What is it like to become a doctor? What do you have to go through to be the person who handles sick bodies, who makes life-and-death decisions, who labours in a system with unyielding demands, who daily faces the emotional and physical traumas of others, and who at the same time must make a positive impression on both patients and colleagues? This book is about what becomes of the person who becomes a doctor. It describes one individual’s experience, from 1966 onwards, of being gradually transformed from a nervous student into a professorial physician. The book is not a memoir in the ordinary sense, being less concerned with what the author did than with what education and medical practice did to him.
Each of the book’s chapters focuses on a theme, creating a narrative that is roughly chronological, beginning with the perspectives of a junior medical student and ending with reflections on a doctor’s two major ‘crafts’: diagnosis and treatment. In reflecting on a particular span of years, the book’s story is in constant conversation with its historical context, which is a dimension that medical orthodoxy scarcely notices. Reflections are shadowed by theory, but this is not an analytical essay, driving towards specific conclusions and prescriptions. It is a piece of provocative and entertaining literature about experiences and dilemmas that mater to everyone.
A doctor’s education looks at first sight like a straightforward technical training, but ‘re-membering’ it as a personal experience creates a new and disturbing picture, a blend of joys, absurdities and frustrations. The author observes his younger self’s efforts to communicate and to regulate feelings in the prescribed way and begins to see that to become a doctor is to be at the mercy of almost irresistible pressures. He picks up habits by mimicking the teachers, with sometimes disastrous results. He is vulnerable to the power of medicine’s rhetoric and feels the need to be ‘the right stuff’. Communication, and even empathy, are made to seem like performances in which the doctor’s self need play no part. Any other way of being a doctor is unimaginable.
Hospital medicine figures in the book as a loveable yet limited universe. Doctors in the 1960s, as now, were focused on disease and had little to say about suffering, let alone death. They were, and still are, curiously silent about healing, recovery and rehabilitation. From within the hospital, people’s ordinary lives were invisible. Medicine’s hold on a young doctor’s imagination makes it difficult to develop a coherent concept of human nature. For their own purposes, psychiatrists, psychologists, neurologists and general physicians and surgeons create deceptive boundaries that few patients would want. Neurologists appear to be technicians of the brain, psychiatrists of the mind and other doctors of the body.