Images of doctors

Jane Smith, deputy editor, BMJ
jsmith@bmj.com
What picture of doctors emerges from this week’s journal? Forget the news stories—which have the usual fare of doctors up before the GMC (doi:10.1136/bmj.c4194), being investigated for conflicts of interest (doi:10.1136/bmj.c4083), and defending themselves and their patients against various sorts of bureaucracy (doi:10.1136/bmj.c4168). Look instead at the rest of the journal. Here is a succession of images of doctors as people who think completely differently from their patients; are part of the problem when it comes to social inequality; are susceptible to moral deformation through the pursuit of ambition; yet talk to each other across a big divide.
Not surprisingly, most of these images come from the review pages. They start with Christopher Martyn’s funny review of Tim Parks’s book, Teach us to Sit Still: A Sceptic’s Search for Health and Healing (doi:10.1136/bmj.c4213). Martyn clearly doesn’t enjoy the book, which is about the author’s search for treatment and acceptance of his prostate pain, and he doesn’t think his readers will: "Obviously this book wasn’t written for doctors, and I’m doubtful whether they will enjoy it much." Yet his review is a fine example of why it is good to do something you wouldn’t normally do—it usually opens your eyes in a new way. And so it is with this book. Martyn suggests that the book’s moral is that "intelligent, educated, and apparently rational people may think about their health and illnesses in ways that hardly begin to overlap with ours."
Christopher Martyn would probably not have read Tim Parks’s book if he hadn’t been asked by the BMJ’s reviews editor, but Robin Stott seems to have willingly read the two books that he reviewed (doi:10.1136/bmj.4155). Their subject is social inequalities and why these have grown so dramatically since the 1950s in Anglo-Saxon societies. "Both authors believe that many people in society’s privileged sectors hold such views [that the poor are less able, the children of the rich more worthy recipients of the best university education]. Thus the everyday life of communities entrench the inequalities, making it ever more difficult to reverse them." Stott bemoans the fact that the health professions have offered no leadership and "in our own lifestyles and choices we often perpetuate or even aggravate inequality."
The protagonist of Shusako Endo’s novel, The Sea and Poison, makes some very wrong choices. As Theodore Dalrymple explains, the novel is about a young doctor in wartime Japan who "through being too weak to refuse, takes part in a murderous experiment on an American prisoner" (doi:10.1136/bmj.c4152). It was published in 1958, before the scale of experimentation on prisoners was well known. "Most of the doctors . . . are motivated by ambition and are discomfited not by their conscience but only by the prospect of exposure and disgrace."
Doctors are somewhat redeemed in the first of our occasional series of "dialogues" on difficult subjects (doi:10.1136/bmj.c3081). Tony Waterston, a British paediatrician, facilitated an email discussion between Jumana Odeh from Palestine and Mark Clarfield from Israel on cooperation between Israeli and Palestinian doctors. Clarfield is an optimist about what such collaboration can achieve. Odeh, while acknowledging the usefulness of individual actions, is more pessimistic about a dialogue over health that ignores the political situation. I was reminded of Christopher Martyn’s earlier words: these two "think about . . health and illnesses in ways that hardly begin to overlap."
Cite this as: BMJ 2010;341:c4219