The DO Book Club, Jan. 2023: ‘When We Do Harm,’ ‘Floating Feathers’ and ‘When Spirit Touches Matter’

Welcome back to The DO Book Club! For January, I am reviewing “When We Do Harm: A Doctor Confronts Medical Error” by Danielle Ofri, MD, “Floating Feathers” by Ross I.S. Zbar, MD, and “When Spirit Touches Matter” by Mel Friedman, DO.

“When We Do Harm: A Doctor Confronts Medical Error,” Danielle Ofri, MD, Beacon Press (2020), 304 pp.

As physicians, what do you think it is that really keeps us up at night?

As the old saying goes, it’s not the work, it’s the worry. And it’s not just at night. Worry, subtly or not-so-subtly, suffuses almost every conscious moment of our working lives. And I’d wager that if you asked most doctors what it is they worry about, it would boil down to one thing – they worry they might make or have made a mistake that harms someone. We make hundreds of thousands of decisions in our careers – many of them small, but hardly any of them unimportant. We are expected to be right 100% of the time, an impossibility that translates to a professional lifetime of cognitive dissonance.

We’ve all seen the statistics – that medical errors account for thousands of patient injuries and deaths every year. Dr. Ofri, a seasoned clinician, addresses the problem on a personal level, through the stories of two patients who ended up dying, and also on a systemic level – noting the things that inherently allow for and more-than-occasionally promote the errors that wind up actually doing the harm. Her take on the effects of the now ubiquitous and omnipresent EHR is worth reading twice.

If you look at how physicians are trained, the underlying narrative is a relentless striving for perfection. The idea is that there is a correct response for any and every given question or problem. Every clinical interaction is reduced to a series of “board questions.” But rather than stressing ways to achieve a perfect score on every test, Dr. Ofri suggests a scheme for altering the very systems and situations that promulgate errors, freely admitting this will take nothing short of a culture shift in the way medicine is practiced. If you’re an old “Star Trek” fan, it would be Capt. Kirk’s solution to the Kobayashi Maru scenario.

This isn’t a book that has all the answers, nor does it purport to be one. But as medical technology grows more complex and sophisticated, as medical practices and care decisions fall more under the control of corporate minions and not practicing physicians, and as doctors are increasingly pressured to produce positive reviews along with positive (read: cost-effective) outcomes, the potential for harmful errors will only increase.

Primum non nocere, we’ve all been taught. First do no harm. A tad easier said than done these days. So, I strongly suggest you take the time to read this book.

It couldn’t hurt.

“Floating Feathers,” Ross I.S. Zbar, MD, Miles Trevor Press (2020), 252 pp.

Ignore the Zen-like title – this is a modern horror story minus the decaying mansion, creaking stairs and moving-eyes portraits. It wouldn’t be the first scare-fest to be set in a hospital, but the fact that it’s a first-hand account makes it more terrifying than anything fictional. The sub-title gives it away: “A Doctor’s Harrowing Journey as a Patient Within Conventional Medicine and an Impassioned Call for the Future of Care in America.” A mouthful to be sure, but at least you can’t say the author didn’t warn you.

At some point, we all have or eventually will take a page from the great Joni Mitchell’s songbook and get our look at health care from both sides now. By way of disclosure here – I have been a hospital patient through several major health scares, medical and surgical, and I can tell you one thing – once you’re on the other side of the bracelet, as I like to call it, you’ll never look at medicine, health care, yourself or your colleagues the same way ever again.

I don’t have horror stories to tell – I got great care every time. But here’s the thing – as an insider, I knew how to help myself; I knew where the traps were and how to avoid them. I picked my attending physicians. I knew not only when to question but what questions to ask. And, since I was awake and alert for most of the experience, I could pipe up when something didn’t seem right. Dr. Zbar wasn’t so lucky.

Having sustained a fall from a height, he ended up sedated and restrained in an ICU – for three weeks. He is an accomplished reconstructive head and neck surgeon and trained at several of the most highly regarded programs in the U.S. One assumes there wasn’t much he hadn’t seen. But he’d only seen it from one side.

The scariest part of his story is that there are no monsters, villains, or even a demented evil genius. Just the good people we work with every day going about their jobs. If there is a classic horror trope, it would be the old, “The calls are coming from inside the house!” reveal. One might brush off Dr. Zbar’s experience as an outlier – a run of bad luck and a proof of Murphy’s Law. But I don’t think that’s it. If, after looking at things from both sides, it’s still health care’s illusions you recall, then maybe you don’t really know health care at all.

And in case Dr. Ofri’s book doesn’t resonate deeply enough, read this one right after you finish hers – with one suggestion:

Leave the lights on.

“When Spirit Touches Matter: A Journey Toward Wholeness,” Mel Friedman, DO, Torchflame Books (2022), 322 pp.

I always try to highlight books written by or contributed to by our osteopathic colleagues. I received a copy of this one in the mail. It took me a while to sit down and read it, but once I did, I was glad it found me.

Dr. Friedman is a veteran practitioner with a deep commitment to the principles of osteopathic medicine and the application of manipulative techniques to relieve pain and suffering. But his book is not about osteopathic medicine. The journey he describes is actually two journeys – a physical pilgrimage and a simultaneous metaphysical one. In less capable hands, the stories might have become muddled or lost in a blizzard of New Age buzzwords. But Dr. Friedman writes not just from the heart – but from the heart of a physician. His prose will resonate with anyone who cares for others for a living. Intertwined with his actual journey to the Tibetan mountain source of the holy rivers, his book is an entertaining mix of travelogue and interior dialogue. A journey of discovery and self-realization.

Dr. Freidman is a capable narrator and a delightful traveling companion. I think you’ll enjoy the trip.

February’s book

For February, Joan Naidorf, DO, will review “Pathological: The True Story of Six Misdiagnoses” by Sarah Fay. We encourage all who are interested to read along (this book club can be followed at any pace)! If you are unable to get out to a local library or bookstore, we recommend checking out eBook options.

If you read “When We Do Harm,” “Floating Feathers,” “When Spirit Touches Matter” or any previous Book Club selection and want to share your reflections, please leave a comment below or email rraymond@osteopathic.org.

Related reading:

The DO Book Club, Dec. 2022: ‘On Rotation’ and ‘The White Coat Diaries’

The DO Book Club, Nov. 2022: What Doctors Feel, The Rise and Fall of Modern Medicine, A Christmas Carol