Nineteenth-century literary realism develops alongside but is not identical to clinical medical realism. Recent scholarly work has focused, for good reason, on how literary and medical realisms overlapped during this period. However, it is useful also to consider some differences: dissimilarities in language (literary writers privileged spoken vernacular, while physicians developed a written rhetoric with a complex, specialized professional vocabulary), demography (literary realism largely chronicled the middle classes and respectable working people, while hospital-trained physicians wrote about poor urban patients), methodologies (medical men explored quantifiable data; literary realists continued to employ lengthy description), definitions of truth (medical reportage works to present a truthful portrayal of real events; literary rendering strives for a credible portrayal of fictional ones), and relation to the balance of detachment and sympathy (clinical physicians believed that detachment underwrites medical progress, although they did not always deny their sensibilities, often turning to literary realism or romance to manage such moments rhetorically). This chapter argues that medical and literary writers, attempting to negotiate, overcome, or uphold these key differences, defined what it meant for Victorians to tell the truth, well aware that all realism is a representation, and representation is only an approximation of the real.