Today was a difficult day: thoughts on being useful

Today has been- to use popular management speak- challenging. Today was one of those days when, in spite of twenty-two years as a doctor, I find myself distressed at the suffering that I’ve encountered. And I’m left wondering how to find the right balance between being useful, of use to my patients, and still being able and willing to keep within sight of the blood.

My work as a family doctor rarely, of course, has much to do with blood in the literal sense. Instead my colourful language pays homage to Anton Chekhov’s Ward No. 6 and to Ian McEwan’s Saturday. More precisely to two extracts from these medical stories (reproduced below) which I’ve used with doctors to explore with them their thoughts on what it might mean to be a virtuous doctor.  

“People who have an official, professional relation to other men’s sufferings- for instance, judges, police officers, doctors- in course of time, through habit, grow so callous that they cannot, even if they wish it, take any but a formal attitude to their clients; in this respect they are not different from the peasant who slaughters sheep and calves in the back-yard, and does not notice the blood.”

Anton Chekhov: Ward No. 6

“As for the rest of the week, the two morning clinics made no more demand than usual. He’s too experienced to be touched by the varieties of distress he encounters- his obligation is to be useful.” 

Ian McEwan: Saturday

I want to know whether doctors are indeed obliged to be useful, whether they are obliged to be anything other than useful, and if so what and why. 

And I want to know if it’s true that doctors “through habit, grow so callous that they cannot, even if they wish it, take any but a formal attitude to their clients”? And whether this is inevitable / a good thing/ necessary/ avoidable or what?

If it isn’t inevitable, if it isn’t necessary, then I want to know what is it that makes a doctor able or willing to “notice the blood”? And how they can learn to stop noticing when- at least for a while- not noticing is necessary in order for them to continue to be useful.

These questions are, in the end, simply novel ways of posing an old and familiar question: whether being a good doctor is the same as being a virtuous one, and if not, do the two at least share some common ground?  

Because when it comes down to it, you and I- the universal you and I who will, inevitably, one day be patients-need to decide what kind of person we want our doctor to be: the kind who is simply useful or the kind whose usefulness, from time to time, is tempered by the impact of noticing the blood? 

Today was a challenging day. I noticed the blood. The human suffering of my patients and of their mothers and wives got through my calloused medical skin, absorbing my thoughts and, perhaps, temporarily, affecting my ability to be useful in the many different ways that life demands.  Tomorrow is another day. And having noticed the blood, and having seen the wounds, I will do my best to help tend them. I hope I will manage to be of some use.


  • Julie Solomon

    Surely you have to define what is meant by ‘useful’ before you can begin to respond to the question. Perhaps you’re being useful simply by noticing the blood in the first place – so much goes on within a patient, hidden from the world, that the sheer act of noticing must go some way towards being useful to them. The callousness that develops in many of those who have “an official, professional relation to other men’s sufferings” is their own protection – without it, they might have to stop being useful at all. Is there virtue in omission of this kind? Or is it worse to be partly useful than not useful at all?


    The challenge that you point out is obviously a personal insigth that we must manage everyday as long as our professional life goes along. We certainty have this struggle between caring for our patients in balance as for the caring we need for ourselves. The balance should mean happiness and “meaning”.
    It is very difficult for a Doctor not to be useful, at least when is trained for doing things. On the other hand, even is he can’t, she must share his own time with the sick, and by giving to “his hidden dimension of illness: the human suffering, “some meaning” , she will find her meaning.(As Patricia Starck remind us).