The Doctor’s Word by R. K. Narayan

from a collection of short stories, Malgudi Days, published by Viking in 1982

Dr. Raman is a fictitious physician in the imaginary South Indian city of Malgudi. Renowned for his diagnostic acumen and “certain curt truthfulness … he was not a mere doctor expressing an opinion but a judge pronouncing a verdict.” When Dr. Raman is called upon to make a house call and subsequent operation on Gopal a very good friend, Gopal, he faces a professional ethical dilemma: truth-telling against the power (often placebo-like) of a doctor’s enthusiastic, optimistic encouragement of a beneficial prognosis, since he blithely tells Gopal, not believing a word of it, that the latter will do well.

This story’s concern is not only with professional ethics but also with the tension that often arrives when personal ethics and professional ethics intersect and conflict since it is clear that Dr. Raman violates his usual practice of truth-telling in the interest of his friendship. It is also a commentary on paternalism; Dr. Raman tells the patient’s wife and patient only what he wants them to hear since the truth as he perceives it would be damaging to the patient’s outcome, a much censured notion known as “therapeutic privilege.”

This story demonstrates the economy and grace with which expertly wrought fiction can capture and present for discussion important issues in (medical) ethics. I have used it with success in a student seminar on the medical ethics of truth-telling, prognosis and conflict of interest.