Exactly 100 years ago today (20 November 1906), George Bernard Shaw’s play The doctor’s dilemma had its premiere performance. A central theme in its preface was that doctors could not be trusted to act in their patients’ best interest, because “doctors are hideously poor” and, accordingly, had a direct personal and pecuniary interest in patient treatments.
Shaw was equally scathing about the profession’s involvement in “a conspiracy to hide its own shortcomings”; its overwhelming preoccupation with illness at the expense of preventive medicine; its failure to acknowledge the role of science; and its employment of “the grossest quackery”. Finally, as a prominent member of the Fabian Society, Shaw proposed that the medical profession become “a body of men trained and paid by the country to keep the country in health”.
What would Shaw make of medicine today? He would immediately recognise that doctors are no longer hideously poor. He would approve of the UK National Health Service, but be disturbed by political moves for its privatisation. He would further contend that the profession continues hiding its shortcomings and would point to the Bristol Royal Infirmary and Bundaberg Hospital scandals. But he would be heartened by the profession becoming more open and proactive in dealing with medical mishaps. Finally, he would enthusiastically endorse evidence-based medicine.
However, Shaw would attack the commercialisation of medicine by doctors and international megacorporations, especially their manipulation of market demand by their promotion of social ill health. And he would surely lament the relative impotence of preventive health in influencing modern lifestyle maladies. Finally, one can imagine that alternative medicine would not escape his vitriolic pen.
But society and medicine have changed — utterly changed. Indeed, what is the modern doctor’s dilemma?