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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 November 3; 335(7626): 941.
PMCID: PMC2048862
Between the Lines

The therapy of obedience

Theodore Dalrymple, writer and retired doctor

It is more difficult these days than ever before to be a literary doctor, what with continuing medical education, revalidation, 360 degree appraisal, the research assessment exercise, and other hobgoblins of the bureaucratic mind, to say nothing of the increase in the actual work to be done.

Time was, however, when even the busiest doctors could retire to their studies and write occasional essays. One such was the Edinburgh physician John Brown, who was born in 1810 and died in 1882. He was famous for his Horae Subsecivae, that is to say Idle or Stolen Hours, a collection of miscellaneous essays that were reprinted many times, but are now forgotten except, perhaps, by the silverfish and other small creatures that inhabit the less frequented parts of second hand bookshops.

Dr Brown was strongly of the opinion that a man should not write unless he had something to say, a dangerous principle that, if taken seriously, would denude the world of much, perhaps most, of its printed matter, not least a good proportion of the medical journals.

My favourite among his essays is entitled “The Doctor—our Duties to him.” This was one of his series of lectures on matters of health to the working men of Edinburgh, and contains four duties of patients to their doctors that, I think, would now cause howls of rage among medical ethicists and other right minded people. They are as follows:

First, It is your duty to trust the Doctor. Secondly, It is your duty to obey the Doctor. Thirdly, It is your duty to speak the truth to the Doctor, the whole truth, and nothing but the truth; and Fourthly, It is your duty to reward the doctor.

We must not imagine by this last duty of the patient to his doctor that Dr Brown was an avaricious man; on the contrary, he was universally loved and respected in the Edinburgh of his time, which I am sure would soon have sniffed out any tendency on his part to greed or illicit enrichment.

While Dr Brown explicitly counted the gratitude of patients among the rewards a doctor could reasonably expect, he thought that payment was good for patients, and he provided reasons for this opinion that are not negligible, but are alien to most modern sensibilities:

Now, I know that few if any of you can pay your Doctor . . . but let me tell you—try and pay him, be it ever so little. It does you good as well as him; it keeps up your self-respect; it raises you in your own eye, in your neighbour's and, what is best, in your God's eye, because it is doing what is right.

Dr Brown would no doubt think we, for our part, had fostered dependence in our patients, and in compensation had returned to them a kind of querulous autonomy. Self importance, not self respect, is what we value now.

As for obedience, Dr Brown illustrates its therapeutic virtues by recounting the case of a man given a prescription by his doctor with the order to “Take this,” who subsequently returned to the doctor completely cured. It turned out that he had eaten the piece of paper on which the prescription was written, and felt much the better for it.

Time for a controlled trial?

It turned out that the man had eaten the piece of paper on which the prescription was written, and felt much the better for it

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