The language of caring

William House, Retired GP; Chair of the BHMA

Published in JHH17.1 – Stories in medicine

Sir Luke Fildes’ famous painting The Doctor has always given me a warm feeling of gratitude to the artist for capturing on canvas this intimate, but tragic, moment. The painting was made in 1887 when general practice was very different to the way it is now. Yet the loneliness of the doctor amidst the distress of the family will be familiar to most doctors. I feel it still, despite having retired from practice as a GP 10 years ago. Using the visual language that he has mastered, Fildes has told us a story that rings true. Unsurprisingly, this image is still frequently used to portray the qualities of a good doctor. Yet, like most things in life, the reality is a little different.

In a carefully researched and eloquent article published in the British Journal of General Practice in 2008, the writer Jane Moore reveals the story behind the painting’s creation.

Sir Luke Fildes (1843–1927) was a well-known Victorian ainter of the social realist movement. He was a contemporary of Charles Dickens … and provided the illustrations for Dickens’ last novel The Mystery of Edwin Drood (1870). Although in his early career, Fildes made his name depicting the plight of the poor, like other painters of his era, most of his income came from painting portraits for wealthy clientele. This included Sir Cecil Rhodes and several members of the royal family.

Moore goes on to explain that The Doctor was commissioned by Sir Henry Tate for the then princely sum of £3,000. It is likely that this painting was at least in part inspired by Fildes’ memories of the tragic death of his own eldest son, Phillip, on Christmas morning, 10 years prior to the painting’s creation. Phillip was … ‘attended by a Dr Murray, who impressed Fildes with the care and attention he gave to his dying child’. Moore quotes other possible influences behind the painting, and then she goes on to describe how the painting was based on, what amounts to, a stage set in the artist’s London studio….

…where he had carefully constructed a cottage interior with the doctor “played by” a professional model who is thought to bear some physical resemblance to Fildes himself. Therefore, this picture, though based on a real event in the artist’s experience, was as fictional and romantic an
account of a doctor’s activity as that found in novels of the period which include George Elliot’s Dr Lydgate in Middlemarch… or even Mary Shelley’s Dr Frankenstein (1818).’

So have I ‘fallen prey’ to this artist’s fiction? Have I been drawn into an unrealistic and romantic idyll? I have been called ‘a romantic old sod!’ in the past, but surely, I must protest that there is more to medicine than academic knowledge, rapid availability and diagnostic skills! Emotional detachment soon becomes coldness, aloofness. If this is so, as I believe it to be, the challenge for the doctor becomes a balancing act: connected with the patient enough to form a therapeutic alliance, but detached enough to avoid being drawn into an unhealthy complicity.

Moore goes on to muse upon the apparent indulgence of the doctor in the painting: remaining with the stricken family when there is no medical treatment available, and effectively using his presence and his time to support them in their tragic plight. She contrasts this with the introduction of the NHS Direct
telephone consulting service in 1997, nine years before her article was written. Later, in 2014, this nursestaffed advice line was, in it’s turn, replaced by the NHS 111 service which seems to be aiming at minimising direct human contact. More recently, this is coinciding with the now widespread use of recorded advice
messages on GP appointment lines in England suggesting alternatives to a GP appointment. It seems to me that the key loss from all of this has been the minimising of the human relationship between the one who suffers and the real, live human being offering (whatever else they may be able to provide) a caring contact. Of course, this is the very service depicted by Fildes in his painting, and by the caring Dr Murray attending the premature illness and death of Fildes’
own son. The endurance of these bedside scenes surely tells us that caring human contact really matters.

End note: The painting can still be seen hanging in the Tate Britain Gallery in Central London. You can see the picture at