The Detective and the Virtuoso

Arthur Conan Doyle was an MD before he sold his first book, A Study in Scarlet. In it, he introduces Sherlock Holmes, a character he modeled, at least partially, after his college professor, Joseph Bell.

Holmes incorporates two of the, to a physician then and now, most important facets: that of a virtuoso and detective.

No one can be both, except for the rare superhero. A detective deduces. To them, the small things matter, the fine mesh of information and knowledge they weave, matters more. Detectives seek truth through the analysis of seemingly unconnected and falsely interconnected facts. A medical detective knows the body as well as the environment in which it exists, knows the threats it faces, and its peculiarities.

A virtuoso, on the other hand, practices. Much. To them, knowledge means the application of skill, a deep dive into the finer and finest details of a case, and being able to suss out and remove the offending part. This may sound like a surgeon’s calling, but an intensive care physician, able to masterfully stabilize a patient, is just as much a virtuoso.

Doyle knew that he had already created a highly unlikely figure: the virtuoso detective. It was, thus, that he did not add the two other qualities a physician must bring to Sherlock Holmes’ personality. Instead, he gave him Dr. Watson. Watson embodies the other two, arguably as important, if not more so, facets of medicine: humanity and strength.

Watson is a war veteran, wounded, and scarred by enteric fever. Yet, when (at the end of Doyle’s series), World War I happens, he signs up with the Army once more, never to be mentioned again. He is also a man of empathy and extraversion, dating and marrying, where Holmes barely recognizes the existence of romance beside a curious factoid, useful in his investigations. Holmes’ cold, data-driven approach and Watson’s humanity mesh to create the successes of the “consulting detective” business at 221B Baker Street.

The Case of The Modern Physician

While both, detectives and virtuosos, are needed in modern medicine, neither can be of service without including the qualities provided by Watson. It is speculated that Doyle modeled Watson around his colleague, Dr. James Watson, a man said to be exactly that: jovial and a “man of the people” who understood the fears and hopes of his, often rural and less educated, clientele, while also being capable of great feats of resilience and strength.

We’re free to choose our path, virtuoso or detective, but we should always be reminded of our and our patients’ humanity. Resilience can be trained, but humanity is an inherent trait and often the first thing said about colleagues and physicians when referring to them. A is “a nice person,” while B “is quite the ahole.” Those characteristics are often, in intercollegial and interdisciplinary conversations, prefixed, long before the physicians’ skills and mind are discussed. To patients, this is, in fact, the only “interface” they experience that bounds their illness or injury to the medical profession treating them.

Sadly, modern medical schools seem to disregard this important facet more than just a bit. During Doyle’s medical journey, physicians would first apprentice under another, experiencing patients and their complaints long before the first medical term was learned. Only after they understood the person, their fears, and their needs and graduated from this apprenticeship would the academic part, the learning of the intricacies of the body and its functions, begin. Today, young students, having barely graduated from the sheltered and isolated world of schools and family homes, are thrust into the academic definition of the body and its ailments. Bones are named, muscles learned, and minute traces of substances understood in their interactivity with the vast network of organs and transports in the body. Thus prepared to choose between Virtuoso and Detective, those young physicians are now tasked with, while struggling to learn and understand in clinical settings, finding their humanity and building their resilience.

The Future

Medicine is ever-changing. Medical knowledge doubles every 12 to 15 months, what was true yesterday may not be tomorrow. Both virtuoso and detective more and more rely on tools to perform their work. Detectives run large datasets through even larger scenario databases, virtuosos serve their patients better by augmenting their skill trough modern means, such a cyber-knives or DaVinci robots.

But the “Watson Component,” humanity and resilience, remains. And with technology aiding us in the Holmes side of things, maybe it is time again, to focus on those. Both in medical school and in practice. More time for humanity, thanks to less time spent being a detective. That doesn’t mean those traits will die out. Quite to the contrary, they will flourish and enable a new generation of even more effective detectives and skilled virtuosos. But beneath all that, we would do well to remember those Watson traits. And free up some of that new found time to concentrate on them.