Literary Portraits of the Family Physician

LITERARY PORTRAITS OF THE FAMILY PHYSICIAN TONY MIKSANEK* Doctors have been portrayed in literature as everything from gods to goons, reflecting not only the variety of attitudes and emotions conjured by the medical profession but also cultural and socioeconomic differences . Both good and evil doctors abound in the pages of world literature past and present [1], as evidenced by the familiarity of names such as Dr. Jekyll, Lemuel Gulliver, Doctor Zhivago, and Sherlock Holmes's foil, Dr. Watson. Fictional family physicians, however, have fared exceptionally well in comparison to other literary medical practitioners. If the definition of a family physician is extended to include the general practitioner and country doctor, then this group of physicians are well represented in works of literature. Certain images and qualities of fictional family practitioners surface repeatedly, including a strong sense of patient advocacy, dedication, compassion, and community service. Selected works of literature are reviewed which highlight the image and role of the family physician. Certain features or symbols can function to identify the doctor, such as a white coat, stethoscope, and black bag. Attire, such as the revered white lab coat, may symbolize or communicate authority, professionalism , purity, and even goodness. In modern America, the doctor's white coat frequently symbolizes the medical profession [2]. Contrary to the formality of the white labjacket, fictional family doctors are more likely identified by a worn overcoat or a black bag. Whether for practical reasons (such as the need to stay warm during frequent night calls) or symbolic ones, literature's family doctors are generally outfitted in coats other than white. For example, in Sarah Orne Jewett's A Country Doctor [3], a noted country doctor is identified by a "rough driving coat." Similarly , the youthful country doctor in Mikhail Bulgakov's A Country Doctor 's Notebook [4] is found battling blizzards, disease, and ignorance, armed only with "an overcoat topped by a sheepskin, fur hat" [4] and *Benton Medical Center, 205 Bailey Lane, Benton, Illinois 62812.© 1992 by The University of Chicago. All rights reserved. 0031-5982/93/3601-0798$01.00 Perspectives in Biology and Medicine, 36, 1 ¦ Autumn 1992 57 a black bag. The doctor's black bag also serves as a symbol of family physicians, and Bulgakov's character lists some typical (and surprising) contents of one such bag: "caffeine, camphor, morphine, adrenalin, clamps, sterile dressings, hypodermic, probe, Browning automatic, cigarettes , matches, watch, stethoscope" [4]. Nineteenth-century American literature frequently represents the country doctor making house calls in a horse and buggy, and as time passes, the evolving modes of transportation are clearly chronicled by fictional physicians visiting their patients by horse, then horse and buggy, and finally automobile. A wide diversity of physician age is represented in literature, ranging from the revered experience and reassurance of the nearly retired general practitioner to the youthful enthusiasm (and perhaps insecurity) of the freshly graduated doctor. In this regard, Bulgakov's country doctor confesses the basis of his diagnosis: "Intuition prompted me. No need to rely on my knowledge; as a doctor only six months qualified, I had none" [4]. Female family physicians are positively portrayed even in nineteenth-century literary works such as Doctor lay [5] and A Country Doctor [3]. Typically, the paternalism of fictional family practitioners is admired rather than abhorred, since it is viewed as an essential element in the doctor's effectiveness in helping patients improve and recover from their illnesses. Authors have placed a high premium on the ability of family doctors to comfort their patients even when unable to heal or cure. Late nineteenth- and early twentieth-century literature depicts a doctor -patient relationship quite different from today's. Patients are described as having decreased expectations of both the physician and healing . As such, patients have fewer complaints, and less is expected from the doctor in terms of curing illness or extending life. From the physician 's perspective, there is often little he can do to affect the outcome of an illness. Hence, literature suggests that both fictional doctors and patients agreed on one thing: the doctor's chief duty is to attend. Availability is of primary importance, and the ability to reassure, comfort, or simply preside at...