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This paper progresses the original argument of Richard Ratzan that formal presentation of the medical case history follows a Homeric oral-formulaic tradition. The everyday work routines of doctors involve a ritual poetics, where the language of recounting the patient9s ‘history’ offers an explicitly aesthetic enactment or performance that can be appreciated and given meaning within the historical tradition of Homeric oral poetry and the modernist aesthetic of Minimalism. This ritual poetics shows a reliance on traditional word usages that crucially act as tools for memorisation and performance and can be linked to forms of clinical reasoning; both contain a tension between the oral and the written record, questioning the priority of the latter; and the performance of both helps to create the Janus-faced identity of the doctor as a ‘performance artist’ or ‘medical bard’ in identifying with medical culture and maintaining a positive difference from the patient as audience, offering a valid form of patient-centredness.

‘Thinking with Homer’, or drawing creatively on themes and scenes from Homer's Iliad and Odyssey , can help us to better understand medical culture and practice. One current, pressing, issue is the role of the whistleblower, who recognises and exposes perceived poor practice or ethical transgressions that compromise patient care and safety. Once, whistleblowers were ostracised where medical culture closed ranks. However, in a new era of public accountability, medicine looks to formally embrace whistleblowing to the point that not reporting transgressions can now constitute a transgression of professionalism. Where medical students identify with the history and traditions of medical culture, they inevitably find themselves in situations of conflicting loyalties if they encounter senior clinicians behaving unprofessionally. What are the implications of facing these dilemmas for students in terms of role modelling and shaping of character as a doctor, and how might a study of Homer help with such dilemmas? We suggest that a close reading of an opening scene in Homer's the Iliad can help us to better appreciate such ethical dilemmas. We link this with the early Greek tradition of parrhesia or ‘truth telling’, where frankly speaking out against perceived injustice is encouraged as resistance to power and inappropriate use of authority. We encourage medical educators to openly discuss perceived ethical dilemmas with medical students, and medicine as a culture to examine its conscience in a transition from an authoritarian to an ‘open’ society, where whistleblowing becomes as acceptable and necessary as good hygiene on the wards.

We use Homer and Sun Tzu as a background to better understand and reformulate confrontation, anger and violence in medicine, contrasting an unproductive 'love of war' with a productive 'art of war' or 'art of strategy'. At first glance, it is a paradox that the healing art is not pacific, but riddled with militaristic language and practices. On closer inspection, we find good reasons for this cultural paradox yet regret its presence. Drawing on insights from Homer's The Iliad and The Odyssey, we argue for better understanding of confrontation, anger, bullying, intimidation and violence in medicine in order to change the culture. For example, equating medicine with war is not a given condition of medicine but a convenient metaphor with historical origins and a historical trajectory. Other, non-martial metaphors, such as medicine as collaboration, may be more appropriate in an age of team-based care. Taking lessons from Homer, we suggest three key ways in which cold-hearted confrontation and anger in medicine can be transformed into productive, warm-hearted engagement: the transformation of angry impulse into (1) reflection, (2) moral courage and (3) empathy. Thinking with Homer can offer an aesthetically and morally charged alternative to the current body of literature on topics, such as anger in doctors, and how this may be 'managed', without recourse to an instrumental economy where emotions are viewed as commodities, and emotional responses can be 'trained' through communication skills courses.

In current undergraduate medical curricula, much emphasis is placed on learning the skills of communication. This paper looks at Homer's Iliad and argues that from it we may learn that our skills can be mechanistic, shallow and simplistic. Homer was regarded in the Greek and Roman world as the father of rhetoric. This reputation rested greatly on book 9 of the Iliad, the embassy from the Greek leaders to the bitter, wrathful Achilles. The mission of the three emissaries is to persuade him to return to the ranks of the Greeks, who are being routed since his refusal to fight. We learn how the outcome of a conversation may be predetermined by the previous relationship of the speakers, and how a man beyond reason responds to reason; we should reflect that Homer's audience heard the piece knowing the outcome, giving it a tragic inevitability. We, the audience, cannot analyse the discourse rationally, because in this, as in all communication, reason is disturbed by emotion.

Empathy is thought a desirable quality in doctors as a key component of communication skills and professionalism. It is therefore thought desirable to teach it to medical students. Yet empathy is a quality whose essence is difficult to capture but easy to enact. We problematise empathy in an era where empathy has been literalised and instrumentalised, including its measurement. Even if we could agree a universally acceptable definition of empathy, engendering it in the student requires a more subtle approach than seems the case currently. We therefore examine this modern concept and compare it with others such as pity and compassion, using the medium of Homer's Iliad. Two famous scenes from the Iliad elicit pity in the characters and the audience. Pity and compassion are, however, given a complexity within the narrative that often seems lacking in modern ways of conceptualising and teaching empathy.

In a series of previous articles, we have considered how we might reconceptualise central themes in medicine and medical education through ‘thinking with Homer’. This has involved using textual approaches, scenes and characters from the Iliad and Odyssey for rethinking what is a ‘communication skill’, and what do we mean by ‘empathy’ in medical practice; in what sense is medical practice formulaic, like a Homeric ‘song’; and what is lyrical about medical practice. Our approach is not to historicise medicine and medical education, but to use thinking with Homer as a medium and metaphor for questioning the habitual and the taken-for-granted in contemporary practice. In this article, we tackle the complex theme of ‘translation’. We use the lens of translation studies to examine the process of turning the patient9s story into medical language. We address the questions: what makes a ‘good’ translation? What are the consequences of mistranslation and poor translation? And, while things are inevitably lost in translation, does this matter?

Improving the quality of communication between doctors and their patients and colleagues is of vital importance. Poor communication, especially within and across clinical teams working around patients in pathways of care, leads to avoidable medical error, where an unacceptable number of patients are severely harmed or die each year. The figures from such iatrogenesis have now reached epidemic proportions, constituting one of the major killers of patients worldwide. Despite 30 years9 worth of explicit attention to teaching communication skills at undergraduate level, communication in medicine is failing to improve at an acceptable rate. The authors suggest a rather unusual approach to this dilemma of ‘communication hypocompetence’— thinking medicine lyrically —as an extension of thinking with Homer9s little-discussed lyrical aesthetic. A key part of the problem of communication hypocompetence is the well-researched phenomenon of ‘empathy decline’ in students, where ‘hardening’ and cynicism occur as over-determined ego defences. Empathy decline may be a symptom of the repression of the lyrical genre in medicine, where the epic, tragic and dark comic genres dominate. The lyrical genre emphasises coming to know the patient as a person and an individual. Importantly, central to performing the lyric genre is the heightened use of the senses in taking a history, physical examination and diagnostic work. Framing medicine as lyrical work challenges undue emphasis on ‘cure’ at the expense of humane ‘care’.