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The Reading Room: A review of ‘Medical Humanities & Medical Education: How the Medical Humanities can Shape Better Doctors’

14 Oct, 15 | by cquigley



Medical Humanities & Medical Education: How the Medical Humanities can Shape Better Doctors

by Alan Bleakley. Published by Routledge, 2015.

Reviewed by Dr Claire Elliott

How can medical education be changed to produce better, kinder medical students? How can they develop more astute clinical skills and improved awareness of the ethical and professional aspects of caring for and treating patients? In this book, Alan Bleakley argues for the democratisation of medical education – with integration of medical humanities as a core discipline – to help effect this change. He argues powerfully for a ‘critical medical humanities’ to be integrated into the medical curriculum in order to challenge the existing culture of medicine, which he feels breeds what he calls ‘insensibility’ and ‘insensitivity’.

Bleakley describes insensibility as the dullness to perception or blunting of close observation by clinicians. He feels that, for example, the decrease in physical observation and clinical examination in the consultation causes the loss of sensibility. He notes that there is a trend for medical students and doctors to request more investigations such as laboratory tests, x-rays and scans and subsequently their skills for ‘hands on’ examination of patients decrease. Indeed, the longer you are at medical school, the greater the lack of sensibility. He distinguishes this from insensitivity, which he describes as a way in which medicine (as currently taught and practiced) can lead to a lack of awareness or ability to be open to the experiences of peers and patients. Clinicians witness suffering all the time, but Bleakley notices that our current practice of medicine enables or encourages us not to see it.

Bleakley gives us a comprehensive view of the origins and growth of medical humanities in North America, UK and internationally. He observes that we have moved on from the exciting first wave of a new discipline to a more discerning and sophisticated second wave. He provides a full and detailed discussion of the choice of the name ‘medical humanities’, suggesting perhaps that it should be called ‘health humanities’. He argues for a critical medical humanities to reshape clinical thinking and practice to help students improve their tolerance of ambiguity. Bleakley argues persuasively that we need a new approach to medical education to help lessen the burnout, cynicism and high suicide rates that are prevalent amongst doctors. He believes that medical humanities helps stop medical students becoming inured to their patients and can help redistribute the power of noticing by experts to all of those involved in patient care. A key part of his argument is his suggestion that medical educators can challenge existing ways of teaching and practice by seeing the work of radical performance artists such as Bob Flanagan. Flanagan, who had cystic fibrosis, made a film, Sick: The Life and Death of Bob Flanagan, Supermasochist, in which he mixed his relationship with terminal illness and his sexual pleasure from being dominated by his partner.

The need for empathy in medicine is frequently encouraged, yet Bleakley discusses some of the problems with teaching it, as it can be superficial or even disingenuous. It may be that reading fiction can help with this. However, by taking us back to Homer’s Iliad, he (with Dr Robert Marshall who co-authored this section) explores how the powerful emotions of this epic story with its tales of war and killing, the heroic and the temporary nature of life on earth, can engage us emotionally in a more genuine way than teaching empathy through communication skills.

In focussing towards goals and making diagnoses, clinicians often do not see or hear what does not fit with their models of disease. In this way, we cannot see the individuality of the patient or where he or she does not fit in with our expected patterns. This tunnel vision approach is limiting for both doctors and patients. Bleakley suggests that creativity can be gleaned from learning to experience (in contrast to learning from, or through experience). This can allow the flourishing of imagination and new ways of experiencing medicine. Bleakley explores and describes a variety of types of creativity, including collaborations between jazz musicians and surgeons to matching volunteers with chronic illness in the community with second year medical students. Bleakley (who plays the saxophone) illustrates that improvisation and creativity, as used in playing jazz, can directly contrast with the reductive, pragmatic and minimalist approach to learning medicine.

Bleakley tells us about ways in which artists and doctors can work together to enhance observational skills. This can improve the noticing that is needed for clinical acumen and for sensitivity to patients’ needs. He emphasizes the need for awareness of all the senses to improve clinical acumen and decision-making. He describes examples of where clinicians are encouraged to observe, listen, smell, and touch (skills encouraged by William Osler), and this have been shown to improve their abilities. Bleakley also examines the role of close listening to the patients’ story in his exploration of narrative in medicine. He challenges the term ‘history taking’ and suggests that ‘receiving’ would be a better term as it suggests less of a power imbalance between patient and doctor. He explores the ways in which studying narrative can help clinicians, yet also suggests ways in which it can limit expression or cause harm.

Within the context of the medicalisation of normal life, Bleakley considers the ‘normality’ of taking prescription drugs. He investigates how the powerful (such as pharmaceutical companies) create an ‘insensibility’ in the general population of the potential dangers of taking medication for conditions that could be considered within the range of normal behaviour (such as ADHD, psychological problems). He cites a variety of novels where this medicine-taking activity is integral to the life of the characters.

Finally, Bleakley considers one of the common questions from within and outside medical humanities. He asks if the impact can or should be evaluated. He proposes that there are more important issues than measurement of impact: to be a critical contrast to the science based curriculum, to help clinicians be more humane and socially aware, to reconsider the meaning of wellbeing and health, and to educate for the tolerance of ambiguity.

This book is not an anti-doctor polemic, though it does challenge the existing structures and methods in medical education and clinical practice. By proposing a new and critical medical humanities, it suggests ways in which we can subvert the status quo and produce a more observant, imaginative, kinder and resilient medical student who works within an environment where the power is more equally distributed amongst the patients, and all of those who work within health care.

The Reading Room: A review of Henry Marsh’s ‘Do No Harm’

10 Feb, 15 | by cquigley


Reviewed by Eoin Dinneen, Academic Clinical Fellow, University College London Hospital


Do No Harm is a remarkably simple book. So much so, The Guardian (the book was short listed for The Guardian ‘First Book Award’) asks, ‘Why has no one ever written a book like this before?’ Each chapter’s starting point is a real life case. The clinical and extra-curricular vignettes recited allow the reader the privilege of being a fly-on-the-wall during moments of incredible personal and professional strain, sometimes during frank disaster, and occasionally during enormous relief and hilarity. In total, the book makes up a lean, unadorned, honest memoir of just some of the emotional thrills and surgical spills from a life spent in a busy tertiary neurosurgical unit. There is no twisting, confluent, fictional, engineered storyline because the quotidian of Marsh’s operating theatres, clinic rooms and foreign trips provides a surplus of heroes and heartache to sate the appetite of even the most demanding reader, publisher or dramaturge.

Do No Harm is beautifully written. Most impressively and intimately so when Marsh is describing what a living functioning brain actually looks like. Many doctors will have encountered cadaveric specimens as medical students, but their warm, electrochemically fizzing, ‘live’ predecessors evoke true wonder, especially when the reader (or the patient for that matter) is in the hands of Marsh and his remarkable familiarity, structurally at least, with our grey matter.

The illuminating passages detailing neurosurgery are intense and intensely bright. Time seems to slow with each passing pulsation nervously noticed. Marsh describes the clean and perfect cerebral anatomy; the glistening dark purple veins, the clear liquid crystal CSF, the flashing strands of arachnoid, the smooth yellow surface of the brain and the minute bright red blood vessels. Despite repeating modestly, both in the text and in promotional work around the book’s publication, that neurosurgery is but a simple matter of thuggish hole drilling and the such, this is brain surgery. Intricate, terrifying, compelling brain surgery. The minute topography of what lies inside the human skull under the meninges sparkles and moves almost as much for the reader as we feel it continues to sparkle and dance dangerously for Marsh. When Marsh was a student at the Royal Free Hospital, the doors to the neurosurgery theatres were closed to juniors. Now at St George’s Hospital, medical students are still not allowed into the neurosurgery clinic consultation rooms. Do No Harm briefly opens the door to the world of neurosurgery, doors traditionally closed to doctors let alone to patients.

If describing the anatomy of the brain should be considered ‘home turf’ for Marsh, what is even more remarkable is the profound illumination he pours on humanity when he turns his literary attentions to his patients as people, rather than brains. Cartesian duality complexly and complicitly underpins all the surgical stories, but on a simpler level the book is rich in revelatory illustrations of the doctor-patient relationship and of plain, complicated, sometimes nonsensical human behavior itself. As a surgical trainee myself, it has often vaguely agitated the foreground of my mind during busy days how few difficult questions prospective surgical patients ask prior to their surgery. Marsh notices this discrepancy also, but with characteristic flair and simplicity born of experience he highlights that, ‘as patients we are deeply reluctant to offend a surgeon who is about to operate on us.’

Also worth noting are Marsh’s musings on modern hospital care. When caring for his own dying mother in the family home, Marsh reflects on the difference between his mother’s death and that which is afforded the vast majority of dying patients who are ‘cared’ for in hospitals, care homes, nursing homes and palliative care centres. With trademark honesty Marsh points out that hospital workers are ‘caring professionals whose caring expressions (just like mine at work) will disappear off their faces as soon as they turn away, like the smiles of hotel receptionists.’ Marsh’s uncompromising frankness to tell it how it is makes for unsettling yet categorically undeniable reading for today’s healthcare professionals. Sadly, it may ring a bell for some of our patients too.

Amidst the achingly tense surgery and desperately sad patient case histories (so tragic that when Marsh met the producers of Holby City he dissuaded them from creating a central role for a neurosurgeon because his tales were so forlorn), there is much more to be taken from this book. Do No Harm, I suspect, will come to be seen in the future as a time capsule of the NHS of 2014. Though many of the patient and surgical anecdotes are picked from the many years of Marsh’s medical career, the book is predominantly written in the current day: the 21st century NHS with all its vaunted idealism, sheer enormity, HR directives, staff diversity, exasperating IT systems and senseless inefficiencies. Yes, the NHS we know, work in and die in. Marsh’s caustic commentary of the systemic incompetence and his grumbling subversive distrust of management will of course be familiar to many, but it is here much more cleverly penned than our daily flippant, flapping volleys.

On that note, though they provide the lightest and most sardonic moments in Do No Harm, Marsh’s thoughts on modern hospital management and individual managers is (with one notable exception involving the Chief Executive in Chapter 13) quite adversarial and sometimes pithy. Marsh is not unique in this respect; in fact his attitude again captures the prevailing mood amongst his Consultant colleagues nationwide. However, in the same way that Marsh tells us how he idolized and imitated his great bosses, we junior surgeons are highly likely to follow their lead in a similar apish process. It is not at all a surprise, therefore, when popping into the Doctors Mess, or passing even the most junior of doctors chatting in the corridor, to hear them complaining bitterly about managers they have had no real recourse to come into contact with yet. One feels that Marsh writes of his surgical mistakes in a genuine attempt to inform his successors so that such mistakes are not lost to a graveyard of long forgotten medical errors and repeated unwittingly. If the book is meant to be instructive in any respect for junior doctors, should there not also be some leadership on how to create harmonious interactions with hospital managers who are, lest we forget, our colleagues, and the people who run our hospitals and our healthcare system?

Do No Harm presents itself as a collection of parables, with Marsh himself cast in a panoply of roles, from the international surgeon superhero in Ukraine to the local friendly south London doc who cycles to work like the village vicar. He writes himself as a naughty schoolboy figure furtively struggling against the hospital establishment, and then challenges this by impatiently chastening a scruffy, insouciant junior doctor at the morning meeting like a schoolmaster from his days at Westminster College. Marsh represents an authoritative member of the modern medical milieu but also, movingly, puts himself on the ‘other side’ as a family carer.

Marsh does not dwell on religion or on God. He seems to intimate in a variety of ways that organized religion is not how he makes sense of the cosmos. After an ill-fated operation, which goes catastrophically wrong in the 18th hour of surgery, Marsh renders a young man paralyzed. When he breaks the terrible news to the waiting family, the patient’s mother beseeches Marsh to remember her now quadriplegic, mute son in his prayers. The neurosurgeon does not pray within the context of Do No Harm. Instead, a man of letters, of learning and of neuroscience, in this startlingly honest book about ‘Life, Death and Brain Surgery’, Marsh remembers his patients.

Do No Harm by Henry Marsh. London: Phoenix (an imprint of the Orion Publishing Group Ltd), 2014

The Man in Bed Five by Jack Garnham

28 Jan, 15 | by BMJ

I go to see the man in bed five.


He winks at me. Cracked lips separate to reveal an imperfect set of yellow teeth as a wry smile spreads slowly across his face. It comes with an enormous effort. He looks worse; the burden of disease seems to weigh heavier with each passing hour. Sickness has slowly reshaped him, like an obsessive sculptor continually revising his creation. His wife fiddles nervously with her plain wedding band; I feel his decline, but for her each step in the inexorable march of his illness is devastation. She looks at me, and in her eyes I see a deep love and a profound fear. They have been married for forty years. He tells me about his two children. He loves them. His daughter lives in Australia. He has a dog that he takes for walks on the common. He waves a frail arm towards the trees outside the window and tells me that he is looking forward to going home. In our short time together he has granted me open access to his private world, to the countless unique experiences that conspire to create an individual. I will miss him when he is gone, the man in bed five.


This once vibrant character is dulled by his sterile surroundings: the bland hospital gown robs him of his humanity; the peeling walls and filthy windows drain him; plastic tubes run into and out of his body. For a moment the hospital is a colossal parasite, nourished by this wasted figure; it breathes in around me and exhales a fetid breath, content at having shelled the man in bed five.


I am protected. My fraying badge and cheap stethoscope defend me. The flimsy chart I hold is my shield. I am part of the profession, this most noble profession, and to hurt is weakness, to feel is fragility. He is his disease; he is a hospital number, a set of laboratory results, a trace on a machine, a faint bleep heard from the nursing station. To watch him break I must stand on the other side of the glass. I bid a clinical farewell to the peculiar collection of observations that was once the man in bed five.


One day the faint bleep fades. The rush of clinical medicine devours the mourning period; a different set of observations arrives to occupy the bed, and there are pressing results to chase and urgent investigations to order. He remains in my mind as the hours pass. Is it appropriate to grieve? Would it be easier to succumb to indifference? These were the questions asked of me by the man in bed five. Can you balance compassion with detachment? Can you manage the intolerable pain of regular loss? Can you walk the fine line? I bury these thoughts and continue to work.


As finals draw closer I find myself more frequently troubled by these questions.


I still have no answers.


Correspondence: Jack Garnham, Imperial College, London (

Physicians and Magicians: A Magical Education in Life, Death, Power, Potions and Defence Against the Dark Arts by Fiona Dogan and Mark Harper

20 Jan, 15 | by BMJ


The worlds of magic and medicine both involve the sudden initiation of an intimate relationship between two complete strangers – the magician and their subject, or the doctor and their patient. Magic requires the subject to have some degree of trust in the magician, to accept that props and setting may be required to aid the illusion, and to witness such a high degree of skill that belief in the magician’s ability is sustained once the trick is complete. In the medical setting trust and confidentiality, the use of medical equipment, and the expertise and competence of the doctor are but a few essential components of a successful interaction. This is not to imply that the art of medicine is a trick, but rather a complex set of circumstances that can be engineered to promote the best possible outcome for both the doctor and the patient – or the magician and their audience.

The concepts of magic in the Harry Potter series can be used as examples to study issues that medicine raises in our own society. By focusing particularly on The Order of the Phoenix, The Half-Blood Prince and The Deathly Hallows, it is possible to compare the learning processes for both young magicians and medical students that are considered necessary to prepare them for life in their profession. Within the books there are interesting issues regarding perspectives of professional knowledge and power, with diverse examples of socio-economic status informing the treatment of certain groups by others. The psychology of the misuse of power by those in positions of authority and professionals acting under duress provide a measure of insight into the actions of doctors under a totalitarian regime. Finally the ethics of using science and magic are debated throughout the series, and provide valuable material for discussion of moral issues that can be translated directly to medicine.

Physicians and Magicians: A Magical Education for Physicians in Life, Death, Power, Potions and Defence Against the Dark Arts 


There is a clear comparison between magic and medicine in the structure of training which can be classified into three, occasionally overlapping, areas which broadly equate to the classic educational paradigm of knowledge, skills and attitudes.

Right from the very beginning (we are excluding Owl Post although that may be equated to the acceptance letter) the similarities are striking. The young, aspirant magician’s trip to Diagon Alley, to buy a pile of books they don’t understand and a wand they don’t know how to use, equates to the medical student’s first visit to the University bookshop and purchase of stethoscope and other medical equipment. A cat, rat or owl would make a more interesting and interactive companion than a skeleton – if somewhat less relevant to medical studies. Here we see the first inklings of a professional attitude, in that both sets of students begin to take on the accoutrements that distinguish them from the non-medical or Muggle population.

There are also many similarities in the education process. Hogwarts requires seven years compulsory teaching, with the witches and wizards “coming of age” the year before they qualify. This provides a greater degree of freedom for them to practice their magic and hone their skills in the Muggle world, unprotected by the castle’s enchantments and restrictions on underage magic. Similarly doctors in the UK qualify after five years but have a further two years as junior doctors, gaining more responsibility during their sixth and seventh years.

Furthermore, both educations consist of a combination knowledge acquisition through book learning and skills through an apprenticeship. There is also a degree of crossover in the subjects studied: Potions and pharmacology, Arithmancy and chemistry, and Muggle Studies and communication skills.

There are even parallels in the same work hard, play hard ethic. Hours are long, learning goes on late into the night and copious quantities of beer are consumed – though there may be some suspicion that Butterbeer is not as potent as real ale.

Right from the beginning, both sets of students are externally regulated by either the General Medical Council (GMC) or the Ministry of Magic (MoM). As well as overseeing competencies these bodies define and regulate the appropriate attitudes through the ‘fitness to practice’ committee and, as Harry discovers more than once in the series, the Improper Use of Magic Department. Furthermore they effectively create a closed-shop which cannot be breached by the non-professional. (1,2)

However, whereas the GMC and the medical profession seem to be striving towards an ever more open and inclusive approach to the delivery of medicine, it could be argued that the MoM is rigidly sticking to a more archaic, paternalistic model. Muggles do not possess magic, and are generally not permitted to even know that wizards and witches exist. If mistakes are made and members of the Muggle population do become unintentionally aware of magic, it is acceptable to have memory charms performed on them without their knowledge or consent. This is demonstrated throughout the books, from the murders committed by Peter Pettigrew on the night of Voldemort’s destruction to the treatment of the Roberts’ family at the Quidditch World Cup in the Goblet of Fire. In The Deathly Hallows Hermione decides that the best course of action for her parents is to modify their memories, in order to make them forget they have a daughter and feel a sudden desire to leave the country. As she possesses the knowledge and skill to perform such a spell, she does this herself without consulting her parents or any of her fellow magicians. (3–5)

Much as one might, at times, wish to remove a patient’s memory of an interaction -ethics aside – conventional (i.e. non-magical) medicine still only has the power to induce prospective amnesia, and even then on an imperfect basis. (6) Additionally, research has shown that better outcomes are associated with patients understanding their illness and being involved in decisions about their treatment so maybe a shift towards a more informative and holistic partnership between patients, doctors, magicians and Muggles can only be a good thing. (7,8)


Power in life…

It’s not only actions that have consequences but attitudes too, particularly when it comes to wielding the kind of power possessed by physicians and magicians. The “use-or-not” of power is both a central theme of the Harry Potter books and an important consideration in terms of the doctor as magician.

The magical world is hidden from Muggles, as Hagrid explains to Harry at the very beginning of The Philosophers Stone, because people would want magical solutions to all their problems if they knew it was available. (9) His point is reinforced in The Half-Blood Prince during a conversation between the Muggle Prime Minister, the ex-Minister for Magic Cornelius Fudge and his replacement Rufus Scrimgeour:

‘The Prime Minister gazed hopelessly at the pair of them for a moment, then the words he had fought to suppress all evening burst from him at last.
“But for heaven’s sake — you’re wizards! You can do magic! Surely you can sort out — well — anything!”
Scrimgeour turned slowly on the spot and exchanged an incredulous look with Fudge, who really did manage a smile this time as he said kindly, “The trouble is, the other side can do magic too, Prime Minister.”’ (10)

This is useful in exploring the expectations some people – and some doctors – have about the power of medicine. In the past the physician was more like the magician, albeit one who used sleight of hand rather than real magic, creating power through obfuscation in a veneer of classicised language and instruments, such as the stethoscope, that put space between them and the patient. Interestingly, as their real powers have grown, the façade has come down to a large extent and patients can have much greater knowledge of their conditions and of the ‘spells’ possessed by the doctor.

Nonetheless, expectations have simultaneously risen and it often seems that patients think doctors should be able to do magic. Maybe it would help to show them how “the other side” also has “magic”; whether it is the ability of the virus to mutate to escape drugs and detection, or the cancer to hide in the patient’s own cells (DNA even) to evade chemotherapeutic spells and radiation wands, only to re-emerge like Voldemort from his Horcruxes. There is still no “Magic Bullet” to specifically target every disease process. (11–14)

The exchange above also illustrates how the patient can be affected by the amount of power they feel they have over their condition. As he feels he is losing control of the situation, the Muggle Prime Minister cannot contain himself any longer, and his words are redolent of patients and their relatives in the face of a poor prognosis. (15)

The Dursleys are Harry’s Muggle family from his mother’s side. Despite being among the few Muggles who know about magic, they choose to ignore it for as long as is possible because they see magicians as troublemakers and a source of embarrassment. They pretend that Harry is mentally unstable rather than admit to him being a wizard. It is only in The Order Of The Phoenix when…

“The arrival of Dementors in Little Whinging seemed to have breached the great, invisible wall that divided the relentlessly non-magical world of Privet Drive and the world beyond.”

…they see the possible impact of magic on their own lives, and they begin to ask for Harry’s advice and guidance.

There are patients who have an analogous distrust of doctors, to the extent that they will leave conditions far longer than they should in order to avoid confronting the medical world. The Dursleys represent this group and demonstrate how people can have deep-seated and rationalised (though not necessarily rational) views. The Dursleys are, therefore, useful characters to consider when dealing with patients can be very afraid of a condition that they do not fully understand. (2)


… and power over death

The biggest ethical dilemma raised in Harry Potter books relates to the death of Albus Dumbledore in The Half-Blood Prince. After putting on a cursed ring by mistake Dumbledore asks Severus Snape for help. Snape uses a potion to trap the curse in Dumbledore’s right arm temporarily, although they both know he will still be dead within the year. Dumbledore then asks Snape to kill him when the time comes, as this will prevent him suffering for longer than necessary whilst also solidifying Snape’s position with Lord Voldemort in his double agent role.

This situation is analogous to palliative treatment and physician-assisted death. As Snape delivers the final blow himself rather than provide the means for Dumbledore to take his own life, and Dumbledore is conscious up until the Avada Kedavra killing curse hits him, it would most likely fall under the category of voluntary active euthanasia. (5,10)

The first issue this series of events raises is that of the ethical dilemma that surrounds the boundary between a duty of care and actively shortening a patient’s life. Snape finally agrees to undertake this task ‘for the greater good’- to protect his double agent identity and therefore help assure the safety of the students at Hogwarts.

In medicine the death of a terminally ill person in order to benefit the life of another is one of the core issues when discussing the legalisation of euthanasia. Setting aside the moral issues, benefit may be derived from both the individual, in terms of reduced suffering, and the collective, through the reduced drain of limited resources. However, this must be set against the need to protect elderly and vulnerable people, and provide optimum medical care. (16)

The second issue this event raises is the emotional effect on the doctor or magician who delivers the final, fatal blow. We see Snape hesitate before killing Dumbledore and, even though at this stage he is portrayed as Voldemort’s henchman, we can feel his reluctance. This is despite the fact that he is acting on a well thought-out and considered advance directive. As Dumbledore explains in The Deathly Hallows:

“I ask this one, great favour of you, Severus, because death is coming for me… I confess I should prefer it to be a quick, painless exit to the protracted and messy affair it will be…”

Nonetheless, Snape fears for the consequences to himself:

‘“That boy’s soul is not yet so damaged,” said Dumbledore. “I would not have it ripped apart on my account.”

“And my soul, Dumbledore? Mine?”

“You alone know whether it will harm your soul to help an old man avoid pain and humiliation,” said Dumbledore.’ (5)

This illustrates a common argument against euthanasia, regarding the psychological burden that could be felt by the enabling physician. This has been a subject of specialist research for many years, involving doctors who work in clinics such as Dignitas in Switzerland and those who are required to administer lethal injections to criminals in the United States. (17)

Part of the problem is that Snape is, necessarily, acting alone. It would be much easier if he had advice, support and objectivity from others. It therefore underlines the need in medicine for a multidisciplinary approach to these situations. (18)

The description of the last moments before Snape kills Dumbledore bring up two further issues. The first is the effect on the peripheral characters: in the medical context, the relatives; in this context, Harry, who is shocked and frightened by the unfolding events.


The sound frightened Harry beyond anything he had experienced all evening. For the first time, Dumbledore was pleading.’

It is not until The Deathly Hallows that it becomes apparent Snape was acting on Dumbledore’s wishes. At this point it seems that the old wizard is begging for his life to be spared.

‘…Snape gazed for a moment at Dumbledore, and there was revulsion and hatred etched in the harsh lines of his face.

“Severus… please…”

Snape raised his wand and pointed it directly at Dumbledore.

“Avada Kedavra!”’

But furthermore, it is impossible to tell whether Dumbledore had actually changed his mind at the last minute and was, as it seemed to Harry, pleading for his life. And this is something that needs to be considered with medical euthanasia, particularly in patients with degenerative diseases that may compromise their ability to communicate or comprehend over time. These decisions are often made a long way in advance, and it can sometimes prove very difficult to be sure that their wishes have not changed. (10,19)


Defence against the Dark Arts

The steady implementation of the totalitarian state in the second half of the Harry Potter series closely mirrors the rise of Nazism in Germany prior to the Second World War. The persecution of the Jews and the Muggle-borns, Neville Chamberlain’s appeasement policy and Cornelius Fudge’s feverish denial, and the use of propaganda by Voldemort and the Death Eaters are but a few similarities. The actions performed by different magicians under this regime is an interesting study in psychological terms, and provides some insight into the behaviour of professionals such as doctors during wartime and under duress. (20)

Under the rule of Hitler it was deemed necessary for doctors to experiment on classes of people who were considered ‘lesser beings,’ in order to further knowledge and discoveries in the field of medicine. This began with the psychological dehumanisation of the Jews and other ‘undesirables’ through smear campaigns, blaming them for the defeat of Germany in 1918 and the subsequent economic depression. Through the use of careful and steady propaganda it seemed like an almost natural progression for the Jews to eventually be segregated and placed on a registry system. Some doctors chose to accept the idea of the “Jewish plague” and took pride in providing what they believed to be a valuable service to Germany and scientific advancement, whilst other doctors performed their duties under duress to avoid being killed themselves. It became commonplace for those within the medical profession to control, torture and kill Jews, homosexuals, the disabled and many others as part of their day’s work, and to record the results of the various experiments performed. (21)

In Harry’s world there are certain witches and wizards who can be used to represent the actions of different medical professionals under the oppressive regime in Nazi Germany. Firstly interesting parallels can be drawn between Hitler’s “Angel of Death” Dr. Josef Mengele, and the Head of the Muggle-Born Registration Committee Dolores Umbridge. Mengele had a background in genetics and twin studies in particular, and revelled in the fact that Hitler’s regime allowed him to further his studies through experimentation in a way that would not have been possible previously. Similarly Umbridge is vociferous regarding the offensive nature of half-breeds and later Muggle-borns, and seems unperturbed who is in charge as long as she is able to increase her power and her freedom to use it. It later comes to light that she abused her position or power as early as the beginning of The Order of the Phoenix, when she illegally sent Dementors after Harry to try and silence him regarding Lord Voldemort’s return. She was initially appointed by the Ministry as the Defence Against the Dark Arts teacher at Hogwarts in order to keep a closer eye on Harry and Dumbledore, but rapidly progressed up the ranks due to her dedication and ruthless personality. Whilst not in league with Voldemort himself, she certainly upheld his ideals and, similar to Mengele in Germany, seemed to delight in using the political situation to her advantage to achieve her aims. (2,21)

Alecto and Amycus Carrow represent the Nazi doctors who truly believed in their leader’s vision and would do everything in their power to assist in its’ realisation. They differ slightly from the type of doctor portrayed by Umbridge, as they believed in Voldemort’s particular ideals rather than his general approach. The Carrows excelled under Voldemort’s rule during the Second Wizarding War, and revelled at the chance to freely use the previously illegal Unforgiveable Curses: Imperio (control), Cruciatus (torture) and Avada Kedavra (death) – the same methods used on the “undesirables” by the Nazis during the Second World War. Harry is depicted on posters and referred to by the Ministry as ‘Undesirable No.1’.

Professor Snape’s true loyalties are in question up until his dying moments at the end of The Deathly Hallows, where it is revealed that he had indeed been trying to protect Harry all along. Working as a double agent for Dumbledore, he made the difficult decision to continue to work for Voldemort in the hope that he could exert some control over the Carrows’ punishments inflicted upon the students they were in charge of. This has previously been the case with doctors who speak out after working under duress, in an attempt to limit suffering as much as they can in a difficult situation. (5)

The character of Voldemort himself raises important issues regarding the psychology of a dictator. Voldemort used great acts of evil to split his soul into 7 pieces (Horcruxes) to attempt to gain immortality and power. The concept of ‘doubling’ describes how a person is able to commit acts previously abhorrent to them, as they simply ‘switch off’ their other side. This has been offered as an explanation why people, such as Nazi doctors, were able to torture and kill ‘undesirables’ on a regular basis. (10,21)


Throughout the Harry Potter books there are many comparisons that can be drawn between the magical and the medical world. The similarities and differences that have been highlighted give us an original way of looking into important issues concerning the medical profession, and the magician-Muggle relationship raises interesting points regarding the doctor-patient interaction. Ultimately it leaves one wondering whether we as physicians try too hard to be magicians? Or is it that patients actually want us to be magicians? As always, the reality probably lies somewhere between the two extremes.



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  21. Lifton RJ. The Nazi Doctors: Medical Killing and the Psychology of Genocide. Basic Books; 2000.

Author contact details:

1. Fiona N Dogan, 5th year BM BS student, Brighton and Sussex Medical School

2. Dr C Mark Harper BSc MBBS FRCA, Consultant Anaesthetist, Brighton and Sussex University Hospitals

Who are we as Doctors? Why an exploration of our significance can lead to better care by Benjamin Janaway

27 Nov, 14 | by BMJ

Recently I lost a patient. A lady in her 60’s whose hand I held for months and who’s passing will stand as a turning point in my career.

Having spent several months working in oncology my view of the role of a doctor has been tested time and time again. Publically observed heuristics of the role of doctors, portrayed subjectively in television and film, novels and novellas, are the hippocratically charged and dutiful healers. Both a font of knowledge and diary of experience, the doctor is seen as a paternalistic figure and eternal purveyor of the omnipotent band aid.

In some cases, within primary care and acute medicine, this may indeed be the case. Early recognition of pathological processes expressed through familiar clinical paradigms allows for rapid reversal of such malady, leading to objective improvement of the patient and maintenance of this social perception. However my experience of secondary and tertiary care of patients with chronic conditions tells a different story.

These patients, when viewed holistically as both the sum of their experience and the filtered view of our own experience, take on significance both within day to day clinical care and the greater role of disease in their lives. Identification with disease, as I have previously mentioned, is a natural and almost unavoidable consequence of the maladaptive nature of the human mind. Our natural insecurities, developed arguably within Jungian theory to inspire adaptive development, can be argued to be destructive when applied to modern day context.

The presence of disease is not just an event in a person’s life, but an event with added context and personally subjective significance. For example, a broken hand means more to a pianist than a footballer. The subjective significance of a change in health status can be explained by the patient’s reliance on past experience and their perceived importance of such a change within the context of their entire lives. The identification of their lives with the change is what the patient sees, but the objective measurement taken by clinicians is usually less in depth.

In terms of cancer, this identification can be both freeing and incarcerating. I have worked with a number of patients, young, old, religious or atheistic with a number of different cancers of varying aggression. Some of these patients were at the start of a journey with an indefinite end, and some were at the end of a journey of indefinite meaning. For some, the end of a long fight, although sad, had changed their lives dramatically and they had lived more in a short time than they had in their lives.

My own grandfather had been diagnosed with multiple myeloma a few years ago and passed away earlier this year. Being both his grandson and a doctor in training was a balancing act, knowing more about the practical and prognostic side of his care and tempering my expectations with that of him and my family. I found this process infinitely difficult and adaptive, learning from my emotional responses better ways to address his own needs and questions.

I would like to say that one of the many lessons I learned from him is that a stoic disposition and optimistic attitude in the face of uncertainty is a great strength. Life goes on between our plans, and our aspirations and reality do not necessarily correlate and it is up to us to meet these changes head on, learn what we can and move on the future. In the treatment of cancer, and the management of my patients, this stoic and optimistic attitude, balanced with an understanding of the patients own identification and experience of disease, is most useful.

So when we consider our own significance within the patient’s experience we must remember the paternalistic view of the omnipotent healer, but also realise that we play only a part in the production of their lives. We are second to the protagonist, and must realise the overall significance of our words on actions not just on the objective clinical state of the patient, but the holistic sphere of their entire disease experience.

More and more I have realised my role as a junior physician and frontline carer is to support the expectations of the patient within a realistic schema. To attempt to best understand their view, but present it to them within a spectrum of experience based on my continued learning and reflection. The omnipotent heuristic can therefore be argued to be of less importance than the archetypal omnibenevolent. As doctors our roles are to first understand the patient and their own judgement of disease significance, and tailor our treatment and interaction in an empathetic and individualised way.

We try to act in the patients best interests, and that means not only to address the physical aspects of their disease but the entire holistic side. Within oncology, this idea takes on extreme importance, as often the societal view of cancer and its ultimate path takes hold in a patients mind. For some it is a challenge, for some freeing, and for others a less positive conclusion. Whatever the view taken, it is up to us as doctors to realise our lines in the script of the patient’s life when this plot twist comes.

For my lady, and for my grandfather, the advent of their disease granted them a new perspective and through long discussion with both I realised the beauty of a new view. Their priorities and expectations changed and they lived without fear. This realisation painted my day to day communication with both and I would hope played a part in making the last years of their lives not just bearable, but an experience they could learn from and leave their mark on the world.

For me, their mark is on my heart, a sign saying ‘Listen and stay open’.

The opinions expressed in this article are those of the author and may not represent those of SDHCT. No patient identifiable information is included.

Correspondence: Dr BM Janaway, Flat 4, Castle Chambers, 147 Union Street, Torquay, Devon TQ1 4BT

Deborah Bowman in conversation with Leslie Jamison, author of ‘The Empathy Exams’

22 Jun, 14 | by Deborah Bowman



Join the Editor of Medical Humanities, Deborah Bowman, in conversation with Leslie Jamison as they discuss her acclaimed essay collection ‘The Empathy Exams’ and more. Leslie’s work questions how we understand each other and the concept of empathy, drawing on her time as an actor working with medical students and her own experiences of illness and vulnerability. It promises to be a fascinating evening and a rare opportunity to meet an author described by the New York Times as ‘extraordinary’.

This is a free public event, open to all and part of the St George’s, University of London series The Art of Medicine.


Date: Monday 7th July at 5.30 p.m.

Venue: Boardroom H2.5 Hunter Wing
St George’s, University of London Cranmer Terrace,
London SW17 0RE

Register via e-mail:

Hope to see you there.


Ayesha Ahmad: Review of ‘Doing Clinical Ethics’ by Dr Daniel Sokol

4 Dec, 11 | by Ayesha Ahmad

Since Hippocrates in early 5 B.C., Medicine has carried an ‘angel on its shoulder’; a reflexive gaze on the skill, and phenomenologies of healing between the doctor and his patient. Ethics is a code, a practice, and a guide amid the terrain of the hands that tend to the body using instruments of medicine’s enterprise. Referring to the Oath:

I will preserve the purity of my life and my arts’.

Daniel Sokol, Honorary Senior Lecturer at Imperial College, London and recently qualified barrister, undertook the challenge of fitting ‘ethics’ into our contemporary medical practice; whereby Medicine is confronted by a body unprecedented in relation to the ways in which we can perceive, examine, intervene, create, and prolong the existence of our bodies; our lives.


James Poskett: Storytelling in the theatre

18 Aug, 11 | by James Poskett

Telling the Patient’s Story details a theatre company’s attempts to develop medical students’ case presentation skills. Workshops, covering everything from improvisation, personal monologues and body language, had a marked effect on the students, with all participants agreeing that the training improved their delivery of patient histories.

So, the arts and humanities can help medical students improve their case presentation skills thereby, in theory, benefitting future patients. Sounds like convincing evidence of the value of the humanities within the medical curriculum. Everyone happy? Well, not quite. One student offered the following feedback:

“[There is] too much focus on how this relates to medicine. We will realise that later.”


Oncologist Sam Guglani wonders what medical care really means

30 Mar, 11 | by Deborah Kirklin

Care infuses medicine. Well, the word ‘care’ infuses the language of medicine – Healthcare, Intensive Care, Palliative Care, Standard care, Standard of care, Best supportive care, Care Quality Commission. But what actually is medical care? more…

“Newspeak (PART TWO): British Art Now is doubleplusgood!” by Dr Jane R Moore

6 Feb, 11 | by Deborah Kirklin

SAATCHI GALLERY 27th October 2010 – 17th April 2011

A few weeks ago I visited the new exhibition at the Saatchi Gallery with my group of 4th year King’s College Medical Students. Visits to galleries, museums and art installations are an integral part of the ‘The Good Doctor’ Special Study Module but I hadn’t included the Saatchi Gallery before.  Modern conceptual art is challenging and I was uncertain how this visit would help in our exploration of medical matters. I need not have worried; our visit was enjoyable, reassuringly accessible and it was easy to make links to the theme of goodness in contemporary medical practice.

Newspeak Two on display in the large bright rooms at the Saatchi Gallery, King’s Road, London continues the showcase of contemporary British Art started in June 2010 with Newspeak One.  All the original exhibits, including the widely advertised Pink Cher by Scott King, have been replaced and the new collection opened at the end of October.  Charles Saatchi’s Sensation! exhibition (Royal Academy 1997) had – sensationally –  brought late 20th century British Art to public notice. This was the outing of Damian Hirst’s shark, Tracey Emin’s unmade bed, Mark Quinn’s blood sculptures, Chris Ofili’s ingenious uses of elephant dung and the Chapman Brothers doing what they do best – shocking us into a reaction.  So what would we make of Newspeak? more…

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