International Journal of Medical Education.

2010; 1:2-4
ISSN: 2042-6372
DOI: 10.5116/ijme.4b8a.fba9

Sir Robert Hutchison’s Petition and the

Medical Humanities
‘From inability to let well alone
From too much zeal for the new and contempt for what is old
From putting knowledge before wisdom, science before art, and
Cleverness before common sense;
From treating patients as cases;
And from making the cure of the disease more grievous than the
Endurance of the same, Good Lord, deliver us.’ – Sir Robert Hutchison

Sir Robert Hutchison was physician to the London Hospital turning ordinary life events and the ups and downs of
and to the Hospital for Sick children at Great Ormond normal life into medical conditions. The phenomenon of
Street in the later part of the nineteenth and early part of the disease mongering has attracted attention recently. Disease
twentieth century. He is famous for his book ‘Clinical mongering can turn ordinary ailments into medical prob-
Method’, first published in 1897. The twenty-second edition lems, see mild symptoms as serious, treat personal problems
of this path-breaking book on clinical examination has as medical ones, see risk factors as diseases and frame
recently been published. Sir Robert Hutchison is famous for prevalence estimates to increase the market for medicines.3,4
his clinical sayings and especially for his petition written in Knowing when to prescribe a medicine and when not to
his later years. In this article I examine Hutchison’s petition prescribe medicines is an important skill for a doctor. Using
with reference to Medical Education in general and Medical drugs for physiological conditions may not be a good
Humanities education in particular. option. Many conditions respond to non-drug measures
I am a Clinical Pharmacologist and a medical educator and psychological counseling and support. Life style diseas-
at KIST Medical College, Lalitpur, Nepal. I am especially es are becoming more common and maintaining a healthy
interested in the Medical Humanities (MH). In a blog life style can reduce the prevalence of these diseases.
article I had described how I started a MH module for
students at two medical schools in Nepal and conducted a Zeal for the new and contempt for the old
module for faculty members with the help of a fellowship In the second line Sir Robert Hutchison talks about too
offered by FAIMER (Foundation for Advancement of much zeal for what is new and contempt for what is old. I
International Medical Education and Research).1 The MH will first examine this statement in the context of modern
module for first year undergraduate medical (MBBS) drugs and then look at it in the context of other treatment
students was called Sparshanam meaning ‘touch’ in San- modalities. Newer drugs are strongly promoted and mar-
skrit, an ancient language from which many languages of keted for a number of conditions. In many cases a new drug
South Asia are derived. The module facilitators had in a may not be the best treatment option available. Drugs are
recent article described their experiences with designing tested on animals and then undergo clinical trials on
and conducting the MH module.2 The module used paint- healthy volunteers and patients before they are marketed.
ings, group activities, role plays and occasional literature The problem is that these studies are carried out on a
excerpts to examine various aspects of the humanities. limited number of patients only. Many conditions of
Hutchison’s petition was discussed in detail by the student normal use of the drug are not addressed in clinical trials.
groups during the module with comments by the facilita- Considering the limitations of data obtained from clinical
tors. trials even after a drug is marketed it remains under post-
marketing surveillance. Many adverse effects become
Inability to let well alone evident only after marketing and widespread use of a drug.
The petition starts with the statement ‘from inability to let The famous clinical pharmacology textbook by Bennet
well alone’. In the modern world drugs are increasingly and Brown has a diagram describing the life cycle of a drug.5
being promoted and used for improving normal function- A drug is usually introduced with much hype in the market.
ing and for conditions which can be regarded as physiologi- Initially people are skeptical but then the drug shows good
cal and a part of normal life. Convincing healthy people results in early studies. The drug is then hyped as a “wonder
they are sick or can use medicines to further improve their drug”. Soon, however, reports of serious adverse effects are
functioning will enormously increase the market for medi- noted, and sometimes even deaths occur. The drug is then
cines. Medicalisation has been described as the process of at the nadir of its popularity. People begin to term the drug

2
© 2010 P. Ravi Shankar. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use of work
provided the original work is properly cited. http://creativecommons.org/licenses/by/3.0
Shankar  Sir Robert Hutchison’s petition

as a poison. Eventually we know more about the drug and and not as hospital numbers or cases with an interesting
begin to understand it better. We know in which conditions disease.
it can be used and what are the precautions regarding its
use. Eventually the drug finds its status in therapeutics. This Making the cure of the disease more grievous than the
may also be true of many new non-drug treatment modali- endurance of the same
ties. Old and trusted treatments which have been used for Drugs and modern technological procedures can relieve
many years in a variety of patients are worth their weight in symptoms, prevent disease, offer palliation and pain relief,
gold. and occasionally cure. The issue of quality of life, euthanasia
and helping patients to die with dignity is hotly debated. In
Knowledge before wisdom, science before art our MH sessions euthanasia and the right to die with
The third line talks about the hazards of putting knowledge dignity is discussed in detail by faculty and students. Some
before wisdom and science before art. In the early seventies patients with no real hope of a cure are often aggressively
and eighties in developed nations concern was raised about treated with medicines and radiation; procedures and
the overemphasis on science in modern medicine. Modern medicines that are expensive and can be a huge drain on
medicine has developed on scientific discoveries but the family finances (especially in developing countries). Cancer
neglect of the art of healing had led to many deleterious patients so treated may suffer from nausea and vomiting,
consequences. MH arose as a result of acknowledgement of ulceration of mucous membranes, loss of hair, decreased
these deficiencies and aims to provide the contrasting immunity, and increased risk of infection.
perspective of the arts to the scientific one which dominates One of my students who worked in a remote district af-
modern medicine. The practice of medicine is both a ter graduation recently came to visit me saying that in many
science and an art and we neglect the art at our peril. Today cases of terminal cancer he advocates only symptom relief
MH programs are well established in developed nations and and advises patients and their families not to pursue aggres-
have been started in certain developing nations also. sive and expensive modern medical treatment. I think this is
Wisdom is defined as understanding the limits of one’s a sensible policy elsewhere as often families exhaust all their
knowledge and skill. It has been said that person with resources treating ‘incurable’ patients. The issue of what is
knowledge is proud that he/she knows so much while a ‘incurable’ however, is often difficult to determine. Lack of
person who also has wisdom is apologetic that there is so resources and finances makes life difficult for the living
much more to know. Knowing the limits of one’s know- relatives.
ledge and where he/she or the patient can obtain more
information is important in modern medical practice. Many Good lord deliver us
eminent personalities in medicine including Sir William Asking God to save us or protect us from evil is a common
Osler, the father of modern medicine have repeatedly practice while praying to the Lord not only in Hutchinson’s
emphasized the importance of ‘wisdom’. Christianity but also in other religions. When we used the
petition in our MH classes certain students (of other reli-
Treating patients as cases gions) had difficulty in understanding these words and so
In the scientific and technical context of modern medicine failed to properly interpret Hutchison’s petition. We as
it is easy to forget about the patient as a human being and facilitators had to tell them about Hutchison telling students
about the human dimensions of suffering. In a busy teach- and doctors to avoid various actions and practice medicine
ing hospital patients are liable to be considered as cases. At in a humane and compassionate manner. On pointing out
KIST Medical College we discourage patients being referred the modification they were able to follow the thoughts of
to as cases and encourage students to approach them as the writer and understand the importance of Sir Robert
human beings. Illness causes a number of changes in the life Hutchison’s message.
of an individual. When a sick person enters a hospital, all Sir Robert Hutchison’s petition, written more than 75
that is familiar is left behind.6 years ago in an environment of medical practice quite
MH teaches students to treat patients as human beings. different from what we are accustomed to, remains still
It employs initiatives such as sessions on the doctor-patient relevant today.
relationship, looking at the human dimensions of illness,
obtaining a holistic narrative history of patients, and Acknowledgement
‘parallel charting’. 7,8,9 In parallel charting in addition to the
usual formal case history an additional history is obtained The author would like to acknowledge the help of Dr.
dealing with the effect of the illness on the persons’ life, Donald Messerschmidt, Anthropologist and creative writer,
his/her family and community. Many years before MH Vancouver, Washington, United States in copyediting the
terminology came into vogue, the astute Doctor Hutchison manuscript and suggesting modifications.
recognized the importance of treating patients as humans

3
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Email: ravi.dr.shankar@gmail.com

4 Int. J. Medical Education. 2010; 1:2-4