to believe ‘the heart is a red bell-bloom’ and ‘the blood is a sunset’ (Plath no pag). In allowing this metamorphism of the body for a few hours surgeons have the audacity to cut and sew up life, to act as it were as gods with life in their hands.

However does danger lie in forgetting that human bodies belong to human beings? ‘The Case of Lady Sannox’ illustrates a surgical situation in which a lady was ‘no longer a woman to [the doctor], it was a case’ (Doyle 9) and in disregarding the human and allowing his medical fascination to get the better of him unnecessary disfiguring surgery is performed. This text demonstrates that if we forget that patients are also human beings we may forgo the repercussions to their lives in pursuit of resolving their medical problem. Had Stone known the patient was his love, would he have been so quick to operate?

If the ‘Case of Lady Sannox’ illustrates the pitfalls of dehumanising your patient then ‘Blue Afternoon’ does the opposite and explores the danger of being ‘too human’ with your patients. The doctor-patient relationship is an unusual one of intimacy and trust where one party (the doctor) becomes privy to very personal information of the other (the patient) within a very short timeframe. Blue Afternoon alludes to the risks of emotional entanglement of this nature, namely Carriscant falling in love with his patient  and leading him to abandon sense and reason and act in an unethical manner. Likewise, Delphine’s reciprocating emotions apparently stemming from her gratefulness to ‘the man who had saved her life: … her friend, and her saviour’ (Boyd 58) . This goes to demonstrate the need for professionalism and why patients must be placed at a somewhat emotional distance from the doctor.

In conclusion, it would make life simple if patients could simply be viewed as a conveyor belt of symptoms for which there is a diagnosis and treatment … but they are not. The human bodies we see do belong to human beings who have a past and a future. They have lived lives that they will want to talk about and we could easily be caught up in the emotions, so we must somewhat distance ourselves. They also will have lives after they stop being a patient and thus the medication we prescribe, the surgery we perform will have repercussions to be considered.  A balance has to be struck between treating them as humans and treating as cases – they are human cases.  Similarly a balance must be stuck between doctors acting as humans with natural (and often illogical) reactions and as creatures of logic viewing the body as a problem to be solved. We are to be human problem solvers.

CHAPTER 2 - MOTIVATION

The characters in the literature we read all had different motivations causing them to carry out their actions. These included an individual’s reputation and pride, financial gain, the opportunity medicine provides to pursue other interests, the pursuit of knowledge along with scientific interest, and love together with desire.

As a medical professional the sense of pride and the development of a reputation that comes with the job can be a strong motivator however can lead to errors in judgement. In ‘Blue Afternoon’ (Boyd) Dr Cruz’s opinions and actions are greatly influenced by his reputation and sense of pride. Seeing himself as a hero of surgery he is against the modernisation of surgical methods towards Listerism (antiseptic and aseptic surgery),despite being shown by Dr Carriscant the improvements to patients outcomes it had first hand. To further his reputation more he is even suspected to be experimenting with patients and acting in a maleficent manner. The maintenance of a reputation also plays a focal role in ‘The Case of Lady Sannox’ (Doyle). Being focused on his reputation the surgeon carries out actions which he is aware are not in the best interest of the patient; however he thinks of the embarrassment he would face in front of a coroner if he did not act and the patient died and hence carries them out with negative consequences. If he was not as focused on his reputation and instead on the patients best interest this would not have been an issue. In these text the surgeons did however have considerable other motivating factors such as financial gain.

Financial gain is a considerable motivating factor to medical professionals, however, to prevent conflicts of interest, it is important that it stays as a peripheral motivator and not the central motivating factor. In ‘The Case of Lady Sannox’ financial gain appeared to be a significant motivating factor. After turning down the job he is offered a considerable fee leading him to promptly take it.  However, in allowing himself to accept the case based on the financial reward as opposed to his duty as a professional practitioner he considers the patient as a job, and not as a patient, resulting in the marginalization of his professionalism and fails to act in the patient’s best interest. 

Financial gain as a central motivating factor could seem contraindicated in a career as a medical professional. However, in ‘The Blue Afternoon’ it is shown that it is possible to use medicine for financial gain while still having the patients’ best interest at heart, as evidenced by an anaesthetist who uses his career to fund his fascination with flying. Similarly In ‘The Practice’ Williams Carlos Williams explains how he uses his career as a doctor to allow him to be a poet. In this text he explains not only using his career as a doctor for financial stability, but also for motivation to write as he describes believing that doctoring and writing share the same roots.

Scientific interest and a pursuit of the furthering of science can also be focal in motivating doctors. The pursuit of knowledge is central in ‘Frankenstein’ (Shelley). In this text Victor Frankenstein, in the pursuit of knowledge, becomes fascinated with the secret of life. In being fixated with this he builds his monster with negative consequences. This text implies how the pursuit of knowledge can have dangerous results. In ‘A Young Doctor’s Notebook’ (Bulgakov) the pursuit of science and knowledge also are at the heart of motivating Dr Bomgard. Bomgard’s obsession with the treatment of syphilis leads to him undergoing a specialty career in venereal disease. However this text too shows that the pursuit of scientific knowledge cannot always be a reliable motivator. Dr Bomgard finds that some of his patients  will not accept his advice and explanation of the severity of syphilis, showing how even with best intentions patients ignorance can remain a huge obstacle in allowing the furthering of science to be a strong motivating factor.

‘The Blue Afternoon’ also shows love and desire as a motivating factor. In this novel Dr Carriscant’s  becomes infatuated with a female who he then takes on as a patient partly due to his new found love for her. Similarly, in Alasdair Gray’s ‘Poor Things’, desire leads to the idea that the corpse of young attractive lady is revitalized through the replacement of her brain with the brain of the child she is pregnant with in the hope of bringing this new creation up to be the perfect wife. In these two texts the treatments/interventions carried out on the two individuals are related to the physical and emotional desire experienced by the practitioners and not to the duty of care the doctors have to their patients.

It is clear that various factors can influence and motivate doctors’ actions. These factors share significant overlap and usually it is not just one factor motivating the individual but the combination of multiple factors.  The texts mentioned have shown that often treating patients is not a focal interest to some doctors and instead a means to some other end. However the texts imply that the effect on the standard of care a patient receives is usually not affected by peripheral motivators but instead how the professional carries out his actions in the presence of these motivators.

CHAPTER 3 - POWER

Doctor-patient interactions are often used by writers to reveal aspects of a character’s identity. Medical consultations frequently remove people from areas of familiarity, and instead place them in an alien situation; by seeing how they react when they are outside their comfort zone we can gain a greater insight into a character.

A striking feature of the doctor-patient relationship is the imbalance of power between the two. In the 1950s, Parsons described the ‘sick role’, whereby patients have a responsibility to regard the state of being ill as undesirable, and must thus seek competent medical help in order to recover. The patient occupying the sick role is entirely reliant on the expertise of the doctor and is thus rendered powerless. Occupation of the sick role by characters can be used to highlight their vulnerability and their powerlessness.

In Woyzeck (Buchner), the scenes between the eponymous character and the unnamed doctor illustrate the asymmetry of power in medicine; the use of a patient as a human guinea pig reveals the almost absurd extent of the doctor’s power. This maltreatment of Woyzeck, compelling him to subsist on nothing but peas even after he is clearly beginning to hallucinate, reveals his vulnerability to those in power in society. Buchner’s play is in many ways an indictment of the abuse of authority, and the scenes between Woyzeck and the doctor are a microcosmic representation of this. Putting his patients life at risk to satisfy his own scientific curiosity is clearly an abuse of power by the doctor, and leads the reader to question the wisdom of affording doctors this type of absolute control.

In contrast, Kushner uses doctor-patient interactions in Angels in America to reveal something very different about the character of Roy Cohn. If the sick role is typified by passivity and vulnerability, then Roy Cohn is the antithesis of this. Ultimately, Cohn rejects the sick role by refusing to accept the diagnosis and advice of his doctor. "Aids is what homosexuals have. I have liver cancer" (1:46). Cohn’s need for power and control is a defining aspect of his character, and his rejection of the sick role is a representation of his refusal to appear vulnerable or weak.

The imbalance of power in doctor-patient relationships is partly a function of the information asymmetry between doctors and patients. This information asymmetry is perhaps most clearly seen in the difference in language used between medical professionals and the layperson, and writers can use this difference in language to delineate the power dynamics in doctor-patient relationships. In Woyzeck, the doctor berates Woyzeck for not exercising control over his "muscularis constrictor vesicle" and that he is experiencing "aberratio mental is partialis" (no pag). The doctor uses these terms knowing that they are meaningless to his patient, but does so to reinforce the fact that he is dictating the terms of their conversation, and therefore has power over Woyzeck. As the reader is also unfamiliar with these terms, Buchner effectively alienates the audience from the doctor, encouraging their sympathies to lie with Woyzeck.

In medicine, power dynamics do not solely exist between doctors and patients; both doctors and patients may feel powerless the face of disease. As a doctor, Bulgakov was undoubtedly familiar with this feeling of helplessness; in ‘A Country Doctor’s Notebook’, the doctor describes a patient who was waiting to see if she was infected by syphilis as "living under a sword of Damocles" (71). Despite occupying a position of power in society, doctors may be rendered powerless to help their patients by diseases with little or no treatment. In ‘A Country Doctor’s Notebook’, the doctor’s power is undermined when his patient does not have any trust in him: "He’s no good. Young fellow" (68). As a consequence of this lack of faith, the patient does not take the medication or advice given to him, thus removing any power the doctor has to treat the patient’s syphilis. Foucault describes power as something that it ‘exercised rather than possessed’, and these examples iterate the truth of this statement; both the nature of disease and the absence of cooperation from patients serve to limit the power a doctor can exercise when treating patients.

When we were reflecting as a group on the theme of power dynamics in medicine, it became apparent that this was something that we had not really given a huge amount of thought to. In particular, we discussed a power unique to doctors: the power to section patients under the mental health act. Despite being familiar with the 2007 Mental Health Act and the powers it affords doctors, we had not really appreciated the fact that one day we may well find ourselves using it. It was not just the prospect of sectioning someone and removing their personal liberty that we found daunting, but also the idea that society had designated us, as future doctors, as the people who should have the power to decide who is sane and who is suffering from a mental disorder. A corollary of power is responsibility, and responsibility can lead to fears of failure, of not meeting society’s expectations of doctors. Thus, power can be seen as not only a privilege but also as an encumbrance of being a doctor.

CHAPTER 4 – TRUST IN CAPABILITIES

Doctor’s ability to recognise the limit of their capability and skill is the cornerstone of the modern definition of good medical practice; where the need forgo ego and philosophise one’s proficiency is imperative. The era of infallible doctors has long passed, leaving a new culture focused on the patient. This was perhaps guided by access to medical knowledge. With thousands of pages of literature available to patients at a few keystrokes, they now possess power to question their doctor’s expertise that was never possible several decades ago.

In The Case of Lady Sannox we are shown a surgeon to whom the very notion of accepting weakness is absurd. Reaching the top of his profession and continuing to strive far beyond his colleagues, Douglas Stone does not consider his imperfections. His arrogance is ubiquitous; he believes he was “born to be great”, possessing skill of “no other man in London”. It is his self-importance that provides the story. When offered a lucrative sum by a prospective client Stone decides to take a case which he would not otherwise have accepted. Unsure of operating, his judgement is warped when his client threatens to take his business elsewhere. He has several reservations about the surgery, but the thought of another doctor operating compels him to operate. Cutting out part of her lip, and suddenly realising she is his mistress; he falls into a state of distress leaving his “brain about as valuable as a cap full of porridge”. It is unfair to direct blame solely at his urge to protect his fragile reputation, as his craving and need for money is unambiguous. But, it is also irrefutable that the client had been acquainted with Stone’s substantial self-confidence: marked by the deftness in which he was able to manipulate him. (Conan Doyle no pag.)

Bulgakov’s fictionalised-autobiography of his early career, A Country Doctor’s Notebook, explores competence; in the beginning with a young newly-qualified doctor with no practical experience, to the morphine-addicted experienced practitioner. The only doctor in a desolate region, he is faced with a substantial variety of cases: from infections to urgent life-saving surgery. On many occasions he excuses himself from the consultation, running to his study and trying to find information in one of his textbooks. It is then perhaps surprising that he is able to conceal his inner panic; emphasised in the account of an operation where he “felt [his] blood run cold, but [ ] said in a clear voice: ‘Sterilise a scalpel, scissors, hooks and a probe at once’”. (33) His fear of performing surgery is again focussed upon when he is relieved that a patient would rather die than undergo an amputation; this is short-lived however, as the patient changes their mind. Yet in the operating theatre his assistant remarks “I suppose you’ve done a lot of amputations”. (no pag.)

Despite his turmoil the result is always of benefit to the patient. Very seldom does he cause harm; when he does his daydreams of guilt and prosecution take over. He thinks lower of himself, that he is not fit to practice medicine. It is ironic that as he becomes a better doctor, his fight with his mind becomes ever more present. So, perhaps it this inner debate that prevents him from becoming conceited. The solitude would certainly allow feelings of grandeur to foster.

Although, perhaps in surgery there is a requirement for immense self-worth. After all, anything inferior than flawless is usually undesirable; with mediocrity possibly deadly. Sylvia Plath, in “The Surgeon at 2 AM” (Plath), expresses the thoughts and feelings of the aforementioned practitioner during an operation. The surgeon regards the patient not as a person but, much like Douglas Stone, as a case. A canvas upon which to perform. The patient’s emotions are irrelevant. All that matters is that what was broken, will be fixed. Will be made perfect. This reasoning elevates the importance of a surgeons talent above all else, arguing that ego, and arrogance is just a bye-product of ability.

Most readings have presented doctors with an inability to assess their own proficiency. Conan Doyle presents the pitfalls of this, while Plath shows the benefits. However, it can be construed that the texts present the ability to self-assess and possessing egomaniacal confidence as absolute opposites. When applied to clinical practice, I doubt this to be true. I would argue that the ability to simultaneously have unqualified self-confidence and the understanding to self-assess is almost a pre-requisite for a good doctor.

CHAPTER 5 – ETHICS

I doubt you could find a single doctor or medical student who couldn’t tell you the four principles of good medical practise. Autonomy, beneficence, non-maleficence and justice – the four ideologies are presented as a cheat sheet on how to be a good doctor (as well as a good person!). They are neat, straight forward and easy to understand – everything life is not. There will be times of conflict where the best course of action is unclear, so what do doctors have to guide them? They will have to make decisions where the only guidance they have is that they thought it was the best course of action at the time. This is why ethics, the process of making a decisions with moral corollaries, are so important.

Literature has always been seen and used as a way for people to explore topics and ideas. There are many texts which deal with the theme of morality. Characters face and make morally ambiguous decisions with repercussions for many people as well as themselves, much like doctors are expected to do so daily.

Consider, perhaps, why relationships between doctors and patients are deemed so unethical. It is an unusual relationship in which a person hands a degree of power over to the doctor – leaving them far more vulnerable and open to manipulation than normal. This unequal power distribution has many implications for the patients’ autonomy and consent in such a situation.  In Blue Afternoon (Boyd) Delphine only begins the illicit relationship after Carriscant treats, and saves, her life. The reader must doubt his motivation in wanting to treat her – is his main concern her health or is he taking advantage of an opportunity to get closer to Delphine. His actions whilst she is under anaesthesia leave no uncertainty as to what his motivation was. The reader must question what their relationship was built on and why Delphine had a change of heart. The relationship between doctors and patients must be seen as a neutral and safe one where a certain degree of trust between both parties are maintained, which is why it is necessary for ethical boundaries to be upheld.

An important part of being an ethical doctor is to keep in mind the principles that underpin medicine and to question the morality of your decisions. Baxter’s decisions in “Poor Things” (Grey) are unquestionably unethical. Through McCandless the reader experiences horror and revulsion at his experiments – for which Baxter seems to find no fault, going as far as to consider his quest noble. His motivations for reviving Bella are selfish and perverse and he never considers if he should do something, only if he could achieve it. With his cold, objectionable manner and abrasive personality (all features people dislike in their doctors) Baxter is a perfect embodiment of an immoral, unethical doctor.

Sometimes it is not possible to uphold the standards of medical practise that doctors would like. As in “The system of Dr Tarr and Professor Fether” (Poe), idealistic views and methods, though beneficial for all involved, may prove too difficult to uphold. It is not unethical to admit that you are never going to be able to treat people exactly the way you would want to, but nevertheless that does not excuse treating patients in a manner less than the standard of care everyone deserves. In The Fifth Child (Lessing 98) Ben’s treatment in the institution is not only unethical but inhumane. The mother never set out to treats Ben this way – it stems from a lack of understanding of what was wrong with him and a desperate situation in which she knew not what to do. Even now there is not very much known about the correct way to treat mental health problems and there are many situation in which attempting to help may make the entire situation worse – especially for the patient.

In Frankenstein though the character of Victor makes many errors, you could also argue that creating the creature was not the biggest mistake; rather, by turning his back and fleeing from him, he abandoned his duty of care, in a way creating the revenge driven monster we see towards the end of the book (Shelley). Frankenstein abandoned his duty of care towards his creation an action that, in a modern society, would have landed him with a negligence suit! This leaves us to wonder how responsible doctors are for the health of their patients and the people around them. In legal terms a doctor has “no obligation to assist a person in distress” (Sokol). On the other hand, the GMC would say that to be an ethical doctor you must offer any help you can in an emergency; to ignore a plea of assistance would be heavily condemned.

CHAPTER 6 – MEDICINE IN THE FUTURE

Medicine modernises. It is immediately apparent that the next 50 years that will constitute the medical practice of current students will be radically different to the present, just as 50 years ago was to today. Science advances, practice evolves, attitudes change, and ethics are continuously re-evaluated. That change will happen is inevitable and medical students appreciate that. However, what we might not spend the time considering is that inevitable and unalterable are very different things. Intentional change is alteration by definition, and it will be our generation calling the shots. With that responsibility in mind, what might medicine look like in the future, and what role will doctors play in forming it?

The curtain on the genome has been lifted. Information dictates what we are at a cellular level, but it is neither the whole picture nor an unalterable one. The advent of IVF was the first time the process by which fertilisation has occurred for the rest of human history was bypassed – sex is no longer a necessary part of reproduction. Moreover, the BBC announced that the UK has become the first country to approve creating three-person babies, with a donor contributing 0.1% DNA as mitochondria (Gallagher). These procedures offer amazing possibilities to the benefit of the families involved, but good intentions do not eliminate risk.

“Every human being in the Central Power has been enhanced, genetically modified and DNA-screened. Some have been cloned. Most were born outside the womb.” (Winterson 75)

The Stone Gods imagines a plethora of new possibilities where human beings are editable. As the protagonist, Billie imparts the text’s cautionary message. However, who says nature should dictate the foundations of our species and not us? Nature is capricious but represents a lottery that we were all subject to – a natural process does not discriminate. This is at the foundation of an objective equality for human beings, and genetic engineering may challenge it. Selecting or altering an embryo for a desirable change unavoidably includes a judgement of what life should be like.

“There was never any debate about the ethics of Genetic Reversal – it just started to happen because MORE figured out how to do it.” (69)

Doctors play a major role in defining what a ‘normal’ human being is, immediately implicating them in any course of action that seeks to remove the outliers. Through debate, we must decide how highly we value our current understanding of equality.

Perhaps the cautionary tone of the Stone Gods is too reactionary. The debate of nature or nurture has not been resolved – we appear to be more than the sum of our genes.

“We’ve got ninety-nine per cent the same genes as any other person… Does that cheer you up at all? (Churchill 205)

Caryl Churchill’s A Number explores the significance of our genes through the vivid illustration of different reactions to cloning. Each of Salter’s sons fits on a spectrum of reaction to having been cloned: from acceptance, through troubled reflection, to outright rejection. Medicine does not occur in a vacuum. Rather it impacts on beliefs that are foundational to all of us – in this case, identity. What is most illuminating about A Number is that Michael, Bernard 1 and Bernard 2’s responses demonstrate their individuality. They are genetically identical, but their differing environments and upbringing have determined who they are. The term ‘copy’ seeks to cheapen their worth when in fact Bernard 2 gets it right with his thought, “I do think they’re them just as much as I’m me” (167).

In A Number, Salter’s desire for another Bernard represents his shot at parental redemption. We might infer from the text that Doctors would be doing the children an injustice to allow parents to selfishly hit repeat and begin again. Parents are judged to have responsibility for their child and, because environment and nurture matter so profoundly, does this transfer to the Doctor if they bring about a life? Frankenstein and A Number raise this complex principle of accountability. Both texts use angry, rejected but reasonable characters to expose the naivety of the perpetrator. There was never any guarantee that the practical reality would reflect what was intended, and neither Frankenstein nor Salter had the foresight to consider how it might go wrong. Guilt and murder are employed as revenge for the attempt to avoid taking responsibility. There is a cautionary message – we may realise our error too late to undo the harm caused.

To consider hastening the evolution of our species is new territory. Public scientific debate might have shifted from God’s hand to natural processes, but are we ready to hand ultimate agency to man?

It may be that humans are never able to create life themselves, but, as a thought exercise, it allows us to consider what it is to be human. The characters examined range from flawed human beings, to clones, monsters and robots. Yet every one of them has a consciousness that demonstrates a relatable range of human emotion. So, “Is human life biology or consciousness?” (Winterson 73) A full understanding of our own species may forever elude us, and these binaries may be unhelpful in that pursuit, but an awareness of the debate is important if medicine is to ‘do no harm’.

Change does not guarantee progress. As we approach the boundary line to ethically uncharted territory, will it ever be considered prudent to self-impose limits and leave possibilities unexplored? Stopping short is anathema to a discipline that seeks to redefine what is possible. To a pioneer, inertia might be stagnation, but the doctor must consider regression. The moral element is inseparable; medicine is not about doing more, rather doing more good.

EPILOGUE – CONCLUSIONS

This project is by a group of students lacking in answers, but interested in the questions. Digesting literature on the topic of our future careers has dispelled naivety, informed, alarmed and encouraged us along the way. We focused our efforts on grappling with one not-so-simple question; ‘what makes a good doctor?’.

As students we have chosen to study medicine for many different reasons – perhaps these are not coherent even within our own minds. As long as a doctor’s motivations don’t interfere with an outcome that is in patients’ best interests, perhaps there is no right or wrong. Beneficence is first and foremost about doing what is best for the patient. However, there is an element where we must consider our own best interests – a good doctor recognises that there are situations where they may be led or want to act unethically.

Medicine is not always comfortable. When confronted with a challenging situation, we need to recognise our initial reactions, moderate them, and judge whether they deserve to be accepted or discarded. Patients are human beings to be treated as such but, while never seeking to reduce a patient to their ailment alone, a good doctor must act within the bounds of professionalism.

Power is not intrinsic to doctors; it is afforded. For the practitioner, an appreciation of the trust placed in them by patients and society should never be far from their minds. Power is to be held lightly and used responsibly. Success and disaster are a part of the job, whether we as doctors are accountable for them or not. Some things are out of our control and we will all make mistakes, but perspective makes that tolerable and reminds doctors to stay grounded. A doctor’s desire to improve and learn from their mistakes must be balanced with the courage to back themself when the situation demands it.

As future doctors ourselves, we have the sneaking suspicion that our current idealism will not prevent errors of our own. The doctors described highlight the flaws inherent in humanity, not just in medicine. Therein lies our deeper understanding that all of the errors made by these fictional characters are real possibilities for our future selves. The doctor carries the human propensity to ‘mess up’ into every consultation. We can only hope that awareness of this fact will provide the necessary reflection for the ordinary physician to become a ‘good doctor’.

ACKNOWLEDGEMENTS AND DEDICATIONS

Acknowledgements

This project would not have been achievable, or as enjoyable, without the guidance of our three tutors:

Dr Ally Crockford PhD

Dr Lena Wånggren PhD

Dr Iain McClure BA, MA, MB, BS

Through selecting relevant texts and guiding conversations in the right direction they allowed us to explore what it means to be a doctor through literature.

I feel more confident and more satisfied when I reflect that I have two professions and not one. Medicine is my lawful wife and literature is my mistress. When I get tired of one I spend the night with the other. Though it's disorderly it's not so dull, and besides, neither really loses anything, through my infidelity.

— Anton Pavlovich Chekhov

INFORMATION SEARCH REPORT

Recognising the Information gap –

At our first meeting we discussed with our tutors the topics and that were to be covered in our project. Our tutors then provided a reading list that addressed these topics.


Distinguishing ways of addressing the information gap-

The literature we used came from three sources. The tutors provided a Google Drive in which many of the texts were obtained. Texts were also obtained from the library using library searches. Finally on occasion texts had to be found online using search engines i.e. Google Books.

Constructing strategies for locating the information-

Many texts were easily located through an open access Google Drive provided by the group tutors. Texts located in the library were found using their online catalogue with relevant search terms. Texts online were found using search engines with Boolean algebra where required.

Locating and accessing the information-

As the Google Drive was open access it was easy for us to access the texts in them. Texts were also obtained from the University library. Online texts were located using relevant search engines with relevant search terms and then accessed on applicable websites.

CONTRIBUTIONS

Contributions

Peter Eves –  2nd year medical student from  Bangor, County Down

Group leader; background readings; medicine in the future; conclusion.

Esther McNeill- 2nd year medical student from Ballyclare, County Antrim

Background readings; attitudes to patients; conclusion; images.

Sarah MacInnes-  2nd year medical student from South Uist, Western Isles

Background readings; ethics; website design.

Jess Woods – 2nd year medical student from Stockport, Greater Manchester

Background readings; power; introduction.

Dominic Cryans- 2nd year medical student from Bellshill, North Lanarkshire

Background readings; trust in capabilities; referencing.

Robbie Miller- 2nd year medical student from Ayr, Ayrshire

Background readings; motivation; acknowledgements; contributions; information search report.

WEEKLY DIARY

Each week the group read different novels, short stories and excerpts relating to a pre-conceived topic for that session. During the sessions we discussed our opinions and thoughts on the texts as well as the theme for that week.

21/01/15

The Elephant Man: Dramatic interpretations and medical narratives

· ‘Words for Elephant Man’, Kenneth Sherman

· ‘The Elephant Man and Other Reminiscences’, Frederick Treves

· ‘The Elephant Man’, Bernard Pomerance

Texts as bodies/Bodies as texts

· ‘Speech Begins after Death’, Michel Foucault

· ‘Of Medicine and Poetry’, William Carlos Williams

· ‘The Death of the Author’, Roland Barthes

29/01/15 Physician’s Experience

· ‘A Country Doctor’s Notebook’, Mikhail Bulgakov;

· ‘The Surgeon at 2a.m.’, Sylvia Plath;

· ‘The Practice’, William Carlos Williams;

· excerpts from ‘Hallucinations’, Oliver Sacks

4/02/15 The Frankenstein Legacy

· ‘Poor Things’, Alasdair Gray

· ‘Frankenstein’, Mary Shelley

11/02/15 Medicine and Power

· ‘The System of Doctor Tarr and Professor Feather’, E.A.Poe

· excerpts from ‘The Fifth Child’, Doris Lessings

· ‘The Case of Lady Sannox’, Arthur Conan Doyle

18/02/15 The (In)Ethical Doctor

· ‘Woyzeck’, Georg Büchner

· ‘Blue Afternoon’, William Boyd

25/02/15 It Could Be You

· ‘Darkness’ and ‘It Could be You’, Daryl Cunningham

· ‘Depression pts 1 & 2’, Allie Broche

· ‘Hell’ from Strindberg’s ‘Inferno’

· Strindberg and Helium videos

· ‘4:48 Psychosis’, Sarah Kane

· excerpts from ‘Hamlet’, William Shakespeare

4/03/15 Cultures and Epidemics

· ‘Angels in America’, Tony Kushner

· ‘Love on Trial’, Stanley Kenani

11/03/15 Futures of Medicine

· ‘The Stone Gods’, Jeanette Winterson

· ‘A Number’, Caryl Churchill

19/03/15 ‘Empire Antarctica’ – Gavin Francis

REFERENCES

Boyd, William. The Blue Afternoon. London: Penguin, 1994. Print.

Boyd, William. The Blue Afternoon. New York: Knopf, 1995. Print.

Bulgakov, Mikhail, and Hugh A Aplin. A Young Doctor’s Notebook. Richmond, Surrey: Oneworld Classics, 2011. Print.

Bulgakov, Mikhail, and Michael Glenny. A Country Doctor’s Notebook. London: The Harvill Press, 1995. Print.

Büchner, Georg. Woyzeck. London: Eyre Methuen, 1979. Print.

Churchill, Caryl. Plays Four. London: Nick Hern, 2008. Print. 161 -206

Doyle, Arthur Conan. The Case of Lady Sannox- Round The Red Lamp. Freeport, N.Y.: Books for Libraries Press, 1969. Print.

Gallacher, James. ‘UK Approves Three-Person Babies’. BBC News. N.p., 2015. Web. 19 Mar. 2015.

Gray, Alasdair. Poor Things. New York: Harcourt Brace Jovanovich, 1992. Print.

Kushner, Tony. Angels In America. New York: Theatre Communications Group, 1993. Print.

Lessing, Doris. The Fifth Child. New York: Knopf, 1988. Print.

Parsons, Talcott. ‘Illness And The Role Of The Physician: A Sociological Perspective’. American Journal of Orthopsychiatry 21.3 (1951): 452-460.

Plath, Sylvia. Crossing The Water. New York: Harper & Row, 1971. Print.

Poe, Edgar Allan. Comic Tales Of Edgar Allan Poe. Edinburgh: Canongate Pub., 1973. Print.

Shelley, Mary Wollstonecraft. Frankenstein. Charlottesville, Va.: University of Virginia Library, 1996. Print.

Sokol, D. K. ‘Law, Ethics, And The Duty Of Care’. BMJ 345.oct10 1 (2012): e6804-e6804. Web. 12 Mar. 2015. http://www.bmj.com/content/345/bmj.e6804?hwshib2=authn%3A1426532729%3A20150315%253Aab3a6b1e-c239-441e-ace2-a63b0eaef5b9%3A0%3A0%3A0%3AB122dt0uQjiBcpAJWz%2FRNg%3D%3D

Treves, Frederick. The Elephant Man And Other Reminiscences. London: Cassell, 1923. Print.

Williams, William Carlos. The Practice- The Autobiography of William Carlos Williams. Print.

Winterson, Jeanette. The Stone Gods. Orlando: Harcourt, 2007. Print.