09:30 – 10:30 PLENARY LECTURE

 What Archie Cochrane’s Case Narrative of 1943 Teaches

 Brian Hurwitz

Known as the founder of evidence-based-medicine, Prof Archie Cochrane’s fascinating memoir, published after his death, is about his ‘misdiagnosis’ of a dying POW screaming. A newly qualified clinician in chest medicine, he diagnosed the young Russian as in pain from pleural rub; having no morphine he did the only thing, held him in his arms – whereupon the screams stopped – until he died, peacefully.

Of especial interest was his report of his ‘shame’: at his misdiagnosis (the screams were presumably fear: of death, of dying alone) and/or of his breaking the clinician-patient boundary, becoming instead ‘co-present’, as human to human.

Is there still a sense of shame in modern clinicians, despite all the hospice care and Rita Charon’s writing and moving TED talk – Honoring the stories of illness | Dr. Rita Charon | TEDxAtlanta – YouTubehttps://www.youtube.com/watch?v=24kHX2HtU3o

And is there more to be said about medical shame? Ie, not that of the patient (about which more should be said in any case!) but of the clinician? Caryl Sibbett talked about the sort of knowledge: of the human condition, of the limitations of medicine, of the vulnerability/lack of vulnerability of doctors to disease, of the shame of being a patient especially when a doctor….that medical practitioners find difficult to – sic – grasp. (Nettlesome knowledge

Nettlesome knowledge, liminality and the taboo in cancer and art therapy experiences: implications for learning and teaching. / Sibbett, Caryl; Thompson, W.T.)

Threshold Concepts within the Disciplines. ed. / R. Land; J.H.F. Meyer; J. Smith. Rotterdam: Sense Publishers, 2008. p. 227-242.