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Commentary on The Doctor

Kumagai, Arno, K., MD

doi: 10.1097/01.ACM.0000529866.97564.c1
Medicine and the Arts

A.K. Kumagai is professor and vice chair for education, University of Toronto Department of Medicine. He is a cross-appointed researcher in the Wilson Centre and F.M. Hill Chair of Humanism Education, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada; e-mail:; Twitter: @akumagai1.

Funding/Support: The author acknowledges the generous support of the F.M. Hill Foundation of Women’s College Hospital and the University of Toronto.

In the late 1880s, the British industrialist Sir Henry Tate commissioned a painting by Luke Fildes, and Fildes chose to paint a picture of a subject very close to home: the doctor who attended his one-year-old son Phillip as he lay dying on Christmas morning in 1877. The Doctor is the result.

The Doctor is a group portrait: leaning over the child, who is positioned across two chairs, is the doctor, who with chin resting in his hand, stares intently at his patient for whom he can do nothing more. The central focus of the painting is demarcated by the light that the tilted shade of a lamp throws on the doctor’s face as he waits on the child, whose face also glistens, as he lies listlessly in an improvised bed. In the background and enveloped in shadow are the child’s parents: the mother slumped over in despair, and the father, who rests his hand on the mother’s shoulder and quietly, thoughtfully watches the doctor’s ministrations. One may interpret the ray of morning sunlight coming through the cottage’s window as a sign of hope; however, informed by the biography of the artist and the history of his painting, one senses instead a mute finality to the scene.

The doctor waits, the parents wait. The doctor waits for the child to turn the corner with the dawn’s light or to pass away after a brief life. The parents wait for a miracle, wait for a gift from the doctor—the return of their son. All wait for these things, and yet, all wait upon … what?

In Discourse on Thinking the philosopher Martin Heidegger1 distinguishes between two concepts of waiting. Waiting for implies the act of anticipating a specific action or event. It implies purpose and direction; its culmination is the event’s completion. In contrast, waiting upon involves opening oneself to something whose nature is not known.1 Waiting upon implies allowing oneself to be open to that which is incomprehensible, to what Heidegger calls “releasement,”1 to the mystery of being.

Although The Doctor appears to be a still portrait—a group frozen in time and grief—the painting is in fact highly dynamic: all are caught during a moment of waiting, being, and becoming. In the silence at the edge of night, all are waiting upon; all are fully present and open to the mystery and fragility of life. All are also bearing witness to change, to the transition between life and death, vitality and stillness, presence and infinity. This change also occurs in each individual occupying this sacred space—in Heidegger’s words, an “opening”1—in which people become different than they are. No one—not the doctor nor the parents—leaves unchanged. In fact, another dimension is present in this painting: in viewing the work, the viewer is also called into the act of waiting upon, of bearing witness, of becoming.

This iconic painting by Fildes has been criticized as highly idealized and not representative of today’s medicine—nor, for that matter, of the state of practice in the 1880s.2 Nonetheless, an important message still resonates in this depiction of one of the artist’s most life-changing moments. In the world of modern medicine; in the midst of the beeping of monitors, the glare of computer screens, the cacophonous debates over coverage, policy, finances, and safety; amidst the snowdrifts of paperwork for prior authorizations, reimbursements, and “documentation,” those of us in the health care professions often overlook these moments of great pain and loss. By calling us into the intimacy of suffering, by making us complicit in the act of waiting upon, The Doctor reminds us of the unique privilege inherent in the care that one person provides for another: the privilege of bearing witness and opening up oneself to the mystery, tragedy, and wonder of being human.

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1. Heidegger M. Anderson JM, Freund EH. Conversation on a country path about thinking. In: Discourse on Thinking. 1966.New York, NY: Harper and Row.
2. Moore J. What Sir Luke Fildes’ 1887 painting The Doctor can teach us about the practice of medicine today. Br J Gen Pract. 2008;58:210–213.
© 2018 by the Association of American Medical Colleges