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BMJ. 2007 August 4; 335(7613): 263.
PMCID: PMC1939759
Medical Classics

The Doctor's Dilemma

Iain McClure, consultant child and adolescent psychiatrist, Murray Royal Hospital, Perth

George Bernard Shaw (1856-1950), Irish dramatist, arts critic, socialist thinker, and winner of the Nobel prize for Literature in 1925, had a bit of a problem with doctors. By the turn of the 20th century he had formed the opinion that the medical profession was in a terminal state, requiring urgent and heroic intervention. Shaw, one of the greatest British dramatists since Shakespeare, was quite happy to make the first of several subsequent incisions.

As a founding member of the Fabian movement in 1884, Shaw had set out to transform society by means of a “permeation” (to quote his fellow socialist pioneer Sidney Webb) of Britain's political and intellectual life. He was concerned about the huge disparities between the privileged and the lowly, not least in regard to the poor's meagre access to the potential of education. A high-school drop-out himself, Shaw had undertaken a massive programme of self education in his 20s, courtesy of the British Library's reading room. Following this, his subsequent combination of prodigious intellect and panoramic knowledge meant that few subjects intimidated him in his quest for fairness and truth.

By 1905, Shaw had reached the height of his dramatists' powers, with plays such as Man and Superman and Major Barbara enjoying international accolades. It was at this point that he decided to write The Doctor's Dilemma, a scabrous comedy that would come to be regarded as the greatest satire on the medical profession since Molière's Malade Imaginaire.

The protagonist of Shaw's ironically labelled “tragedy” is Sir Colenso Ridgeon, a recently beknighted, bachelor physician, troubled by unfulfilled matrimonial desire. Colenso has received his knighthood in recognition of his pioneering immunological research, specifically his discovery that tubercular patients can be cured—in the right hands of course—by inoculation with a miracle substance, Opsonin.

The play opens with Colenso holding court, firstly for an entertainingly observed spectrum of medical colleagues who come to pay tribute to him and, secondly, for a beautiful young woman, Mrs Dubedat, who consults in search of a cure for her moribund, consumptive, but divinely gifted husband. Now we see Colenso's dilemma. He has already promised the last slot in his forthcoming treatment programme to a consumptive colleague, the plodding but decent Dr Blenkinsop, who, after working all his days in a deprived, disease-ridden general practice, has eventually been infected by one of his hapless patients. The ensuing drama, brimming with high comedy and sizzling one-liners, brilliantly fillets Colenso's personal and professional ethical system, as he is squeezed into a decision that leaves him (as with all successful tragedies) reduced and chastened.

What constitutes a good doctor? How should medical services be organised? On what basis should doctors choose who is to be given the chance to live and who, in consequence, may die? All of these questions and more are tackled by The Doctor's Dilemma, a play that, while perhaps not the greatest of Shaw's works, is peppered with thought provoking argument and, crucially, is still highly relevant to our times. It is, in consequence, an undoubted medical classic.


Articles from The BMJ are provided here courtesy of BMJ Publishing Group