GP AND AUTHOR
Many readers instantly associate Sir Arthur Conan Doyle with his literary genius in creating the fictional detective duo Sherlock Holmes and Dr Watson. Yet, delving more deeply, he practised as an apothecary and GP in Portsmouth and Plymouth, over a century ago (1882–1890). Around this time, he penned three short stories, Crabbe’s Practice1 (1884), Round the Red Lamp2 (1894), and The Stark Munro Letters3 (1895). These medical tales paint a vivid picture of general practice in the 19th century and contain many insightful and poignant quotes about GPs, illness, reflective practice, and portfolios, which have numerous consonances for the modern day GP:
‘And a doctor has very much to be thankful for. His patients are his friends — or they should be so. He goes from house to house, his step and voice are loved and welcomed in each. What could a man ask for more than that? It is a noble, generous, kindly profession, and you youngsters have got to see that it remains so’.3
With a contemporary viewpoint, Conan Doyle’s narrative explains that ‘Dr Winter is of more avail than all the drugs in his surgery’,2 because of his ‘healing touch — that magnetic thing which defies explanation or analysis. His mere presence leaves the patient with more hopefulness and vitality’.2 Interestingly, this pre-dates Balint’s phrase ‘The doctor is the drug’,4 that was coined in 1957.
Conan Doyle predicted that ‘preventative medicine will develop until old age shall become the sole cause of death’.2 Sadly this remains unrealised, yet GPs currently have increasing responsibilities for health promotion, in addition to diagnosis, treatment, and management.
Euphemisms pervaded mental health: ‘The heir to the estate was struck down by the sun while fishing without his hat. His mind has never recovered from the shock’.2 He has a ‘chronic state of moody sullenness which breaks out into violent mania’.2 Even the stigma of alcoholism and sexually transmitted infections linger to this day, though chlamydia and HIV have replaced syphilis. In a short, cryptic story entitled The Third Generation, Conan Doyle actively colludes to omit the taboo diagnosis of congenital syphilis, concluding that:
‘... at the end of a third generation what has happened? The line of the drunkard and debauchee, physically as well as morally weakened, is either extinct or on the way towards it and the average of the race is thereby improved’.3
Unfortunately, these ethical echoes of the past still resonate deafeningly nowadays.
He acknowledges that:
‘... it is hard for the general practitioner who sits among his patients both morning and evening, and sees them in their homes between, to steal time for one little daily breath of cleanly air’.2
‘When a man is up to his neck in practice, he has not time to gratify his private curiosity. Things shoot across him and he gets a glimpse of them, only to recall them, perhaps, at some quiet moment [of reflection].’ 3
‘... there are times when one feels that something is wrong. I’ve seen some sad things in my life’.2
These observations are as true today as when they were written.
Finally, when developing a portfolio:
‘... inspire respect. Be friendly, genial, and convivial — but preserve the tone and bearing of a gentleman. If you can make yourself respected and liked you will find every club and society that you join a fresh introduction to practice. Literary, debating, political, social, athletic, every one of them is a tool to your hand … I joined this. I joined that. I pushed in every direction. I took up athletics again much to the advantage of my health, and found that the practice benefited as well as I. Do not grudge labour where the return may be remote and indirect. Those are the rungs up which one climbs’.3
THE INSPIRATIONAL PORTFOLIO GP
Seeing the past and predicted future through Conan Doyle’s eyes, shows that much has changed, yet much remains the same. His historical, challenging and inspirational reflections are as fresh and relevant nowadays, as when they were written.
In the 21st century, every GP can rise to the challenges of maintaining high standards of healthcare cum scientia caritas, because:
‘... a properly balanced man can do anything he sets his hand to’, ‘he’s got every possible quality inside him, and all he wants is the will to develop it’.3
Through continual professional development, current GPs and tomorrow’s doctors can pursue excellence, by applying his very simple advice: ‘Do your best. Hang the rest!’5
- © British Journal of General Practice 2013