SGEM Xtra: Make It So – Lessons Learned from Sir Patrick Stewart and Captain Picard

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Date: November 10, 2026

Dr. Kay Dingwell

Guest Skeptic: Joining me on this away mission is Dr. Kay Dingwell. Kay is a rural emergency physician working in Prince County, Prince Edward Island. She has a special interest in gender-affirming care and improving the healthcare experiences of marginalized populations. Kay was previously on SGEM#442, I’m on the Right Track Baby I Was Born This Way, where we discussed improving emergency department care for transgender and gender-diverse patients. Kay is also a huge fan of Captain Picard and Star Trek TNG.

This is an SGEM Xtra. Occasionally, we take a break from reviewing the medical literature to discuss something a little different. Today is one of those days. We are going on an away mission aboard the USS Enterprise NCC-1701-D to celebrate the life and career of Sir Patrick Stewart.

Sir Patrick is an internationally acclaimed actor best known to many of us as Captain Jean-Luc Picard in Star Trek: The Next Generation (TNG). However, his career extends far beyond the bridge of the Enterprise. He is a classically trained Shakespearean actor, a member of the Royal Shakespeare Company, an advocate for human rights, and someone who has used his fame to speak out against domestic violence.

I have been a Star Trek fan for most of my life. In July 2021, I had the opportunity to celebrate William Shatner’s 90th birthday with my good friend Dr. Brian Goldman. We travelled to Ticonderoga, New York, to visit the original Star Trek set recreation. During that adventure, we recorded an SGEM Xtra called Star Trek Made Me a Better Physician.

We discussed how the original series, with Captain Kirk, Mr. Spock, and Dr. McCoy, taught us important lessons about evidence-based medicine, clinical judgment, and the importance of humanity. Today, we are moving from the original Enterprise to the Enterprise-D.

Questions for Kay:

When did you first discover Star Trek TNG?
What was it about Captain Picard that made such an impression on you?
How has your appreciation of the character changed as you’ve gotten older and progressed through your medical career?
Do you think watching TNG has made you a better emergency physician?

Star Trek fans have a running debate about which captain is best. Some prefer Captain Kirk’s willingness to take risks, break rules, and occasionally lose his shirt. Others prefer Captain Picard’s diplomacy, intellectual curiosity, and commitment to ethical principles. We will put up a poll this week to ask listeners who their favourite captain is.

From Shakespeare To Starfleet

Patrick Stewart was born on July 13, 1940, in Mirfield, West Yorkshire, England. He grew up in a working-class family and developed an early interest in acting. Patrick has been open about his difficult childhood. His father was violent towards his mother, something that would profoundly influence Stewart’s life and his later advocacy. He eventually pursued acting professionally and joined the Royal Shakespeare Company in 1966.His theatrical background gave him the commanding voice, presence, and gravitas that would eventually define Captain Picard.

When he was cast as captain of the Enterprise in 1987, he was hardly a household name in North America. Some fans questioned whether an older, bald, British Shakespearean actor could follow William Shatner. Seven seasons, four TNG feature films, and three seasons of Star Trek: Picard later, I think we have our answer.

Have you ever seen Patrick Stewart perform Shakespeare?
Do you think his classical training made Picard a different kind of television character?
Is there a particular Patrick Stewart performance outside Star Trek that stands out to you?

One theme we return to frequently on the SGEM is the importance of humility. Being a physician does not mean having all the answers. Being a captain does not mean being infallible. Both roles require recognizing uncertainty, listening to others, and making difficult decisions.

Five Star Trek: The Next Generation Episodes

There were 178 episodes of Star Trek TNG broadcast over seven seasons from 1987 to 1994. Picking the best episodes is a bit like asking emergency physicians to agree on the best treatment for acute ischemic stroke. There will be strong opinions, passionate arguments, and probably a few people who think everyone else is wrong. We have selected five episodes that demonstrate important lessons about medicine, ethics, and humanity.

1. The Measure of a Man (Season 2, Episode 9)

In this episode, Starfleet wants to dismantle Lieutenant Commander Data to study his positronic brain. The scientist proposing the procedure argues that Data is a machine and therefore does not have the same rights as a person. Captain Picard challenges this assumption. The central question becomes whether Data is property or a sentient being entitled to make decisions about his own existence. It asks us to consider what makes someone a person and who gets to decide. Our decision will reveal what kind of people we are.

These questions are directly relevant to medicine. We encounter patients who may have impaired capacity, cognitive disabilities, severe mental illness, or communication difficulties. Sometimes, healthcare professionals assume what these individuals understand or what is best for them. However, having a disability or requiring assistance does not mean someone lacks autonomy.

Clinical Application: Evidence-based medicine has three important components: the best available scientific evidence, clinical expertise, and patient values and preferences. We can have excellent scientific evidence supporting a particular treatment, but that does not mean every patient will choose that treatment.

Patients have the right to make informed decisions about their own healthcare. The role of the physician is not simply to tell patients what to do. It is to help them understand their options, potential benefits, and possible harms.

2. The Inner Light (Season 5, Episode 25)

This episode is frequently ranked among the greatest Star Trek stories. Captain Picard encounters an alien probe and experiences an entire lifetime as a man named Kamin on a distant planet. He marries, raises a family, grows old, and experiences the loss of people he loves. When he returns to the Enterprise, only a short period has passed for the crew. However, Picard has lived decades in another person’s life.

The episode reminds us that every individual has a story. In emergency medicine, we often meet people at one of the worst moments of their lives. We may know their age, vital signs, laboratory results, and medical history. But how much do we really know about them? We see a 75-year-old patient with shortness of breath. We might not know they were once a teacher, an athlete, a parent, a musician, or someone who changed another person’s life.

Clinical Application: Patients are more than their diagnoses. A patient-centred approach means understanding not just what disease someone has but what matters to them.

The best outcome is not always survival, a normal laboratory result, or discharge from the emergency department. Sometimes, it is relief of suffering, maintaining dignity, or helping someone achieve a personal goal.

3. Chain of Command, Parts I and II (Season 6, Episodes 10–11)

This two-part episode is remembered for Picard’s imprisonment and torture by a Cardassian interrogator. The interrogator attempts to break Picard psychologically by forcing him to deny what he knows to be true. Picard is repeatedly shown four lights and pressured to say there are five. The episode is a powerful examination of torture, coercion, and the fragility of human perception.

Patrick Stewart delivers one of his most memorable performances. The episode also raises important questions about psychological trauma. We sometimes assume that strong individuals can simply overcome traumatic experiences through determination. However, trauma can affect anyone. It can alter memory, perception, behaviour, and relationships.

Clinical Application: Trauma-informed care recognizes that patients may have experienced events that influence how they interact with healthcare professionals. A patient who appears angry, withdrawn, distrustful, or reluctant to answer questions may be responding to previous trauma.

Our responsibility is to create an environment where patients feel physically and psychologically safe. We should avoid unnecessarily taking away their sense of control. This episode also reminds us that dignity and resistance are not always visible. Someone may survive an experience without emerging unchanged.

4. Darmok (Season 5, Episode 2)

In Darmok, Captain Picard encounters an alien species whose language consists of references to stories and metaphors. Although the universal translator can translate individual words, the meaning remains unclear. The aliens are speaking, but the Enterprise crew cannot understand them. Picard must learn the cultural context behind the words before meaningful communication becomes possible.

This sounds remarkably similar to some medical consultations. We use words such as myocardial infarction, pulmonary embolism, sensitivity, specificity, and number needed to treat. These terms make perfect sense to us. But what do they mean to our patients?

Communication is not simply transmitting information. It is making sure the other person understands what we are trying to say.

Clinical Application: Shared decision-making requires more than presenting information. We must communicate in a way that is understandable and meaningful to the individual patient. Using plain language, checking understanding, and asking patients about their concerns can improve communication.

Sometimes the problem is not that the patient does not understand medicine. It is that we have not understood the patient.

5. Tapestry (Season 6, Episode 15)

In Tapestry, Picard has the chance to revisit his younger life and change a decision that led to a serious injury. He discovers that avoiding this mistake would have fundamentally changed the person he became. This episode explores the relationship between risk, regret, and personal growth.

As emergency physicians, we make decisions every shift under conditions of uncertainty. Some decisions turn out well. Others do not. We sometimes look back and wonder what would have happened if we had chosen differently. But hindsight is a powerful cognitive bias. Knowing an event’s outcome can make the correct decision seem obvious when it wasn’t at the time.

Clinical Application: We should evaluate clinical decisions based on the information available at the time, not simply the eventual outcome. A good decision can still result in a bad outcome. A poor decision can occasionally result in a good outcome.

Learning requires reflection, humility, and a willingness to question our assumptions. We should strive to improve without expecting perfection.

Beyond the Bridge:

Advocacy Against Intimate Partner Violence

We have spent much of this episode discussing Patrick Stewart’s remarkable acting career. However, I think some of his most important work has happened away from the cameras. Sir Patrick has been an outspoken advocate against domestic violence. This advocacy is deeply personal. He has spoken publicly about witnessing his father physically abuse his mother during his childhood.

For many years, Stewart believed his father’s violent behaviour was simply part of who he was. Later in life, he learned more about the psychological trauma his father experienced during military service. This helped him better understand his father’s behaviour, but it did not excuse the violence.

Stewart has supported organizations working to prevent domestic abuse and improve services for survivors. He has also spoken about the responsibility of men to challenge violence against women. One widely shared photograph shows him holding a sign supporting the rights of women and girls.

The accompanying message reflects his recognition that older white men are often given greater authority and credibility in society. Rather than simply accepting that privilege, Stewart has argued that it should be used to support people whose voices are not being heard. I have tried to use whatever older white male privilege I have to support those who are often not heard in medicine. That included women and the LGBTQ+ community.

Intimate partner violence (IPV) is a topic that is particularly important to Kay, and she agreed to discuss some of her own experiences. Listen to the podcast to hear about her journey.

What does Patrick Stewart’s advocacy against intimate partner violence mean to you personally?
Has your own experience changed how you approach patients who may be experiencing IPV?
What do you wish healthcare professionals better understood about people experiencing intimate partner violence?
What are some of the barriers that prevent people from seeking help?
What would you like colleagues working in emergency departments to take away from this conversation?

Five Clinical Considerations for IPV

Create a safe environment: Whenever possible, speak with the patient privately, away from their partner or anyone who might influence their answers. Use a professional interpreter when needed.
Ask without judgment: Use open, respectful questions. Avoid language that blames the patient or implies they are responsible for the violence.
Believe and validate: If someone discloses abuse, listen carefully. Acknowledge their experience without demanding that they prove it.
Respect autonomy: Patients may not be ready or able to leave an abusive relationship. Our role is to provide information, assess immediate danger, discuss options, and support informed decisions.
Know your local resources: Emergency departments should have pathways to social work, crisis services, shelters, advocacy organizations, and appropriate follow-up. Documentation, confidentiality, and reporting obligations should follow local policies and applicable law.

That was a super serious discussion about violence. I would like to bring it back to Captain Picard. One of the characteristics I admire most about Captain Picard is that he does not always use force to solve a problem. He listens. He negotiates. He recognizes that power carries responsibility. And when necessary, he challenges the institutions he serves.

This offers an important lesson for healthcare professionals. We have a position of authority. Patients often come to us frightened, vulnerable, or in significant pain. We should use that authority to help people, not control them.

Sir Patrick Stewart’s advocacy reminds us that the responsibility to challenge violence extends beyond the emergency department. It is something we all share.

Five Great Captain Picard Quotes:

If you could sit down with Sir Patrick Stewart for an hour, what would you ask him?
And if you could choose only one episode of Star Trek TNG to recommend to someone who has never watched the series, which episode would it be?

Sir Patrick Stewart spent decades entertaining audiences worldwide. As Captain Jean-Luc Picard, he portrayed a leader who valued intelligence, compassion, curiosity, and moral courage. Through his work in Shakespearean theatre and his advocacy against domestic violence, he has also demonstrated a commitment to understanding the human condition and challenging injustice.

SGEM Bottom Line: “He was a man, take him for all in all, I shall not look upon his like again.” William Shakespeare’s play Hamlet (Act 1, Scene 2)

One of the things I appreciate most about Star Trek is its optimism. Gene Roddenberry imagined a future where humanity had overcome many of the problems that divide us today.

The SGEM will be back next episode doing a structured critical appraisal of a recent publication. We will continue trying to cut the knowledge translation window down from over ten years to less than one year using the power of social media. So patients get the best care, based on the best evidence.

**And remember to “live long and prosper” and be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine.**

Other SGEM Episodes:

SGEM Xtra: How To Save A Life – Screening for Intimate Partner Violence in the Emergency Department
SGEM Xtra: Star Trek Made Me A Better Physician
SGEM Xtra: From EBM to FBM – Gender Equity in the House of Medicine