Moral imagination

William House, Retired GP; JHH editorial board member

Published in JHH17.3 – Beyond COVID

I love the word ‘flourishing’! It conjures in my mind a blossoming of human potential, achievement and joy. So when I heard that the theme of this edition was to be Flourishing in Medical Education I jumped at the chance to write my column on this subject.

There is so much that is important in medical education and medical practice – yes, of course, knowledge and physical skills are vital and the so-called ‘bedside manner’ but surely there must something deeper that depends on human relationships. For my part, I feel much more comfortable understanding the knowledge and practical skills as the ‘nuts and bolts’ of medical education and practice. This creates a space for under[1]standing the human relationships between practitioner and patient, (and also between teacher and pupil) as feeding the soul of clinical and educational practice.

My undergraduate medical training was at the Middlesex Hospital Medical School in London’s West End. One of the very few physical reminders I have from those times is a 1971 edition of the Cecil-Loeb Textbook of Medicine. It is a very large and extraordinarily heavy book. I tried to weigh it for this column on our kitchen scales but they weren’t equal to the job – the word ‘Error’ was the best they could do! This great big book has 1,923 pages of text and an index of another 50 pages. All of this is held together with hefty dark red covers, more or less the colour of dried blood.

1971 was the year I took (and thankfully passed) my final exams and graduated from university – a fledgling doctor. Perhaps I thought that having become a real doctor I should have a proper doctor’s textbook? Looking through this textbook again now, I was shocked that almost every page has my pencil annotations. Much of my reading must have been after the final exams but I cannot imagine how I could have found time to do all this reading while working as a junior hospital doctor. But maybe this intense reading was my attempt, as a freshly qualified doctor, to reconcile my instincts for how do my new job as well as I could in the midst of the broad approach revealed in the book contents. It was certainly fascinating and useful in a practical sense, but the book pays precious little attention to the person that is the patient and, for that matter, the person that is the practitioner. So perhaps it was here that my passion for humanity in healthcare was first kindled – in the realisation of what is often missing from medical education and practice. To this day, so many years later and long retired from practice, still I use every opportunity to question the values that dominate modern medicine.

When I open my copy of Cecil-Loeb, as I have done just now on my desk as I write these words, I find three short pieces of handwriting. One in prose, and two that are more poetic. They were written with great care in dark blue ink on the very first page (facing the back of the front cover). They are undoubtedly in my handwriting. I have reproduced these writings below. They were probably written in the mid 1970s.

A comforting thought for physicians is that however difficult modern science is making things for him in the management of diseases, it is making things ever so much better for his patients.

No attribution

Guerir quelquefois [Cure sometimes Soulager souvent

Relieve often Consoler toujours Console always]


From inability to let well alone; from too much zeal for what is new and contempt for what is old; from putting knowledge before wisdom, science before art, and cleverness before common sense; from treating patients as cases; and from making the care of the disease more grievous than its endurance, Good Lord deliver us.

Sir Robert Hutchison