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Sherlock Holmes and the Case of the Vanishing Examination

doctor in uniform using futuristic looking digital screens and keyboard

We live in a world steeped in technology where we all spend increasing amounts of time on our cell phones and computers and less time observing the world around us. These changes have also affected how we practice medicine. Many physicians today spend more time reviewing imaging studies and laboratory tests and less time taking a thorough history and physical examination, in effect dulling their senses. When we think about the art of observation and deductive reasoning, we are often reminded of Sir Arthur Conan Doyle’s famous literary character Sherlock Holmes. What many do not realize is that Sir Arthur Conan Doyle was a physician, and his character Sherlock Holmes was based on Dr. Joseph Bell, one of Doyle’s professors during his time at the University of Edinburgh. Sir William Osler,1 a contemporary of Bell, also emphasized the importance of observation in his teachings and stated, “The whole art of medicine is in observation . . . to educate the eye to see, the ear to hear and the finger to feel takes time. . . .” When trying to emphasize the importance of observation to medical students and residents today, you may gain more traction if you distill Dr. Bell and Sir William Osler’s wisdom and simply quote Yogi Berra: “You can observe a lot by just watching.”

Arthur Conan Doyle studied medicine from 1876 to 1881 at the University of Edinburgh Medical School. It was at Edinburgh that he would meet Dr. Joseph Bell and serve as his clerk at the Edinburgh Royal Infirmary. Doyle was a moderately successful physician, but his true fame would begin when he created Sherlock Holmes in an 1887 novella titled A Study in Scarlet that was published in Beeton’s Christmas Annual, a popular magazine of the time.

His character having swiftly propelled him to fame, Doyle2 would write to Dr. Bell in December 1893, “It is most certainly to you that I owe Sherlock Holmes . . . I do not think that his analytical work is in the least an exaggeration of some effects, which I have seen you produce in the outpatient ward. Round the centre of deduction and inference and observation which I have heard you inculcate, I have tried to build up a man. . . .”

Dr. Joseph Bell (1837-1911) was a Scottish surgeon at the University of Edinburgh Medical School. He served as the personal surgeon to Queen Victoria whenever she visited Scotland. His diagnostic intuitions astonished medical students and patients alike—even before patients uttered a word, Bell would describe their symptoms and give details of their past lives, rarely making a mistake. He published several medical textbooks, including A Manual on the Operations of Surgery in 1886. However, he was most famous as a teacher—his skill in diagnosis was legendary, and this skill rested substantially on his acute powers of observation.

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-Sutchin R. Patel, MD, Sara L. Best, MD, Ronald Rabinowitz, MD

This article originally appeared in the November issue of The American Journal of Medicine.

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