Sherlock Holmes

Dr Grumble's latest batch of medical students are very green. Very bright but no knowledge. Everything clinical is new to them. It's rewarding to teach bright students who know very little. The less they know the more you can teach them. It's like starting with a blank canvass and painting a masterpiece. Maddeningly Dr Grumble has his students for only a month. It's crazy, of course, but nobody listens to Grumble. He used to have them for eight weeks. In that short time if students and Grumble worked hard the rudiments of history taking and examination could be taught. The beginnings of a masterpiece could be created. Some of these students will end up much greater and more important than Grumble. Amongst them may even be the Lord Darzis of the future. And, hopefully, some really good GPs.

The job of teaching is important but there's little reward. Nobody in the hospital hierarchy really cares about how well you do your teaching. They say they do but they don't. Small group teaching is essential when it comes to clinical work but only the small group even knows you have done it. These days they report back online on the quality of the teaching. But sometimes they do not quite know how good their teaching has been. They do not know that the notes they write will forever be better structured than the notes of those who were not taught properly. They do not know know how those difficult questions were not to make them look stupid or to check their factual knowledge but to get them thinking in the right way to be a decent doctor. They do not know what they don't know, what they really need to know and where they are heading.

Eventually Grumble's students do realise what he was trying to do. Sometimes anyway. Just occasionally Dr G will get an email from a student or doctor thanking him for teaching that took place years earlier. Sometimes in these emails they explain that it was only later they came to realise the importance of the Grumble style of bedside teaching. This is Grumble's only reward. It's his greatest reward. It's the only reward he wants. Dr Grumble had teachers he appreciated, teachers he wanted to emulate. He hopes he thanked them.

Some years ago Grumble used to teach Japanese medical students. Don't ask why. Even Grumble does not know. They just turned up and Dr Grumble just taught them. He used to ask them who wrote Sherlock Holmes. They always knew. The home-grown students can look bewildered if you ask them a question like that. They certainly don't see its relevance. But it is relevant. In a way. Because the next question is about how Sir Arthur Conan Doyle got the idea for Sherlock Holmes. And the answer, which they rarely know, is from Dr Bell who used to teach Sir Arthur when he was a medical student. Dr Bell, like all physicians, was a detective. Sometimes he could tell what parts of the world his patients had visited and what jobs they were in. Dr Grumble can do some of this. It impresses students no end.

The other day Dr Grumble met a patient for the first time and told his students in front of the patient that he thought he had been in the army, that he had worked in the past as a coal miner and that the had given up smoking about six weeks ago. The patient dutifully confirmed all this. The students were visibly impressed. Dr Grumble thought that from then on they would be taking him seriously.

How did Dr Grumble do this? It isn't that difficult. Patients who call the doctor 'sir' have usually been in the armed forces, coal tattoos in old cuts are common in previous coal miners and if fingernails grow at 3mm a month it is easy to work out from the tar staining when the patient stopped smoking. Now doesn't that sound like Sherlock Holmes explaining his deductions to Watson? It's easy to see how medicine lay the foundations not only to a series of good books but also to modern detective work. As Sir Arthur says himself in the only surviving recording of his voice. The recording is a bit stilted and there is only a hint of the admiration and gratitude Sir Arthur showed for his teacher, Dr Bell, without whom there may never have been a Sherlock Holmes.