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In 2372, The Clown created a scalpel in his virtual reality to invoke Harry Kim's traumatic childhood experiences. However, The Doctor corrected the positioning of The Clown's index finger in order to attain "optimal dexterity." (VOY: "The Thaw")
In 2377, when The Doctor tried to explain to Lewis Zimmerman that he was trying to treat him because he cared about him, Zimmerman replied that he was not programmed to care, he was programmed to hold a scalpel. (VOY: "Life Line")