Student notes on Stephen Hoffman’s Under the Ether Dome extract

(by carrollgr)

  1. 1.     Themes

Formation of the Doctor

From this text I gained an insight into how the knowledge and training we receive in medical school will impact on our lives and careers as physicians. It is clear that the author believes his training began on the first day of medical school though at the time this was not evident to him. It is only on later reflection that he realises his first day stands to him in later life as he deals with his patients.

Modern Outlook vs. Old-fashioned Teaching

Though the author describes their lecture hall as “antiquated”, the general training of these medical students seems to be quite modern in approach. Yes, they do spend hours studying from books and yes, there is a huge emphasis on the science of the human but they are also in contact – however small – with patients from first year. They take courses in psychology, medical ethics and literature. It could be argued that with all of the theory they must learn that it could be easy to lose sight of why they were learning all of this in the first place, however, the author describes how they were brought back to reality numerous times, especially when they met the first patent of the clinic.


Building Blocks

This theme had quite a strong impact on me, it brought about the realisation that what we learn in school is all because people before us made discoveries which established the principles we learn today. It wasn’t that this was an alien concept or one that was terribly insightful (it could almost go without saying); it was just that I hadn’t explicitly thought about it before. Once I read it though I realised how thankful we should be to the researchers, scientists, engineers and doctors who went before us. Were it not for them we could not even hope to be trusted by a patient. As the author of this passage says, it was not until one hundred years ago or so that physicians could even dream of treating a patient effectively. Medicine is a new science, one which is dependent on the discoveries and advances enjoyed by the other, perhaps more established, disciplines.


History of Medicine

The History of medicine was another prevalent theme in this passage not only because it was a subject studied in school but also because it seemed to be a shadow that the author felt he was under a lot of the time. Whether it is in the lecture theatre or the hospital, the author here felt that he was under the watchful eye of his predecessors. As well as that, the author talks of a few “distinguishing traits” of the medical profession, when his anatomy instructor faints on the first day, the students are quick to offer solutions despite their “ignorance”. As he puts it, “we make up for our ignorance by firing off opinions with seeming conviction and a vengeance”, this together with the “shadow of history”  that loomed over them in the lecture hall points to a profession that takes itself very seriously.



  1. 2.     Issues


Why is it that all of the nurses mentioned in the passage women while the surgeon, the professor and the consultant mentioned explicitly are men? Perhaps this is purely a coincidence; however it would be interesting to know when this piece was written to see whether or not these gender roles are in line with the time. No one else’s gender is revealed in the extract, even the author’s, so it is difficult to say whether or not sexism is present. My argument for it would be that while gender is not brought up very often, the author repeatedly writes “she” and “her” for the nurse while for residents and interns no gender is mentioned.


Role of the Patient

The author of this piece seems to believe that medicine should be patient-centred “…strong consensus of what was essential in the care of the patient emerged” yet later the “humble patient role” is mentioned. This is in reverence to the elderly man in the wheelchair who spoke for himself when offered the chance by the “eminent physician who led the clinic, his name emblazoned in red script on his knee-length white coat”. While the rest of the passage focuses on the patient as an underdog (an analogy I quite like) there is something unsettling about the patient occupying a humble role while the doctor wears his pristine coat and decides when the patient can speak – he hands him the microphone. The image of the patient as a “sallow and drawn” individual, bound to his wheelchair is very upsetting, especially as the doctor talks about his medical history and ailments to a hall full of strangers. It is true that the doctor then asks the man for his input and what he has to say about physicians is positive, however the fact that the man lights up and is so surprised at being asked to voice his opinion only compounds the issue, that patients are rarely given a voice.

Also the author admits that the clinics “helped me remember what I had come to medical school for in the first place”, perhaps opening up the issue that medical schools in which little to know placement is offered leads students to lose track of why they chose to study medicine in the first place as the theory and constant memorising takes over their lives.

Another point which I feel is important is the author’s guilt for practicing on patients. When he must suture the head of a young man for the first time he feels out of his depth and guilty that this man who trusts him does not know of his inexperience. He later reflects that no matter how long a doctor has been practicing, they are always honing their craft and perfecting it with every patient.



Leading on from the previous point, the author sees patients as the poor underdog and while they seem to really support the patient “(I) instinctively sensed a need to take their side”, not all patients would like to be seen as underdogs who want the doctor to “sympathise” with them.


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