David Payne: Review of “The Doctor’s Dilemma”

David Payne Medicine’s big guns beat a path to Dr Colenso Ridgeon’s consulting room after news of his knighthood is announced. Downstairs, the wife of a consumptive painter pleads with his housekeeper for an appointment in the hope that Ridgeon will cure him of his tuberculosis.

In Shaw’s play, now showing at the National Theatre in London, Ridgeon’s dilemma is whether to treat the brilliant but morally bankrupt artist Louis Dubedat or an impoverished medical colleague.

The issue is complicated by Ridgeon’s desire to marry Dubedat’s beautiful wife, and the fact that the dying artist panders to the vanity of the doctor’s circle of eminent physicians and surgeons by presenting them with exquisite drawings of all of them, with a price tag attached, of course.

Is the life of a talented artist worth more than the hardworking Dr Blenkinsop? Thirty years qualified, he has neither the time nor money to read medical papers (relying instead on clinical experience) and his patients are all “clerks and shopmen” who cannot afford recuperative visits to St Moritz. Drugs are a poor substitute for greengages, eaten an hour before lunch.

Shaw’s play was first performed in 1906, but its themes anticipate the arrival of publicly-funded doctors with the creation of the NHS 41 years later, along with subsequent debates about rationing, and the importance of evidence based medicine.

Medicine, in common with other professions, is depicted as “a conspiracy against the laity.” According to Shaw’s biographer Michael Holroyd, the play was informed by the writers’s experience of St Pancras’ Borough Council’s health committee, where he campaigned against unreliable statistics and medical jargon.

Shaw prefaced his play with a 70-page appraisal of the medical profession and the absurdity of a system where doctors have a pecuniary interest in over-treating patients, the “craze for operations” and the delusion that all doctors are men of science.

Certainly the play reinforces these stereotypes, and others, with the possible exception of Blenkinsop. Maggie McCarthy’s Act 1 performance as Ridgeon’s housekeeper is a prototype of a modern GP receptionist (“I don’t think much of science; and neither will you when you have lived with it as long as I have.”).

Similarly, William Belchambers plays the obedient and unquestioning medical student Redpenny, a breed denounced by Ridgeon as “the most disgusting figure in modern civilisation. No veneration, no manners…”

The play leaves one important question unresolved. The widowed Jennifer Dubedat complies with her late husband’s wish that as a happily married woman, she should marry again. She does, but to whom?

The Doctor’s Dillema certainly delivers on a challenge to Shaw from the theatre critic Willam Archer, that he write a tragedy about death. But as Holroyd concludes, it is also a play about love, about a group of eminent doctors who love their profession, and the beautiful widow of an unloveable patient.

The Doctor’s Dilemma runs until 12 September at The National Theatre, London.

David Payne is editor, bmj.com