Medical ethicists have recently addressed the use of storytelling in medical practice. This essay examines the medical and detective fiction of Arthur Conan Doyle, a doctor turned writer, to demonstrate the value of a narrative approach to engagements between doctor and patient.
Current discussions of medical ethics that focus on the communication between doctor and patient attend to the use of narratives in medical practice. Kathryn Montgomery Hunter advocates a literary critical model for doctor-patient interaction, arguing that attention to narrative power dynamics will allow for more collaborative, less hierarchical interchanges between doctor and patient. "The recognition of the patient's life story as distinct from the case history and a renewed and careful attention to its nuanced meaning are part of the therapeutic interaction" (171). But Howard Brody, who has championed the increased use of illness-and-life narratives between doctors and patients, as well as what he calls "narrative reasoning" (Healer's 247-52) in medical ethics, admits that patient narratives pose problems for doctors. "Overworked and harried physicians display little tolerance for any information from patients that is not already formulated as [...] the standard 'medical history?'" It is no easy task "to s it in an office all day while one patient after another comes in to tell him his or her life story in full, frank, and intimate detall"(Stories 3). The difficulty of appreciating a series of short, similar stories, bracketed by time constraints and duelling generic expectations surfaces in nearly all practical and theoretical texts about doctor-patient relationships. The question of how short, repetitive stories relate to one another through lapses of time is also of central concern to literary theorists of the short story and of serial fiction. Critics such as Jennifer Hayward discuss how the diversity and complexity of serial fiction tends to disrupt narrative hierarchies among author, reader, and character, allowing for a more diffuse array of power within an "interactive, responsive text" (15)--in short, the same sort of jumbling of traditional power dynamics advocated by Hunter and Brody. As the goal of doctor-patient storytelling is greater interaction, what Thomas Gordon and W. Sterling Edwards call "a collaborative approach," in which the patient is "an active participant in the diagnosis" (31), the narrative dynamics of the serial short story should offer useful insights, particularly if the writer is himself or herself concerned with medical issues.
Arthur Conan Doyle's work seems perfectly suited to such an investigation. Not only was he a doctor when he began writing, but he also developed a new serial short story form in the Sherlock Holmes stories in which a single main character reappears in discrete narratives. Doyle gave up medicine for writing, and the connections between medical and literary forms are emotionally charged for him. His anxieties about narrative power and healing emerge vividly in his short stories about the medical life. Doyle portrays the ability of a doctor to engage in a sort of interactive story-making with his patient as the ideal form of medical narrative, but he also investigates how the constraints and anxieties of medical life push toward more controlled and combative narrative forms.
I begin this essay with a discussion of how Doyle, in portrayals of his medical mentors, focusses on the importance of narrative control in the medical encounter. Next, I demonstrate how Doyle's anxieties about his first profession appear in several of his medical short stories in which doctors find themselves in danger of losing this control, though Doyle as writer manages to maintain it through literary technique. Finally, I examine how Doyle's development of the serial short story is consistent with his portrayal of spontaneous, interactive story-telling between doctor and patient and offers a model for the kind of collaborative diagnostics called for by Brody and Hunter. …