Julian Sheather: The ghosts of medicine

I was at the Liverpool Medical Institution recently, judging a debating competition between medical students from Manchester and Liverpool. The Institution is housed in a lovely curving neo-classical building that looks across a busy road to the angular awkwardness of the Catholic Cathedral. I arrived early and wandered through its rooms: the neat library; the oak-panelled Council room; the raked crescent of the lecture theatre. Although the building is still in use, curatorial instincts had been at work. It was as much museum as meeting house. It opened in 1837 and as I wandered I was taken by the fancy that I was seeing a snapshot of medicine, both the practice and the profession, just as Queen Victoria came to the throne. And what did that snapshot have to say? Well the neo-classical building spoke of the enlightenment – of science and status. The fluted columns, the Ionian capitals: the architectural grammar of an ascendant authority. Medicine was to be a power in the land, and the origins of that power lay in the clean light of science, that great dispeller of myth and quackery. The pretty library, bound volumes behind glass, emphasised the point: this was a learned profession. Medicine was also for men. From the walls looked down the silver-haired great: sombre and serious and male. In the council room were glazed cabinets glinting with antique medical instruments. Medicine was about technology, about physical intervention. And yet this was only the most obvious, the most finished and lacquered face of early medicine. For if medicine was male it was also fraternal, and, in a sense of the word probably lost to us now, amateur. This was a field still open to an inquisitive mind with a little time and money. A sense of excitement still filtered through, a sense that new worlds were opening up, that humankind was about to shrug off some of its greatest tormentors – here was Ronald Ross’s monograph identifying the link between malaria and the anophalene mosquito.

And then a fancy took me. If this lovely building was the ghost of medicine past, what would such a building look like today? What would the ghost of medicine present look like? How would it be housed and what would it contain? Not a house now but a towering structure of steel and glinting glass, a medico-industrial complex, almost a town in its own right. No more need of neo-classical architecture – the authority of medicine is unquestioned. The building is a homage to science ascendant: a future-tilted marvel of engineering and optimism. And think what it contains: the library would be a Borgesian labyrinth; the instrument cabinets would run for kilometres; the medicine chest a building in its own right. And what of the people? All professionals now, all with years of study behind them: not an amateur in sight. They are smaller perhaps, a little dwarfed by the building. The frontier spirit has gone and with it the sense of fraternity. This feels a little more anonymous and bureaucratic, more highly specialised. These are busy people in an established world: hard-working, efficient, comprehending. Look a little closer and something else has changed: no longer is medicine the preserve of white men. So many women, such a range of ethnic origin. A democratic revolution seems to have rolled through the corridors. Another thing catches the eye, another offshoot of that revolution: patients have crept into the picture. Patients are making decisions, patients are having a voice. Medicine may be a megalopolis but illness has a slightly more human face.

And the ghost of medicine future? Well here was a surprise. I had thought it would be much much more of the same. I was expecting whole new conurbations: neuroscience, genomic medicine, a new town given over to the biochemical origins of unhappiness, another to the genetics of obesity. But no. The great edifice had altered. It was smaller, somehow a little less triumphant. For something had changed. A new science had developed. Parasitic at first on medicine’s knowledge it had set out on its own. It was simple and it was free of technology. It was a science not of illness but of health, not of suffering but happiness. There were no drug companies and no politicians. There were neither doctors nor quacks. There were no false hopes, no miracle cures. People lived and died, they sickened and recovered. It was only that they had found again the lost art of leading a good life.

And just in case you are interested – Liverpool won the debate.

Julian Sheather is ethics manager, BMA. The views he expresses in his blog posts are entirely his own.