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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 April 21; 334(7598): 855.
PMCID: PMC1853179
Medical Classics

The Citadel

Marcos Martinez Del Pero, clinical research fellow in ear, nose, and throat medicine, Addenbrooke's Hospital, Cambridge

The Citadel is a semiautobiographical story about a young doctor and his journey through his medical career. A bestseller when it was first published in 1937, it was reprinted more than 12 times in its year of publication. As well as providing an insight into medicine at the time, it was influential in setting up and increasing public acceptance of the National Health Service in the years that followed.

The novel's protagonist is Andrew Manson, a young idealistic medical graduate who chooses to work in a Welsh mining town to pay off his medical school debts. The Citadel charts the progress of his personal and professional life, from the hardships of starting out and taking exams, to moving to a bureaucratic government job in London and then on to lucrative private practice. Material success leads to numerous problems for Dr Manson both at home and work, and the story ends with a dramatic turn of events.

The context in which it is written is particularly relevant in the current climate of reform in the NHS. It is set in the late 1920s and early 1930s when there were no specialists and practices varied greatly. It highlighted inequalities between public and private health care and shortfalls within the system. There were public hospitals, and the doctors who worked in them earned greater respect, but if patients could afford to they chose to be treated privately. The Citadel covers many issues that are still evolving today—for example, the use of the “scientific method” (evidence based medicine) in clinicians' practice and “compulsory postgraduate classes” (continuing professional development).

My grandmother (a retired paediatrician) gave me her copy of The Citadel when I graduated. I read it at two different stages in my career: as a house officer and later in my surgical training. Initially it helped me see how life as a doctor could be different from the theory learnt at medical school, an extreme example being when Dr Manson and his colleague blow up the local sewers during a typhoid outbreak to get the council to repair them. The second time I read it, what caught my attention was the relationship between Dr Manson and his wife. Her ongoing support of him throughout exams, research, and the stresses of everyday work is something that I (and my wife!) can now relate to. I am sure if I read it again in five to 10 years' time it would shed light on a different aspect of my job. The fact that it appeals to doctors at all stages of their career makes it a classic.

There are many enduring themes in this novel that make it interesting to a doctor, such as ethical issues and the work-life balance; but above all The Citadel is an easy to read, enjoyable book.

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