Anthony Papagiannis, MD, MRCP
St Luke’s Hospital, Thessaloniki, Greece

In The Citadel, A. J. Cronin’s quintessential medical novel, the hero, Dr Andrew Manson, still a junior doctor in country practice, is unhappy with his lowly professional status and wonders how he can improve matters. Christine, his devoted wife, urges him to try and obtain a higher medical qualification, perhaps the MRCP, the Membership of the Royal College of Physicians. "The MRCP—they only give that to the crowned heads of Europe!" he exclaims in some dismay. Along with Manson we learn that even well into the first half of the twentieth century the Membership examination was not only about medical knowledge, but also included either Greek or Latin and at least one other foreign language as part of a physician’s panoply to fight disease or attempt to fathom its secrets by studying the real classics, Hippocrates or Galen.

A lot of water has passed under the bridge since Cronin’s time, and the examination has undergone many changes. By the time I took the test back in 1990, no particular familiarity with Latin or Greek was required (indeed a demand for the latter might have been in my favor). However, you still had to know a lot of medicine and be sure of your facts: wrong responses in the multiple choice paper would get you negative marks, so guessing was out of the question (this system was later changed). After passing three additional written papers, one still had to display more than adequate clinical skill in examining patients, eliciting and interpreting physical signs under the close scrutiny of paired examiners—one asking the questions and the other grading the candidate’s responses. I felt reasonably proud of myself when I received a "Pass" letter after my second attempt. There were a few moments of basking in glory when the diplomas were awarded in Edinburgh a month later. I was the only Greek in that particular batch of members, among scores of successful British, Indian, Pakistani and Chinese candidates as well as individuals representing a broad range of other nationalities. As Professor Anthony Toft, then Vice President of the College, said in his address, "It is a tough examination, but now that you have passed, you would not want it to be otherwise." I am sure we all felt he was right, and his comment flattered us to no end.

Over the next few years the Membership was the ticket to advancement in my hospital career. This is not an exit, but an entry qualification: you only proceed to higher medical education and specialization in the United Kingdom after you have secured your diploma. Its possession enabled me to train in respiratory medicine, do a doctoral thesis, and even obtain temporary summertime posts as consultant physician in the UK years after I had established my base back home. I added MRCP(UK) after my name on my professional cards and notepaper, and felt a secret thrill of pride whenever I was asked to explain the initials and realized how few of my colleagues possessed that coveted title. Many Greek doctors had trained in Britain for various periods of time but had never attempted to take such a demanding examination. On seeing the title some expressed genuine admiration and approval, others (notably academics) displayed a sour grapes reaction ("I haven’t got it so it must not be really important"), and the great majority simply ignored it as it meant nothing to them. It did not take me long to realize that the precious Membership did not carry much weight in my home country, and that I would only need it again if I ever decided to return to the UK. Naturally, as with all professional examinations worthy of their name, its objective value (which has nothing to do with personal vanity) lies in the fact that "it teaches more than it tests" as the saying goes. Still, the diploma, with its three distinctive red wax seals, looks pretty good among its peers on the wall of my consulting room.

I must now briefly digress. In the first chapter of The Hound of the Baskervilles, that other classic by a physician who made his name as detective fiction writer, Sherlock Holmes is examining a walking stick abandoned in his rooms by a visiting doctor. He teases Dr. Watson about his owner, so Watson takes down the Medical Directory and ruefully confirms the visitor’s details as deduced by Holmes before he appears at their doorstep in person. Obviously the possibility of running a Google search and getting reams of relevant (and not so) information at the flick of a wrist would be unthinkable not only for Arthur Conan Doyle but even for Jules Verne, the father of science fiction, no matter how vivid the latter’s imagination might be.

In any case, one morning a few months before I was to leave Britain a publisher’s invitation to buy the latest edition of the Medical Directory arrived in my letterbox. I was tempted to buy it for reference. That was my excuse anyway, the unspoken reason being that it contained, among thousands of other doctors, a few lines dedicated to my person, including the coveted initials of the membership after my name. For a mere hundred-and-fifty pounds sterling I could own my personal copy and look up my details whenever I was in need of an ego booster. I could even casually show them to friends and colleagues as proof of my proud passage through the medical ranks of the United Kingdom.

Only the other day, as I was searching for something else in the back row of crammed bookshelves, I cast my eyes on the three red cloth-bound volumes. They have been now gathering dust there for eighteen years; their existence, let alone their reference value, was completely forgotten. After all these years my edition of the Directory is to a great extent outdated, though not entirely valueless. We often scoff at people who spend large sums of money on fanciful tailor-made outfits that are only to be worn once on some special occasion, to be discarded or even destroyed afterwards. If one can put a price on medical vanity, now I know that my personal tag was one-hundred-and-fifty pounds back in 1994. I wonder how much it would be worth today.

ANTHONY PAPAGIANNIS, MD, MRCP (UK), DipPallMed, FCCP is a practicing pulmonologist in Thessaloniki, Greece. He received his MD degree from the Aristotle University of Thessaloniki Medical School in 1981. He trained in internal medicine in Greece and subsequently in the United Kingdom, and specialized in pulmonary medicine. He also holds a postgraduate diploma in palliative medicine from the University of Cardiff, Wales, United Kingdom. He is a postgraduate instructor in palliative medicine in the University of Thessaly, Larissa, Greece.