Practising Medicine (being a doctor)

Medicine is the compassionate act of caring while using appropriate knowledge, skills and attitudes. At the heart of this is the relationship between doctor and patient. (see resources page for doctor & patient)

The practice of medicine is often described as an art.

Patients and doctors are both human. Both need to show and be shown compassion.

Medical knowledge is important, but it needs to be based on good science, kept up to date, and used in the context of the patient’s life.

Doctors need to understand how they and their patients make decisions and what influences this process.

Medicine is bigger than the individual doctor-patient relationship. Doctors need to be aware of the role community and society especially inequality play in patients’ health and well-being.

The resources on this page focus on the work and life of doctors. We can use these resources to learn about different medical specialities, explore how the role of the doctor is portrayed in art and consider how this contrasts with our own experience of working in medicine and contemporary professional standards.

To further explore the doctor-patient relationship look at the resources in the next section of the website.

Books

Many clinicians write stories about their medical work. Some are shared, published and made into films or TV dramas and because the stories are entertaining and informative they appeal to a large audience. Some stories highlight the challenges doctors face in their day-to-day work while others provide humorous anecdotes: all become part of the historical record of medical care.

Why do you think that doctors write about their experiences of work?

Have you ever written a story or poem about being a doctor?

What stories have you read or watched that feature a doctor at work? Can you relate to the author or character’s perspective?  Have they helped you in your medical career?

Photo of John Launer's Book

Most of the book suggestions on this page I have read and used in teaching.

These first suggestions are books written by doctors about their experience of work:

  • Some Lives, A GP’s East End  David Widgery (GP – An account of working as a GP in the East End, the book is still relevant) 1992
  • Being Mortal, Illness, Medicine and What Matters in the End Atwul Gawande (American Surgeon – he explores the opinion that medical care should focus more on wellbeing than survival rates) 2014
  • Do No Harm Henry Marsh (Neurosurgeon) 2016
  • In the Bone Setters Waiting Room Aarathi Prasad (Travels through Indian medicine) 2016
  • This is Going to Hurt  Adam Kay (Junior Doctor) 2017
  • Your Life in My Hands  Rachel Clarke (Junior Doctor) 2017
  • Letter to a Young Female Physician Suzanne Koven (Secondary Care doctor) 2017
  • How not to be a doctor  John Launer (GP A collection of fifty of John Launer’s essays that have been featured in his medical columns. As it says in his introduction, they set out an argument that being a doctor- a real doctor- should mean being able to draw on every aspect of yourself, your interests and your experiences, however remote these may seem from the medical task of the moment. The book reinforces how much we learn from stories) 2019
  • Dear Life Rachel Clarke (Palliative Care Specialist) 2020
  • Everything is True A junior doctor’s story of life, death and grief in a pandemic Roopa Rarooki (Junior Doctor) 2022

These books have been recommended to me:

  • Fragile Lives Stephen Westerby (Heart Surgeon) 2017
  • Unnatural Causes  Richard Shepherd (Forensic Pathologist) 2018

In the last ten years, many more books have been published by doctors about their work in a wide range of specialities.  Many have found they have a writing talent and have published more than once. This genre of books is often reviewed in medical journals or The Guardian, so keep an eye out for new work. 

Non-fiction stories about doctors and medicine by non-medical authors:

  • A Fortunate Man The Story of a Country Doctor John Berger (1996)
  • A Fortunate Woman, A Country Doctor’s Story Polly Morland (2023)

Fiction Stories about being a doctor or whom the protagonist is a doctor

  • The Doctor’s Dilemma (a play) George Bernard Shaw (the play explores the moral dilemmas created by limited medical resources and the conflicts between private medicine as a business and a vocation) 1906
  • A Country Doctor’s Notebook Bulgakov 1925
  • The Citadel A J Cronin (About general practice)(reviewed below) 1937
  • Cancer Ward Alexander Solzhenitsyn 1966
  • The House of God Samuel Shem (pages 170-171 recommended as a teaching resource) 1978
  • Saturday Ian McEwan (The main character is a neurosurgeon) 2005

What have you read that you might recommend?

Reviews

This is going to hurt Review by a second-year medical student.

The Citadel A J Cronin  (Also dramatised in film and for Radio 4)

The Citadel follows the life of Dr Manson who as a newly qualified doctor starts his working life in a small Welsh mining town. Manson’s medical training has not prepared him to cope with the role of GP, anaesthetist, surgeon, obstetrician, and public health doctor working in an isolated rural community. Manson is very critical of the system in which he is required to work, the poor collaboration between colleagues and the lack of incentive for doctors to keep up to date.

Of his colleagues Manson writes, ‘as it was, they had no unity no sense of cooperation and little friendliness amongst themselves. They were simply set up, one against the other, in the ordinary competitive way existing in General Practice all over the country, each trying to secure as many patients for himself as he could. Downright suspicion and bad feeling were often the result.’

Manson worked for a voluntary contribution medical association which is based on the Tredegar Medical Aid Society and which in due course became the inspiration for the National Health Service as established under Aneurin Bevan.

Cronin was a doctor and much of this story is drawn from his own experiences. He eloquently explores the ethical challenges and moral dilemmas faced by Manson. Much of his commentary is currently topical and relevant to practising medicine in the 21st century.

Film, TV and Drama

This is a useful article – Mad scientists, compassionate healers, and greedy egotists: the portrayal of physicians in the movies.

I’ve watched these films/dramas and all are useful resources for teaching:

  • Carry on Doctor 1970’s TV drama with some good clips showing how ‘not to be a caring doctor’! especially the one on YouTube called ‘The Bleeding Time’
  • Cardiac Arrest 1990’s BBC Drama Series
  • Patch Adams 1998 (Clips can be viewed on YouTube)
  • Mr Bean is a Doctor 1990s Can be viewed on YouTube
  • Wit Film 1999 (recommended scene: the surgeon informs the main character of her diagnosis. This can be viewed on YouTube)
  • Doc Martin  2004 ITV Drama
  • Doctor Foster 2015 TV Drama
  • This is going to hurt 2022 BBC Dramatisation of Adam Kay’s book 
  • Unforgotten Love 2023 Polish Netflix Film

These films and dramas have been recommended to me by other doctors:

  • The Doctor 1991 (A recommended scene to use in education is when the surgeon invites his students to undergo the investigations they order for their patients)

Do you have any recommendations?

Women have been allowed to study medicine since 1876 and now make up more than 50% of medical school student, despite this they remain underrepresented in the role of a doctor in all art but particularly film and dramas.

In a recent study looking at movies produced between 1990-2020 that referenced doctors in their plot summaries, keywords and credits only 18% of characters that were doctors were women. (Link to article)

Poems

My favourite poetry book about practising medicine is this one by Glenn Colquhoun. It’s a great resource for teaching. The poem reproduced below usually provokes a good discussion and may persuade you to buy his book.

Did you know that the poetry anthology Tools of the Trade: Poems for new doctors (Scottish Poetry Library) has been given to all graduating doctors in Scotland since 2014?

There are also some great poetry collections on the NHS page of this website. 

Pictures

BMJ cover

The front cover of this BMJ asks a prime question.

The cover could be used to prompt discussion as could these pictures of doctors painted by famous artists.

Portrait of Dr Gachet Van Gogh 1890 Image in Public Domain
Picture from 1865 of female physician
Licence: Public Domain Mark Credit: A woman doctor is taking the pulse of a male patient seated in an armchair. Wood engraving after G. Du Maurier, 1865. Wellcome Collection. Source: Wellcome Collection.
The Extraction of the Stone of Madness BOSCH, HIERONYMUS Copyright ©Museo Nacional del Prado Reproduced under educational license

This painting by Bosch is a good resource for discussing the ethical aspects of practising medicine. 

What is the man with the funnel on his head doing? Is he a doctor or a charlatan?

In the 15th Century, it was not uncommon for individuals suffering from a learning disability or mental health problem like psychosis to have their skull trephined supposedly to allow the evil spirit (stone of madness) to leave the body. The practice was barbaric and usually resulted in the patient’s death. Bosch painted this picture as an allegory. He is making fun of the ‘doctor’ by depicting him wearing a funnel, implying that this is not the practice of science but of deception and that the doctor is only motivated by money. The other objects in the picture have symbolic meanings – think what these might be before you ‘Google’ the answers.

Other suggestions to view on the internet or at the gallery where they are displayed.

  • The Three Oncologists Ken Currie (on display at The Scottish National Portrait Gallery – linked here)
  • The Healer Magritte
  • The Hospital Drawings Barbara Hepworth (Usually on display at The Hepworth in Wakefield)
  • The amazing Graphic art of Ian Williams

See the next page ‘Doctor and Patient’ for more suggestions including The Doctor by Sir Luke Fildes, probably the most famous image of a doctor in Western art.

What other images of doctors in paintings/sculpture and photography interest you, and why?

What sort of doctor does your patient see when they look at you?

How do you want to appear?

Take a moment to look at a photo of you at work, or draw a picture of yourself as you would like to be seen.

Additional suggestions

The aim of this website is to share art resources but I would also like to mention a few knowledge based non fiction books that have helped my medical practice.   

For further inspiration look at The Doctors Bookshelf, a great blog about books for doctors, mostly non-fiction.

Also Human The Inner Lives of Doctors Caroline Elton 2018

Dr Caroline Elton is a psychologist, who for over 20 years has listened to doctors talk about the impact their work has had on their lives. She uses her knowledge to examine the experience of working as a doctor in 21st-century medicine.

The Daily Mail reviewed Elton’s book and said, ‘Doctors are people, too. They possess the same virtues, faults, fears and desires as the rest of us but it’s easy for patients to forget this obvious truth, Caroline Elton’s revelatory book is a welcome reminder of this.

Adventures in Human Being Gavin Francis 2015 Published by Profile Books

Francis’s book is set out in chapters relating to each part of the body. He combines historical facts, literary references, medical knowledge and personal anecdote to bring to life the disease processes and illnesses that affect the health of patients. In his introduction, Francis writes, ‘the practice of medicine is not just a journey through the parts of the body and the stories of others, but an exploration of life possibilities an adventure in human being.’

The book enables the reader to take a step back and view each part of the body as a component of the larger whole. The book has several historically interesting black-and-white pictures.

Paradox of Progress James Willis 1995

Although this was written in the 1990s when GPs still wrote in Lloyd George paper records and did their own on-call this book still has a lot to offer any doctor. It describes the importance of the role of both the specialist and the generalist. The paradox Willis describes is that technological change and progress are not always associated with improved health care. Download this book for free on the author’s website.

Bad Pharma  Ben Goldacre 2012

Ben Goldacre is a doctor, science writer and  a Senior Clinical Research Fellow at the Centre for Evidence-Based Medicine, part of the University of Oxford

His work unpicks the evidence behind claims from journalists, drug companies, politicians and quacks and was published by the Guardian under his hugely successful column  ‘Bad Science’. This work led to the publication of his first book ‘Bad Science’. The evidence and debate in his second book, Bad Pharma provided the impetus for Parliament to review the role of drug companies in research.

The text on the back of Goldacre’s book says, ‘Warning; the pharmaceutical industry has serious side-effects. Doctors and patients need good scientific evidence to make informed decisions. But companies bury unflattering data, while regulators stand by, and doctors are misled by needlessly flawed research. Patients are harmed as a result.’ Goldacre’s book shows that the problems he has identified can be fixed.

You can read more about his work on his website badscience.net

Thinking, Fast and Slow Daniel Kahneman 2011

Kahneman is an Israeli American psychologist who is renowned for his work on the psychology of decision-making and judgement. He was awarded the Nobel Prize in Economic Sciences for his work in behavioural economics in 2002. His work challenges the assumption that humans are generally rational and their thinking logical.

Thinking, Fast and Slow is to be commended for both its broad-reaching scope and the simplicity of language used to describe complex psychological models. The book discusses the way in which humans make decisions and how the decision-making process is prone to influence by internal and external factors such as anchoring, priming, hindsight bias and loss aversion. Kahneman’s description of type one and type two is a concept that every doctor should be aware of. The book also contains many useful thought experiments which help the reader understand how behavioural economics can be applied to our everyday lives.

Expert by Roger Kneebone 2020

A very good review in the Guardian

Page created 2019

Updated January 2024