The drama of being a doctor

All the world’s a stage,
 And all the men and women merely players;
 They have their exits and their entrances,
 And one man in his time plays many parts,
 (William Shakespeare As You Like It II.vii)

One comparatively unusual and perhaps uncomfortable way of thinking about the practice of medicine is that the consultation with a patient is a kind of theatre. The doctor and the patient have their roles, actually encapsulated by the medical sociologist’s Talcott Parson’s conceptualisation of the “sick role”—which the patient plays.1 What part the doctor adopts has oddly received less attention from medical sociology, partly perhaps because the profession is resistant to the notion that sometimes the consultation entails playacting.

Talcott Parsons idea of the sick role in the 1950s was the first theoretical concept that explicitly concerned medical sociology. In contrast with the biomedical model, which pictures illness as a mechanical malfunction or a microbiological invasion, Parsons described the sick role as a temporary, medically sanctioned form of deviant behaviour.

Parsons used ideas from Freud’s psychoanalytic theories to shed light on the social and psychological forces involved in episodes of sickness. The Freudian concepts of transference and counter-transference led Parsons to see the doctor/patient relationship as analogous to that of the parent and child. The idea that a sick person has conflicting drives both to recover from the illness and to continue to enjoy the “secondary gains” of attention and exemption from normal duties also stems from a Freudian model of the structure of the personality.

Since Parson’s work other issues like “breaking bad news” have received much similar attention in the academic …