Give the textbooks a rest—the play is the thing

Mitzi Baker

Medical students listen to a panel discussion after a reading of “The Imaginary Invalid.” Panelists included (from left) Lorrin Koran, Michael Marmor, Carey Perloff, Constance Congdon and Jean-Marie Apostolides.

A fictional hypochondriac created nearly 350 years ago is giving modern-day medical students something to ponder. On Jan. 26, first-year Stanford medical students attended a reading of Molière's "The Imaginary Invalid" as part of a new program that encourages the future doctors to develop societal—as well as scientific—skills.

Molière, who was in the final stages of chronic tuberculosis when he wrote and starred in the play in the late 17th century, created the character of Argan, whose love-hate relationship with his doctors permeates the story.

Argan employs a team of physicians who prescribe questionable and costly treatments, and even plots to marry his daughter to a doctor so that he will have medical care in the family. Yet he rants about the price of his therapy and refuses to pay the bills in full.

The opportunity to tell all who surround him the detailed nuances of his bowel problems and imminent death, and to complain about his doctors, gives life to the self-proclaimed dying man.

In San Francisco's Zeum Theater, the Stanford students watched actors from the American Conservatory Theater read through an adaptation of Molière's play in contemporary English. The event was the first of the new "Medicine and the Arts" program, established by an endowment from the Marmor Foundation.

The arts program is part of the school's "Practice of Medicine" course. Directed by Clarence Braddock III, MD, MPH, associate professor of medicine, the course aims to go beyond training medical students as technicians, but as contributors to the well-being of society in general.

Marmor Foundation family member Michael Marmor, MD, professor of ophthalmology, spearheaded the program, which will offer medical students a cultural event within the course's curriculum each quarter, accompanied by discussions that will encourage reflection on the meaning of these activities.

"One goal is to continue liberal education into medical school, and to help our students to broaden their approach toward life as well as medicine," Marmor said.

The performance spurred a dialogue about the role of medical professionals in society, as well as the nature of illness itself. After the actors left the stage, a panel of experts assembled to explore the intersection of the play as a work of art and as a social commentary.

Panel member Lorrin Koran, MD, emeritus professor of psychiatry, pointed out that the students may encounter self-centered, argumentive, unappreciative patients in their practice, and these patients will not be as amusing as Argan but will still deserve the best care.

"Physicians are obliged to investigate their complaints and accept the reality of their suffering," said Koran. "Even hypochondriacs die of something."

He advised them to treat their patients as people, not just diseases and symptoms. "We should help to solve the non-biological problems in life, to help our patients realize their full potential," Koran said.

Constance Congdon, who adapted the play, said she had eliminated much of Molière's original diatribe against the medical profession. "I was offended; the things he was saying about the medical profession just aren't true any more," she said. "I'm a playwright, I like stirring the audience, but that had to go."

Congdon and Carey Perloff, the artistic director of ACT, posed the question to the audience: Was Congdon too soft on doctors, or perhaps still too hard?

One student said the play's portrayal of doctors as charlatans and quacks made a mockery of medicine. But student Rebecca Hjorten disagreed, saying, "I think this play protects us too much." She added that the trust patients place in doctors must be earned, and that physicians must constantly work on being worthy of that trust.

Although Moliere was responding to medical practice of the 17th century— and all in attendance agreed that the field has improved since then—Marmor raised the question of how the story remains relevant today.

Master's of medicine student Oliver Crespo compared Argan's reliance on the enemas and other herbal concoctions to today's emphasis on drugs and the power of pharmaceutical companies.

"This play portrays how much of a business medicine is now, and how we keep patients on medications," Crespo said. "I'm sure 99 percent of the people in this room will practice good medicine...," he trailed off.

Koran picked up Crespo's thought. "... But that leaves the one person in this room." He continued, "The regimen can be complicit in the hypochondriac's illness. In clinic, we see people taking 20 drugs. Unless we are careful, we can contribute to a life out of control because of medications and tests."

In a follow-up e-mail to the students over the weekend, Braddock asked them to reflect on how the sentiments expressed in the play relate to the practice of medicine.

"It's interesting to me how the level of certainty that those physicians had in their enemas and purgatives was just as high as we have in our antibiotics and chemotherapy," Braddock wrote. "I'm not suggesting that our treatments are equally ineffective as those, but rather that our public has just as much reason to be skeptical as the public in any other time, and that protestations of certainty on our part are often viewed more as arrogance than as reassurance."

To this, medical student James Torchia responded, "I think that part of this may stem from physicians' need to believe that they are actively doing something to help their patients, even when the true problem and/or solution is not known. I wonder if similar situations—albeit far less extreme—occur in this day in age?"

The reading the students attended was a part of the early development process for the play. The full production of "The Imaginary Invalid" will run in ACT's Geary Theater from June 7 through July 8.