In practice, physicians, and especially surgeons, have always had to learn some type

of detachment (or dispassion to use the early modern term) in order to cope with

the more revolting aspects of their art.1 At times the relationship between acquiring

dispassion and the effects it has on the (in)humanity of medical practitioners

has been questioned. Does constantly seeing sickness and death make one lose

compassion? If so, what is one left with in its place? As recently as 1994, tempers

flared in the British Medical Journal following the publication of a letter from an

anonymous London-based general practitioner. She, or he, accused some doctors

of ‘disturbingly callous and rude behaviour’ towards patients and suggested that

‘courses to remind (or perhaps teach) doctors how to behave to their patients be

put high on the agenda.’2 The letter prompted a strongly worded editorial in the

Weatherall agreed with the sentiments of the letter and offered explanations for why

so many medical practitioners appeared to be detached from their patients’ pain and

suffering. First, he suggested that ‘doctors may always have had a limited facility

to treat their patients as humans’; second, they are worse at it now ‘because of the

rushed and specialized nature’ of medical training and practice; and third, we could

try to reform medical education but there is probably little point, as ‘problems of

doctor-patient relationships have been around for hundreds of years and during times

of completely different patterns of medical education, clinical practice, and social

pressure’.4 Weatherall ended his editorial with a plaintive cry:

It is difficult to equate the delightful, caring, and extremely gifted young people whom

one encounters on their entry to medical school with some of the horror stories described

in today’s journal. What on earth has exposure to a few years of the medical profession

done to some of them?5