Friday, March 21, 2014

Writing Doctors - 1: The Autopsy of Sherlock Holmes

I'm currently re-reading The Complete Sherlock Holmes, with way more pleasure than I had anticipated. I did not remember liking it that much on my first read, over fifteen years ago. I thought it dated and, frankly, a little boring. However, I really enjoyed the BBC's series Sherlock, and it made me want to read the original work again. Surprise, I'm having a blast.

The writing is fast-paced (for the nineteenth century, I grant you), the characters of Holmes and Watson are engaging (with Holmes sometimes laugh-out-loud funny), and their relationship is fun. Of course the stories end abruptly, and the author lazily omits long stretches of narrative that are only dealt with in two or three short sentences. But even that, I found this time around, leaves place for the reader to fill in the blanks, which is something that I love to do. In fact, generations of Holmes fans have actually practiced this in something they call “The Great Game”. Maybe those unfilled gaps also explain why the work has know so many successful adaptations over the years. All that to say that, basically, they're as fun a read as any recent crime fiction bestseller, which I suppose they were in their time as well. 

But one thing of particular interest to me is how Conan Doyle's medical background shows up in his writing.

It's well-known that Sherlock Holmes was inspired by one of Conan Doyle's medical school teachers, so I won't dwell on that too long. What strikes me, however, is how much the famous “Sherlock Holmes method” owes to the diagnostic process used in medicine.

As one of my colleagues recently put it, doctors are like detectives. They use symptoms as clues to deduce what the disease is. Simply put:
1- They listen to the patient's story.
2- They ask a number of questions.
3- They formulate a differential diagnosis, that is, a series of hypotheses as to what the disease is.
4- They examine the patient and run some tests to rule out some hypotheses and rule in others, to arrive at a final diagnosis.

This is exactly what Sherlock Holmes does in almost all of the stories.

1- He meets with the client and listens to his story.

2- He asks a number of questions. These often don't make sense to the client or the reader (which is part of the fun of Holmes' character, of course). That is because, just as a doctor, he is looking for specific information that will allow him to refine his differential diagnosis: he already has, in his mind, various hypotheses that he is seeking to rule in or out through the client's answers. In the same way, the questions a doctor might ask you don't always make sense to you. 

As an example: 
Patient: “My joints hurt all over." 
Doctor: “Have you travelled to New England Recently?” 
That question may seem unrelated to joints, but the physician is thinking of Lyme disease as a possible cause for joint pain, and seeking to rule it in or out of his differential diagnosis.

Compare this to:
Client: "Without a word, he grasped my arm and hurried me into a carriage (...).
"One horse?" interjected Holmes.
"Yes, only one."
"Did you observe the colour?"
"Yes, (...). It was a chestnut."
"Tired-looking or fresh?"
"Oh, fresh and glossy."
These questions seem a little strange, but Holmes is trying to differentiate between a carriage that came from far away and one that came for nearby. In that story, this helps him locate a house where a crime was committed.

3- He formulates a number of hypotheses (which he does not share with Watson, or the reader. This is of course a (kind of cheap) literary device to create suspense, but it also reminds me of something I often tell my patients when they ask me what I think before the consultation is over: "I'd rather answer that when I have finished the consultation, because I want to have all the information in hand, lest I give you a false answer" (Okay, I've never actually used the word “lest” with a patient, but it's a cool word)).

4- He goes to the scene of the crime, examines it, and then goes out in the field to test his hypotheses, to arrive at the solution to the mystery, just as the doctor will ask for a blood test, or a CAT-scan, or a voodoo reading of chicken entrails (less often).

So. Crime writers, great detectives and doctors. Same family. Now all I have to do is write that great crime novel that will take the world by storm. My dear Watson.


Alexander Newcombe said...

Awesome dissection (totally intended) of Sherlock. I also like that you have one of your trademark paragraphs with nested bracketed phrases :) Looking forward to reading more, Vincent!

Pierre Mackay said...

Great Blogs of Fire ! Loved every word
Who is the next doctor/writer on your list?
Rabelais? Michael Crichton? Alexander McCall Smith? Jacques Ferron? CĂ©line? Chekov? Philippe Panneton (Ringuet) ?
You got yourself quite a vein...

Vincent Mackay said...

Thanks Alex. I can't seem to get rid of those brackets. I have grown to love them.

Vincent Mackay said...

Thanks! I an thinking of Saint Luke the evangelist... Juste kidding. Although he was a physician, apparently. But seriously, I'm thinking of Martin Winckler fort the next post. Stay tunes.

Vincent Mackay said...

I meant stay tuned. Damn autocorrect.

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