The most self‐important person I have ever met was the proprietor of a cheese shop. He wasn't hostile, like the famous cheese salesman portrayed by John Cleese in the television sketch. He behaved more as if he was a professor of cheese studies at Oxbridge. If you named a cheese, he would hold forth on its history, its bacteriology, its merits and its drawbacks. He didn't sell Gorgonzola, only ‘Mountain Gorgonzola’. I once asked him if he stocked valley Gorgonzola, but he didn't think that was funny. Then I had the temerity to ask for some ‘cheap and cheerful Cheddar’ for a cauliflower cheese. He explained solemnly that, if a cheese was worth cooking with, it was worth paying for, too.
We finally fell out when I arrived one day to find a hole in the pavement outside his shop, because a water main had burst. I asked him if one of his cheeses had exploded and he was furious. He had lost a lot of business that day because of the hole. I never dared to go in his shop again.
Looking back, I think my attempts to provoke him were rather ironic, since I probably belong to the most self‐important profession of all. No one takes doctors more seriously than doctors themselves. Possibly this is because we lack any form of institutionalized court jester to take us down a peg or too. Unlike lawyers (at least until they become judges) we do not have opposing advocates trying to pick holes in every argument we propose. Unlike politicians, we do not have anyone to jeer at us, or throw eggs at our clean white coats. Our clients never tease us in the way I teased the cheese man. In day‐to‐day life, our self‐importance goes largely unchallenged and therefore largely unexamined.
On the whole, the written literature of medicine only inflates our self‐esteem even further. There are dozens of excellent books telling us how to become more compassionate and humane as doctors (and some hint subtly at the authors’ eligibility for sainthood), but I cannot ever recall reading one that advised doctors to ‘come off it!’ This is a shame. The mentors who have most inspired me have shared a certain quality that I would describe as a twinkle. They knew when patients needed them to crack a joke or to swear. Above all, they seemed to take their patients far more seriously than they took themselves.
There is a corollary to this. Pomposity actually sits better on many other professions than it does on doctors. I have enjoyed many an evening out in good restaurants, admiring head waiters who knew how to play their part. They understood that their job required a certain sense of theatre, and a performance of gravitas, in order to make customers feel that they were getting their money's worth. Had they been cardiologists, their comportment would have been ludicrous. Medicine is too serious a job for acting a part. Patients need authenticity, and they can spot fake piety or defensive arrogance a mile off. Most would probably prefer their consultant to chuckle rather than to pontificate.
Shedding self‐importance also conveys a further message: when all is said and done, medicine is just a job. Some people are road menders and some are hairdressers; it is a moot point whether doctors end up making people's lives safer or happier than these professions, or many others. We also become doctors for a variety of reasons that are no more moral or immoral than anyone else's reasons for choosing their occupation. Yet unlike others, we seem to buy into the delusion that we are special.
It really is a delusion. I remember when I first discovered this as a house physician. I walked onto the ward one evening carrying a portable ECG machine, but pretended I had brought some tools to mend the TV. The patients thought at first that I was serious, and were bitterly disappointed when they discovered I had neither the tools nor the skill to fix it.
When I say that medicine is ‘just a job’, it may seem dismissive or even contemptuous. I do not mean it in that way. I think we should reclaim the phrase as a token of proportionate humility. There is honour in ordinariness, and maybe sanity too. I sometimes wonder if the crimes of medical murderers such Shipman and Bodkin Adams arose not just from some quirk of brain biochemistry or childhood deprivation, but also from an exaggerated sense of professional self‐importance. In them, it may have been writ very large indeed, but it is never entirely absent in medical institutions. The collective conscience of the profession usually keeps it within bounds, but not always.