12. David Mendel

“The role of doctor, like the role of Hamlet, is not one which you can leap onto the stage and perform.” -David Mendel

            In certain professions, we expect a performance. We understand that politicians, for example, are not simply being themselves but playing a role that is expected of them. What they lose in authenticity, they gain in authority. Or maybe their mimicking of authenticity, of being a regular person, is skilled enough to convince us. But even though we may like to imagine that our senator is just a commonsense down-to-earth guy or girl we can see ourselves inviting to our barbecue, most of us realize deep down that this is not the case.

            This performative aspect holds true, as well, for any public-facing profession, whether or not we choose to think of it. We might look at a server at a restaurant as staging a bit of an act, putting on airs of excessive solicitousness in hopes of a better tip, but what about, say, a member of Best Buy’s Geek Squad? What about a public librarian? Or a grocery store employee? When I worked recently at an upscale grocery in a tourist town, it was all performance. I made myself up every day to pretend I didn’t hate my customers; often, I imagine, my performance was less than convincing. (When, in my 20s, I was a public librarian, my performance was probably a little better.)

            But what about a doctor? The idea that a doctor could be staging a performance, disappearing into a role, is, on the surface, an alarming one, but it is, according to the late English medico David Mendel, the key to a physician’s success in treating patients. In his 1984 manual, Proper Doctoring, Mendel dispenses a book’s worth of advice on all those non-medical aspects of the profession that normally don’t get covered in such manuals, which is to say, the doctor-patient relationship. In a series of pithy, sharply observed little chunks of prose, he outlines the proper stance that a doctor should take toward his charges, and it appears at first to be a refreshingly patient-centric approach. As he examines the patient, the doctor must always be patient, solicitous, and above all nice. This is where the acting comes in. “If you are unhappy or tired or annoyed or feeling ill,” Mendel writes, “you must not let it interfere with your performance… You put on your niceness with your white coat, and however horrid you are in real life, you pretend to that degree of niceness which is necessary for optimal results.”

            But part of this performance also involves the strategic withholding of information and this is where Mendel’s apparently patient-centric approach is revealed to be only apparent. Mendel is all about the therapeutic effect of what the doctor communicates, both verbally and non-verbally, and it would certainly seem true that not telling a patient every unnecessary detail about her condition might be a wise judgment call, but what about informing a dying patient about how long she has left to live? Mendel isn’t having it. “A prevalent fallacy among both doctors and patients is that people ought to be told that they are going to die if only to ‘put their affairs in order,’” he writes, dismissing this notion out of hand because “there are few affairs of sufficient importance to the dying to make it worth while upsetting their last days.”

            The obvious answer to this is that it is not—or should not be—the doctor’s decision, but Mendel has built up a system and this system demands this withholding of information. It also demands an impressive performance as the doctor cannot betray the fact of the patient’s impending mortality through so much as a stray gesture. Proper Doctoring was first published 25 years ago (it was reissued to American audiences in 2013 by New York Review Books), so perhaps attitudes have changed somewhat in this regard, or perhaps Mendel’s attitude is specifically British, or perhaps it was always atypical of the profession. Whatever the case, his book’s lasting values comes in making us see that doctoring, like any other profession, is largely a matter of performance. Whether or not that performance lands with its audience—or whether or not it is ethically sound—depends almost entirely on the actor.