International Journal of Medical Education.

2010; 1:2-4
ISSN: 2042-6372
DOI: 10.5116/ijme.4b8a.fba9

Sir Robert Hutchisons Petition and the

Medical Humanities
From inability to let well alone
From too much zeal for the new and contempt for what is old
From putting knowledge before wisdom, science before art, and
Cleverness before common sense;
From treating patients as cases;
And from making the cure of the disease more grievous than the
Endurance of the same, Good Lord, deliver us. Sir Robert Hutchison

Sir Robert Hutchison was physician to the London Hospital

and to the Hospital for Sick children at Great Ormond
Street in the later part of the nineteenth and early part of the
twentieth century. He is famous for his book Clinical
Method, first published in 1897. The twenty-second edition
of this path-breaking book on clinical examination has
recently been published. Sir Robert Hutchison is famous for
his clinical sayings and especially for his petition written in
his later years. In this article I examine Hutchisons petition
with reference to Medical Education in general and Medical
Humanities education in particular.
I am a Clinical Pharmacologist and a medical educator
at KIST Medical College, Lalitpur, Nepal. I am especially
interested in the Medical Humanities (MH). In a blog
article I had described how I started a MH module for
students at two medical schools in Nepal and conducted a
module for faculty members with the help of a fellowship
offered by FAIMER (Foundation for Advancement of
International Medical Education and Research).1 The MH
module for first year undergraduate medical (MBBS)
students was called Sparshanam meaning touch in Sanskrit, an ancient language from which many languages of
South Asia are derived. The module facilitators had in a
recent article described their experiences with designing
and conducting the MH module.2 The module used paintings, group activities, role plays and occasional literature
excerpts to examine various aspects of the humanities.
Hutchisons petition was discussed in detail by the student
groups during the module with comments by the facilitators.
Inability to let well alone

The petition starts with the statement from inability to let

well alone. In the modern world drugs are increasingly
being promoted and used for improving normal functioning and for conditions which can be regarded as physiological and a part of normal life. Convincing healthy people
they are sick or can use medicines to further improve their
functioning will enormously increase the market for medicines. Medicalisation has been described as the process of

turning ordinary life events and the ups and downs of

normal life into medical conditions. The phenomenon of
disease mongering has attracted attention recently. Disease
mongering can turn ordinary ailments into medical problems, see mild symptoms as serious, treat personal problems
as medical ones, see risk factors as diseases and frame
prevalence estimates to increase the market for medicines.3,4
Knowing when to prescribe a medicine and when not to
prescribe medicines is an important skill for a doctor. Using
drugs for physiological conditions may not be a good
option. Many conditions respond to non-drug measures
and psychological counseling and support. Life style diseases are becoming more common and maintaining a healthy
life style can reduce the prevalence of these diseases.
Zeal for the new and contempt for the old

In the second line Sir Robert Hutchison talks about too

much zeal for what is new and contempt for what is old. I
will first examine this statement in the context of modern
drugs and then look at it in the context of other treatment
modalities. Newer drugs are strongly promoted and marketed for a number of conditions. In many cases a new drug
may not be the best treatment option available. Drugs are
tested on animals and then undergo clinical trials on
healthy volunteers and patients before they are marketed.
The problem is that these studies are carried out on a
limited number of patients only. Many conditions of
normal use of the drug are not addressed in clinical trials.
Considering the limitations of data obtained from clinical
trials even after a drug is marketed it remains under postmarketing surveillance. Many adverse effects become
evident only after marketing and widespread use of a drug.
The famous clinical pharmacology textbook by Bennet
and Brown has a diagram describing the life cycle of a drug.5
A drug is usually introduced with much hype in the market.
Initially people are skeptical but then the drug shows good
results in early studies. The drug is then hyped as a wonder
drug. Soon, however, reports of serious adverse effects are
noted, and sometimes even deaths occur. The drug is then
at the nadir of its popularity. People begin to term the drug

2
2010 P. Ravi Shankar. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use of work
provided the original work is properly cited. http://creativecommons.org/licenses/by/3.0

Shankar Sir Robert Hutchisons petition

as a poison. Eventually we know more about the drug and

begin to understand it better. We know in which conditions
it can be used and what are the precautions regarding its
use. Eventually the drug finds its status in therapeutics. This
may also be true of many new non-drug treatment modalities. Old and trusted treatments which have been used for
many years in a variety of patients are worth their weight in
gold.
Knowledge before wisdom, science before art

The third line talks about the hazards of putting knowledge

before wisdom and science before art. In the early seventies
and eighties in developed nations concern was raised about
the overemphasis on science in modern medicine. Modern
medicine has developed on scientific discoveries but the
neglect of the art of healing had led to many deleterious
consequences. MH arose as a result of acknowledgement of
these deficiencies and aims to provide the contrasting
perspective of the arts to the scientific one which dominates
modern medicine. The practice of medicine is both a
science and an art and we neglect the art at our peril. Today
MH programs are well established in developed nations and
have been started in certain developing nations also.
Wisdom is defined as understanding the limits of ones
knowledge and skill. It has been said that person with
knowledge is proud that he/she knows so much while a
person who also has wisdom is apologetic that there is so
much more to know. Knowing the limits of ones knowledge and where he/she or the patient can obtain more
information is important in modern medical practice. Many
eminent personalities in medicine including Sir William
Osler, the father of modern medicine have repeatedly
emphasized the importance of wisdom.
Treating patients as cases

In the scientific and technical context of modern medicine

it is easy to forget about the patient as a human being and
about the human dimensions of suffering. In a busy teaching hospital patients are liable to be considered as cases. At
KIST Medical College we discourage patients being referred
to as cases and encourage students to approach them as
human beings. Illness causes a number of changes in the life
of an individual. When a sick person enters a hospital, all
that is familiar is left behind.6
MH teaches students to treat patients as human beings.
It employs initiatives such as sessions on the doctor-patient
relationship, looking at the human dimensions of illness,
obtaining a holistic narrative history of patients, and
parallel charting. 7,8,9 In parallel charting in addition to the
usual formal case history an additional history is obtained
dealing with the effect of the illness on the persons life,
his/her family and community. Many years before MH
terminology came into vogue, the astute Doctor Hutchison
recognized the importance of treating patients as humans

and not as hospital numbers or cases with an interesting

disease.
Making the cure of the disease more grievous than the
endurance of the same

Drugs and modern technological procedures can relieve

symptoms, prevent disease, offer palliation and pain relief,
and occasionally cure. The issue of quality of life, euthanasia
and helping patients to die with dignity is hotly debated. In
our MH sessions euthanasia and the right to die with
dignity is discussed in detail by faculty and students. Some
patients with no real hope of a cure are often aggressively
treated with medicines and radiation; procedures and
medicines that are expensive and can be a huge drain on
family finances (especially in developing countries). Cancer
patients so treated may suffer from nausea and vomiting,
ulceration of mucous membranes, loss of hair, decreased
immunity, and increased risk of infection.
One of my students who worked in a remote district after graduation recently came to visit me saying that in many
cases of terminal cancer he advocates only symptom relief
and advises patients and their families not to pursue aggressive and expensive modern medical treatment. I think this is
a sensible policy elsewhere as often families exhaust all their
resources treating incurable patients. The issue of what is
incurable however, is often difficult to determine. Lack of
resources and finances makes life difficult for the living
relatives.
Good lord deliver us

Asking God to save us or protect us from evil is a common

practice while praying to the Lord not only in Hutchinsons
Christianity but also in other religions. When we used the
petition in our MH classes certain students (of other religions) had difficulty in understanding these words and so
failed to properly interpret Hutchisons petition. We as
facilitators had to tell them about Hutchison telling students
and doctors to avoid various actions and practice medicine
in a humane and compassionate manner. On pointing out
the modification they were able to follow the thoughts of
the writer and understand the importance of Sir Robert
Hutchisons message.
Sir Robert Hutchisons petition, written more than 75
years ago in an environment of medical practice quite
different from what we are accustomed to, remains still
relevant today.

Acknowledgement
The author would like to acknowledge the help of Dr.
Donald Messerschmidt, Anthropologist and creative writer,
Vancouver, Washington, United States in copyediting the
manuscript and suggesting modifications.

References
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with the help of a FAIMER fellowship. 2010 [cited Accessed
on
February
12,
2010];
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5. Bennett P, Brown M. Clinical pharmacology. Edinburgh:

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P. Ravi Shankar, M.D.

KIST Medical College Lalitpur, Nepal
Email: [email protected]

Int. J. Medical Education. 2010; 1:2-4