John Launer - How not to be a doctor: and other essays

This edition first published in the United States and the United Kingdom in 2018
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2018 John Launer

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EISBN 978-1-4683-1632-2

When I teach groups of other doctors, one of my favourite exercises to make people feel comfortable at the beginning of the day is to ask everyone to say what job they would have done if they hadnt chosen medicine. The answers are always surprising, and sometimes moving. For example, an anaesthetist may reveal she would have liked to be an opera singer. A surgeon discloses an alter ego as a deep-sea diver. Psychiatrists speak of wanting to be foresters, pilots or dancers. Family physicians general practitioners name every job under the sun.

Two things are striking about these revelations. One is the passion with which they are made. In some cases there is wistfulness or regret about the road never taken. But quite often, doctors will say with pride that they have still managed to pursue these interests in one way or another, in spite of the pressures of a medical career. Being a doctor does not stop you from following any of these interests, nor indeed from playing the cello, acting in plays, painting in oils, translating novels from Japanese, keeping bees, or just about anything you can think of. Still less does it prevent you being a parent, lover, partner, carer, dreamer or indeed practically anything. Not only that, but every one of these roles and activities enriches being a doctor, whether or not your patients ever learn about them.

The essays here are all reflections, in one way or another, on the art, practice or teaching of medicine. Taken together, 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. I wrote them while combining several different medical and non-medical roles myself: as a general practitioner in a run-down area of London, as a therapist and tutor in a prestigious mental health institute, as an educator specialising in consultation and supervision skills, and as an author, husband and a parent of twins. The book bears the traces of all these identities, along with my own previous profession as an English teacher. It also covers topics from some of my lifelong passions, including literature, poetry, religion, psychology, art, history, travel and evolution. The essays originated in popular columns that I wrote in two medical journals over several years but are adapted here for general readers. (Where I have based an essay on other published articles or books, these are listed under Further Reading at the end of the book.) Some of the pieces are contemplative in tone, others are polemical, humorous, educational, fantastical, satirical or deadly serious. All serve the purpose of illustrating how nothing is really extraneous to medicine, nor medicine from anything else.

The first essay in the collection is called How Not To Be A Doctor and has given the book its title. It is intended to be ironic, as the essay itself explains. It illustrates how being authentic as a doctor may mean behaving in ways you were never taught, or have seen other doctors behave, but by using intuition and spontaneity. Most of all, it means drawing on what your patients bring you directly most especially their words and stories. Patients need relief from suffering, but very often that relief comes through telling their stories, as many of the essays describe (with details altered to preserve anonymity). Doctors need to be able to hear those stories, to help people make sense of them and, wherever possible, consider how different stories might be possible. Some doctors achieve dramatic outcomes simply by being deeply knowledgeable and technically skilled. More often, I think, we succeed in our work by letting go of the habit of trying to fix everything, or fit it into categories, and instead by listening to peoples stories, questioning these thoughtfully, and noticing how often things will right themselves with a little active help or even with none at all. It is a message I try to illustrate in these pages.

Another message is that we need to be able to tell our own stories as doctors too to speak about our experiences with colleagues or, as I have done here, to set them down in writing so we can understand them better and carry on developing as practitioners. Some of the essays here literally take the form of short stories, either imaginary or autobiographical. They include accounts of when I have been a patient myself, including some episodes of illness that were life-threatening. Being a patient who is a doctor is never quite the same as being a non-medical patient, but every doctor who has gone through major illness knows how it brings more depth to the experience of practising medicine and teaching others to do so.

Throughout the book, I try to convey what practising medicine is like when you look at it as a whole person and not just as a doctor, and how different the work can be from what people imagine: more complex and contradictory, full of unexpected learning, puzzles and humour, and altogether much closer to the arts, humanities and the whole range of other human endeavours than is ever usually recognised.

A doctors world is laid bare in this revealing, entertaining, and moving collection of short essays, providing a distinctive and surprising perspective on the medical field, for both doctors and patients alike. Doctor and popular medical columnist John Launer has written on the practice and teaching of medicine for many years; now, more than fifty of his essays are collected here.

The essays range from How Not to Be A Doctor, an ironic piece illustrating how being authentic as a doctor may mean behaving in ways not taught in medical school, to a story of the imagined conversation between two prehistoric doctors on the primitive diet, to the authors poignant account of being a patient himself as he received treatment for a life-threatening illness. Some take the form of short stories, either imaginary or autobiographical, and some are contemplative in tone, while others are polemical, humorous, educational, fantastical, satirical, or dead serious. They cover a range of topics including music, poetry, literature, and psychoanalysis, as well as contemporary medical politics and the personal experiences of being a doctor.

From the absurd to the profound, the pieces in How Not to Be a Doctor combine erudition with humor, candor, and the human touch to inform and entertain readers on both sides of the stethoscope.