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Reviews By Trevor Thompson and Suhayl Saadi
Contact the authors via Chris Johnstone by e-mail at christopher.johnstone@ntlworld.com

Cinemeducation
A comprehensive guide to using film in medical education
Edited by Matthew Alexander et al
Radcliffe Publishing 2005

by Trevor Thompson

Let me begin at the end - this is a terrific book. If you are involved in medical education you need to go out and buy it today. It is not so much a book to be read as a jobbing manual for the designer of education that works. Two years ago, we started an elective course for second year medical students at Bristol University called “Doctors in the Movies”. It was a roaring success. But I just wish we'd had this book to hand as we grappled with questions like how to use films and what films to use.

The book starts with a not-too-long explanation of the rationale for film in medical education drawing particularly on what has been badged “narrative medicine”. The gist of this is that as well as appreciating the clinical nature of the medical presentations, better doctors are also able to see predicaments in the context of a person's existential fears, family network, hopes for the future etc. In short - their story. This sort of understanding can be and is taught, especially in North America, as “narrative competence”. Here in Bristol we call it “Whole Person Care”.

And how do we teach narrative competence? By confronting students with human stories of the utmost interest and poignancy. Live cases are probably best. But what about the carefully constructed, artistically inspired choreographies of human life we call movies? These can be played again and again (unlike live patients), don't have the same ethical issues associated with them, and have other ploys such as music, lighting, framing to draw us in to human predicaments of every conceivable type.

But if we are sold on the concept of using film in medical education where do we go to find out what films to use and in what ways? This is the over-riding contribution of this book. It does not labour the theoretical case, but seeks to provide a catalogue of suggestions. Its typology includes four sections on particular areas of medical interest with several chapters in each.

“The individual and family life cycle” cites films about childhood, adolescence, family conflict, sexual awakening and the twilight years including end of life issues. “Adult diagnostic categories” deals mainly with psychiatric conditions such as PTSD, drug dependency and eating disorder. “The doctor-patient relationship” includes film suggestions on interviewing skills, professionalism, ethics and error. “Specific Populations” deals with being gay, with race and with complementary medicine.

Each individual chapter in these four sections has the same structure. Take for instance the chapter on Schizophrenia. The authors introduce the diagnosis and then, in a subsection on the symptoms, a film, “A Beautiful Mind” (Russell Crowe) which deals with the mental illness of the Nobel Prize-winning mathematician John Nash. A short summary of the film is provided and then a particular clip is suggested - one in which John has dialogues with an agent who we later discover to be delusory.

For each clip they provide a time code (e.g. 0:33:38 - 0:34:04) and a series of questions in relation to that clip. The time code is approximate but crucial - it can take hours to find a small sequence, especially on VHS. In this clip John responds to peoples' concerns by saying “I like to think it's because I am a lone wolf”. The author suggests that this clip is accompanied with the question “how would you respond to a parent who was concerned that their child was 'a loner'?”

Working with film is hugely good fun. It feels almost impossible that solid educational goals could be attained whilst watching films - a suspicion that might deter some faculty. But films are just condensed life and this book provides a rich sweep of it. Reading this book filled me with new enthusiasm for our course in Bristol and new ideas for films to watch and appreciate. The authors are American and so therefore are most of their films. I don't think Sir Lancelot makes an appearance. The next step has got to be a three volume DVD which would save us all problem of tracking down these movies some of which are not on the high street.

Other hoolet online articles by Trevor Thompson can be found at:
hoolet edition 46 - Review of "A comprehensive guide to using film in medical education"
hoolet edition 29 - Review of "Poisonwood Bible"

The Blue Moon Book
Anne MacLeod
Luath Press Ltd

by Suhayl Saadi

Escaping from an apparently love-worn marriage, on her way through Edinburgh to an adulterous tryst with her lover, print journalist Jess Kavanagh sustains a serious head injury and ends up aphasic. Given time off work by his newspaper editor, her prickly, world-weary, cuckolded and conflicted partner, football hack Dan McKie roams the metaphysical space between her bedside, their past together and his philandering near-present. Meanwhile, unaware of the RTA, her apparently jilted, 'conference' lover, a Tartan Oxbridge academic of all things Pictish, tries to get on with his unfulfilled life among the dreaming spires and wonders exactly what went wrong.

In her acknowledgements, MacLeod states that “The Blue Moon Book is fiction grounded in the currently expanding field of medical narrative”. It's important to note that this novel is on a higher plane altogether than most of the unbearably turgid, sentimental material on bookshop shelves that constitutes an unending parade of 'sick lit' (cf. the nauseatingly bland and mawkish Hollywood TV movies that must surely have been screened every mittel afternoon for the past thousand years). MacLeod's story primarily is about human relationships, about the nature of consciousness and yes, unashamedly it is about the messy, non-evidence-based, non-sense phenomenon that we call love.

All the central characters in this intense and engaging book feel very real, there are none of outdated, facile errors that one sometimes encounters from non-medical writers (e.g. there is not a pair of half-moon spectacles in sight) and the novel effects a beautiful yet dissonant harmony between the poetic and the carnal. Jess's story is that of the painstaking reconstruction of a mind, a body, a life - and what better subject for a novel? The Blue Moon Book is a corpus of broken mirrors, of human palimpsests, of forgetting and remembering.

It's also about social class. All the major characters are recognisably middle-class (in the post-1980s sense) and they barely interact, cerebrally, linguistically or emotionally, with the few working-class individuals in the novel. Only in the workplace or on the street does a kind of functional engagement occur. This surely, is an elision which continues to be an accurate reflection of 'post-modern' Britain.

In some ways, Dan McKie's journey is as painful and touching as his wife's, for this philanderer, too is a broken person. He attains a painful sense of redemption through nursing Jess back to health, but even with the almost blank page she has become he struggles to give her back what already had been lost. Relationships can just get tired-out, worn down like old stones in the Scottish rain by the pressures, the sheer mundanities as well as the florid infidelities, of modern life. One keeps wondering when Jess's lover will realise the truth about what has happened to her and perhaps over the course of the novel the credibility of this Hardy-esque attempt to engender dramatic tension through the plot device of the ignorance of her otherwise-brilliant and perceptive lover, the attractive professor of Pictish rocks, becomes a little hard to sustain. But this is a minor quibble, for as we all know, life is full of such fleeting tragedies of coincidence and this is not a detective novel but one about human interaction.

There is wonderfully evoked sense of place throughout - Glasgow, Edinburgh, Kraków, the Highlands - and at times, MacLeod's prose is architectural, almost geological. The increasingly complex and fraught web of relationships is spun with enviable (?surgical) precision. The structure of the book is quite cinematic, with headings for each point-of-view, so that it is as though we are jump-cutting between consciousnesses, times, moods, as we explore the archaeologies of various lives.

The prose is economical and yet also, in the right places, highly lyrical. MacLeod, who apart from being a well-published poet and novelist (this is her second novel), is also an accomplished Gaelic singer, works as a dermatologist in the Scottish Highlands and has drawn in a balanced and highly effective manner on her medical knowledge and experience in ways both subliminal and narrative in this story which takes place as much beneath the skin as in the never overplayed mythopoeic shadows of various ancient monuments. Many of the characters are health professionals, striving, in some sense, for the shamanic: Roger Neighbour meets pheromones, Calvin and the Fissure of Rolando. The Blue Moon Book is an excellent and highly accessible novel and apart from being in itself an intriguing and exquisite literary voyage, it should be required reading for anyone interested in the human condition as well as for health professionals everywhere.

Reading this strongly sensate book, at times one feels that one is taking a walk through a spectacular mist of Lowland rain, the kind that makes the stones glisten in the sunlight. Each raindrop is a life, as impermanent as the forgotten meanings of the dead language of the symbols cut into Pictish stone. To read The Blue Moon Book - a work of modern alchemy if ever there was one - is simultaneously to forget and remember, and like Jess Kavanagh to have to re-make both the world and its history with only the tools of one's own, flawed consciousness.

Other hoolet online articles by Suhayl Saadi can be found at:
hoolet edition 46 - Review of "The Blue Moon Book"
hoolet edition 37 - Keats 'n' Me
hoolet edition 32 - Words of Healing
hoolet edition 31 - Book Review: ‘Lanark; A life in 4 Books‘ by Alasdair Gray
hoolet edition 30 - ‘The Burning Man‘ by Suhayl Saadi - Reviewed by John Montgomery
hoolet edition 29 - The Fall

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.