In the performing art of medicine: the doctor as actor.

How much of a doctor–patient interaction is acting by one or both participants? Doctors seem to dislike the word acting as a descriptor for the part they play in a clinical consultation, preferring words like professionalism to account for their approach and behaviour with patients. Having no difficulty with the concept of patients being cast in a sick role, they demur from the notion of themselves acting, perhaps considering it a mark of insincerity, something phony. Previous suggestions that the ability to act confers on a doctor the gift, irrespective of their mood, to respond appropriately to a patient’s concerns, seem to have gone unheeded. Once an important part of a doctor’s interaction with patients, acting is a lost part of the art of medicine, worthy of reconsideration. Acting, in this context, is a willingness to release one’s personality, that is, to act out one’s personality—from within, and not a pretense or an affectation of deception. While primarily for patients’ benefit, this form of acting can also help clinicians enjoy and embrace the ordinary, turning routine into extraordinary. The clinical consultation has been likened to a duet, the patient leading, setting the tune and tempo, to which the doctor responds. Jazz is produced when the doctor’s improvizations are effective; occasionally, the duet falls out of tune and sometimes there is noise. ‘Most people who fall ill have chosen to cast themselves in the role of patient’ according to Jonathan Miller. ‘Viewing their unfortunate situation, they see themselves as sick people and begin to act differently.’ Anatole Broyard’s brilliant analysis of his own terminal illness, concluded that ‘there is an etiquette to being sick’ and that ‘every seriously ill person needs to develop a style for his illness.’ As a means of coping, the adoption of a style gives the patient a voice for his or her illness to meet it on one’s own terms, not to surrender to it but to reduce it to a mere character in the narrative. Developing a style for illness also helps avoid falling out of love with oneself. ‘The sick person’s best medicine is desire— the desire to live . . . ’, and this, for Broyard, is part of staying in love with oneself. Trying not to act sick for his doctor, lest the latter see only his illness and not his person, he conceded that ‘I juggle him. I toss him about. I throw him from hand to hand, and he hardly knows what to do with me.’ Was this acting by another name? His plea was for doctors to go beyond the science into the person and to encourage patients’ stories. He had high expectations of his own doctor, demanding not only talent but also a doctor with style. Doctors, for their part, continually adapt and improvise their role to what is presented by their patients’ illnesses. When doctors were ineffective and limited to prescribing potions, purges and placebos for the suffering, the performative nature of their role was more in evidence. An inspection of the portraits of distinguished clinical gentlemen from bygone times, now hanging in gilt-laden halls, with each subject coiffed and posed in ceremonial finery, will leave no doubt as to the theatrical potential of the medical profession. Several literary accounts, many humorous, of celebrated doctors provide a familiar portrayal of what was once an important part of the doctor’s act. Marcel Proust, whose father and brother were doctors, had the opportunity to observe the medical profession at close quarters. During a visit by Dr. Dieulafoy, not to cure the patient but more to confirm for the family what they already knew—that the patient was in extremis—‘one thought one was in a Molière play.’ Received in the drawing-room, ‘like the actor who is next to appear on the stage . . . ’ the doctor entered the sick room with a dignified bearing, ‘tempered by a decorum suited to