wellingtongoose (wellingtongoose) wrote,

Semantics of Healthcare Part 2.5 - Dr Watson Scientist and Psychiatrist

One thing that I find a lot of really good writers get confused about in Sherlock Fandom is the extent of John's skills as a doctor. In some cases he is so vastly overqualified that I feel like I'm reading a superman comic rather than a gritty portrayal of front line combat. In other cases poor John is so clueless that I start worrying for his fictional patients and his registration with the General Medical Council.

Another short, not-be-taken-too-seriously, guide on how to make John a good (but not supernatural) doctor, his potential as a scientist, psychiatrist and drug dealer for Sherlock. 

Medical students do more than drink themselves stupid...

...some of us are even teetotal, which you would be too if you had to come face to face with the consequences of binge drinking every day.

Getting into Medical School - In order to get a place at medical school, John would have had to do A-levels. These are exams taken in Year 13 (age 17-18). A-levels are not part of compulsory education which stops at age 16. Although the UK does not issue school leavers' certificates - GCSE exams taken at the end of compulsory schooling are recognised by employers as a sort of school leavers' certificate. A-levels are on a whole new level of difficulty compared to GCSEs. Generally humans only have the physical and emotional capacity to take three or four subjects at A-level. To enter medical school you must have at least 3 A-levels one of which must be in chemistry.

Thus John Watson would have quite a good grasp of not just biology but chemistry and possibly physics as well. I am unfamiliar with the science curriculum in other parts of the world but at the time when John was taking his A-level exams, it is generally agreed that the subjects covered were more extensive and challenging than that of modern A-levels. Therefore his knowledge in the field of chemistry and physics would probably exceed that of current UK A-level students and possibly high school students in the US.

I doubt he would be as proficient as Sherlock, given that it is implied Sherlock did a degree in chemistry at university but I doubt John would have trouble keeping up with scientific explanations of Sherlock's experiments. Additionally, as a medical student he would have got into the habit of self-study and it is plausible that he could easily refresh his knowledge and further educate himself in the field of chemistry or physics because he has a good foundational knowledge. 

Boldly going where no one has thought of before

There’s a head in the fridge - unlike what many people think, medical schools are not just there to churn out automatons. One very important part of the medical school curriculum is to produce future leaders in scientific research. There is a long and distinguished tradition of doctors leading the way in producing new drugs and discovering new diseases. Alexander Fleming was a full time physician and so were many of the other great innovators in this field.

Scientific research requires an entirely different set of skills to being a doctor. Firstly, you need a very firm foundation in biology, chemistry and physics in order to even start a research project. Secondly you need to have the ability to analyse and appraise data to produce a meaningful conclusion.

I believe that Sherlock and John may frequently discuss his experiments and given that most of Shelock's experiments are biological in nature, John may easily be able to help improve Sherlock's experimental method should he be so inclined because medical school prepares students to be more than just a doctor.

I understand why John would not like finding severed heads in the fridge or eyeballs in the microwave but he won’t be disgusted; he’s definitely seen much worse. He’d also be a lot less clueless about the experiments that Sherlock is setting up around the house if he cared to looked close enough.

Amendment: I think part of his horrified reaction to the head is that he understands just how  illegal it is to abscond with body parts from a teaching hospital morgue. It is both a crime for the person who stole them and for the establishment for not keeping a better eye on human remains. Even with prior consent from the patient, you cannot remove their severed head from the hospital, keep it in your own fridge and experiment on it. Public health would have a fit, the Medical Ethics and Law commission would explode and Health and Safety would puke. 

I find it hard to believe that Molly sanctions Sherlock's thievery. There is an accurate date record of who enters and leaves the morgue because it is a highly restricted area. Molly stands to loose her job, her registration with the General medical council, if she's pathologist and go to prison for a very very long time. 

I personally think that John would be able to contribute to Sherlock’s scientific experiments and it would be something they might be able to bond over. John is not able to match Sherlock in terms of crime solving, but I believe that they might be able to brain storm together as equals in terms of Sherlock’s experiments. As part of his medical school course John would have been given some lab time, though not as much as science students. He would definitely know how to handle suspicious/caustic/evil smelling substances that he would want to dispose of.

As for Sherlock: the key to being a good scientist is good organisation of time and materials. Although we see the kitchen table is cluttered by Sherlock’s apparatus it is not a mess. Sherlock would have been trained during his undergraduate years (if he did pursue a degree in chemistry) how to organise ones materials and apparatus for maximum efficiency. Additionally, he would understand the dangers of over incubating his pathology experiments and take reasonable precautions with toxic substances.

Nothing about his home-made laboratory would please a health and safety inspector but Sherlock would not pose quite as much of a health hazard as people think. Safety procedures are practically drilled into research students from the first minute in the lab. Sherlock is by no means careless to the point of being suicidal – he would know exactly how to ensure his own safety and be very motivated to do so given that he knows the consequences of being lazy with dangerous chemicals/pathogens.

I now pronounce you patient and doctor

How to section your flatmate – quite a few very good pieces of fanfiction feature psychiatric disorders as part of the main plot. I personally find these stories have a great deal of emotional depth and are very rewarding reads. However several people have asked me about the extent of John’s psychiatric knowledge so here is a quick summary of what I think John would know.

John the GP – if your headcanon involves John being an experienced GP then he should be very knowledgeable about all common physiatrist disorders. For simplicity’s sake I would class “common” as any mental illness that you can meaningfully discuss with your (non-medical) friends.

As a GP in the army he would be exposed to a different range of psychiatric illness from a civilian GP. This is because a large bulk of the psychiatric work a civilian GP undertakes is for patients over the age of 65. John would have more experience with disorders that commonly manifest in young adulthood to middle age e.g.

  • Depressive disorders
  • Bipolar disorders
  • Schizophrenia
  • Disorders linked to substance abuse and misuse
  • Anxiety disorders
  • Personality disorders mainly borderline and anti-social,

He should be able to diagnose most psychiatric disorders even if they present in an atypical fashion and treat these conditions from a medical perspective (i.e. prescribe drugs). Doctors do not engage in psychotherapy, in fact most GP do not even know the intricate steps involved in the many different types of psychotherapy. If John were to give Sherlock counselling, it would be as his friend and not his therapist.

Sherlock's Legal Drug Dealer - John, as a qualified doctor, is allowed to write prescriptions for anyone. He does not need a second opinion or signature to prescribe himself or his friends and family medication.

Would he treat Sherlock? This is a difficult question to answer, some doctors find it much more convenient to treat their close friends and family for minor illnesses. It saves a two week wait to see a GP when you know exactly what is wrong and what you need. However other doctors are much more cautious because when you are treating someone you love it prevents you from being impartial and clouds your clinical judgement. For example no sensible surgeon would ever operate on their friends or family. Therefore I think that John would happily treat Sherlock's cut, grazes and chest infections but when it comes to things like drug addiction, mental health issues etc. I believe John would be sensible enough to send Sherlock through the NHS system. 

However given Sherlock's wonderful people skills and tract record of complying with authority, John might find getting Sherlock through the system challenging. In this case - some treatment might be better than none. Additionally on sensitive topics like addiction and mental health disorders, approaching Sherlock as both his doctor and friend may produce much better results than shunting him off to see a professional. 

So would John be able to help Sherlock cope with drug addiction. Scarily controlled drugs such as morphine have stricter prescription regulations only in theory. Doctors are not legally allowed to prescribe themselves controlled drugs but they can prescribe it for other people.

If John does get addicted to painkillers he could easily sign his own prescriptions - the pharmacists would be none the wiser as long as he used a private prescription. If Sherlock get addicted to a controlled substance, it would be morally and ethically wrong for John to help him obtain drugs but he could do so by writing Sherlock prescriptions for anything from cannabis to morphine. 

Being a drug dealer is not in keeping with John's character given that he has probably seen firsthand what drugs can do to people. However if you're writing dark!John - there are so many avenues you could go with that. Many people write dark!Sherlock keeping John permanently ill and dependent. I personally think that be  dark!John's perfect MO. 

John would be knowledgeable on how to help people break the cycle of addiction (this is something that GP do a lot) particularly for smoking and drinking. Even medical students are taught the rudiments of manipulating people to give up their addiction. John, as a GP, would have had a lot of practice.

He would also know the most current methods of detoxing for alcoholics (though this would have to be done in hospital) and illegal drugs. Additionally he would be well versed in how to treat drug overdoses from paracetamol to opiates. Therefore if Sherlock has a drug problem, John would definitely be competent enough to spot it and treat it, if he manages to get Sherlock to comply that is. 

Once a doctor writes a prescription for anyone, that person legally becomes the doctor’s patient. The doctor then has a duty of care for the person receiving the prescription from that point onwards. If Sherlock has a mishap when taking something John prescribed him – John is legally liable for neglect and I imagine Mycroft would not waste time reminding him of this.

John the army surgeon – If you want John to be a BAMF army surgeon, I’m afraid you will have to be realistic about his knowledge of psychiatry. He is a "pretty good" doctor but even Surgeon!John has his limits. 

Firstly, if John did not do any GP training in your headcanon, he would only have a very limited amount of exposure to psychiatry (possibly only a month during the whole of medical school). He’s knowledge may not be much more than that of a lay person simply because he doesn’t use his psychiatric knowledge in medical practice.

If (bending all the laws of reality) John is working as a locum GP in Sarah’s surgery, I imagine he would get all the minor surgery cases and leave the psychiatry/paediatrics/obs & gynae to the other doctors. 

Side note: if John ever does want to section Sherlock under the mental health act - he'd need a second doctor (and third person) to sign the sectioning form. For anyone who doesn't know what sectioning is:

"The Mental Health Act, which was introduced in 1983, is intended to help doctors deal with patients who may have a psychiatric disorder.

Under the Act, patients can be sectioned or detained against their will and given treatment."

 Sherlock and His Asperger's - firstly I do not think Sherlock has Asperger’s - or if he did, he'd never be diagnosed by psychiatrists on the NHS. Explained in the essay here. 

Pervasive developmental disorders including autism and Asperger’s syndrome manifest in childhood. The symptoms become very obvious very early on. For Asperger's suffers, parents tend to notice around the age fo 4-5 when children start school and need to interact with peers. For austism, parents usually notice much earlier around 2-3 when they realise their children are regressing socially. 

As an army GP John would not be seeing any children - unless he was stationed in a military base back in the UK where he could occasionally see families of soldiers. Even civilian GP who do a lot of work with children do not have the ability to diagnose autism/Asperger's syndrome. This takes a three hour appointment with specialist child and adolescent psychiatrists. 

To diagnose a pervasive developmental disorder in an adult is more complicated as social conditioning and knowledge will have morphed the classic signs. For example children with Asperger’s find it difficult to name the emotion when presented with simply smiley faces. Adults, particularly those as brilliant as Sherlock, would immediately be able to give an answer because he has learnt the equation: "smiley face = happy" but there is not emotional intelligence involved in the process. 

John's knowledge in paediatrics and child and adolescent psychiatry will be very rusty and filled with more holes than swiss cheese. His child and adolescent psychiatry would have been a week long stint in medical school (maximum) and give that he would never have used any paediatrics knowledge in his medical practice, he would be utterly unqualified to diagnose anyone (particularly an adult) with Asperger's!

After watching THoB again, it looks like that Lestrade wants to say "Asperger's" but he can't quite remember how to pronounce the name. John merely fills it in for him - but he doesn't give an opinion one way or the other. Therefore John never actually labels Sherlock's social problems with any psychiatric term.  Greg Lestrade, needless to say, would not recognise Asperger's Syndrome even if Sherlock actually had it let alone when he doesn't. 

Part 1 - Exploring Dr Watson's Army Career
Part 2 - How can an Army GP be fighting on the front lines? John's Dual Career

Part 3 - Guide to making John a Realistic Army Surgeon

Feedback would be very much appreciated! Thank you to all the people who have commented - I really enjoy our discussion and I've learnt so many new things from you all. 

Tags: character: john watson, meta: john watson

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