The Doctor's Dilemma by George Bernard Shaw. Penguin, £7.99, pp 192. ISBN 0140450270
George Bernard Shaw, in The Doctor's Dilemma (1911), both undermines and reinforces a rounded view of the good doctor. The play introduces one character, Sir Ralph Bloomfield Bonington—“cheering, reassuring, healing by the mere incompatibility of disease or anxiety with his welcome presence. Even broken bones, it is said, have been known to unite at the sound of his voice.” Sir Ralph (known as BB) is kindly but sadly deficient in medical knowledge. The play's physician protagonist, Sir Colenso Ridgeon, is able to murder the husband of the woman he desires to wed simply by referring him to BB for antituberculosis treatment. If BB gives the mistaken impression that one can have competence or beside manner but never both, Shaw sets the reader straight in his preface. He makes clear, by savagely attacking their absence, that both scientific acumen and compassion are necessary qualities of the good doctor. Shaw includes under “science” both a clear understanding of biological mechanisms and the statistical study of outcomes, placing him in synchrony with today's evidence based medicine. He also devotes nearly a quarter of his preface to attacking vivisection because he thinks that a profession that would justify the torture of animals cannot be trusted to treat humans compassionately.
Shaw sees huge deficiencies in both science and compassion in the medical practice of his day, but he does not blame doctors. Good doctors must practise within a good system, free of perverse incentives that push “wildly beyond the ascertained strain which human nature will bear.” A good doctor would tell the idle rich patient that he needs for good health not a bottle of medicine but (Shaw quotes Dr John Abernethy, 1764-1831) to “live on sixpence a day and earn it.” A good doctor would tell the poor patient that she needs for good health not a bottle of medicine but decent housing, clothing, and food, good air to breathe, and a host of other things she is quite unable to obtain. In both cases, doctors who are paid for providing drugs and who must compete with their fellows to attract patients would soon face poverty if they gave sound advice. Besides the poverty that affected a good portion of the profession in the early 1900s, Shaw saw as inhumane the demands on the doctor to be available for emergencies at all hours of day or night. Shaw's solution was a government financed system in which doctors were paid a salary to promote prevention and public health.
Returning today, Shaw might be pleased with how we had solved the problems of doctors' poverty and working hours. He might argue that we still have a long way to go in the science and compassion line—especially because he thought that a truly scientific and compassionate attitude would naturally breed humility, a virtue he might find in as short supply in today's medicine as in his own time.