The DO Book Club, July 2022: Playing Doctor Part 1, How Doctors Think, Wet My Hands

A little something for everyone this time around.

Our membership in the osteopathic profession started when we found a seat for that orientation session as an OMS 1, so a book about the medical school experience seems appropriate as academic years conclude and graduations produce another round of new physicians.

Throughout our education, training and practice, we always tried to “think like doctors.” But what exactly does that mean? And do all doctors think alike? Should they? Below, I discuss a book that explores these questions.

And what does our career look like from the far vantage point? How did we get here and what happens as we and our loved ones move into the realm of the patient? A third book, written by a DO, shares the author’s experience navigating these questions.

Three interesting reads – all for different reasons. And, I think, all applicable, no matter where in your own story you find yourself.

Playing Doctor-Part One: Medical School: Stumbling Through with Amnesia, John Lawrence, MD, R.R. Bowker, August 2020, 236 pp.

The French have a saying: Plus ca change, plus c’est la meme chose. The more things change, the more they stay the same.

This is a funny book – written not long after med school graduation and based on a series of emails to friends about the rather unique experience that, for better or worse, tends to define the rest of our medical lives. It doesn’t quite have the edge or the subversively cynical narrative voice of Samuel Shem’s The House of God. It’s more of an unvarnished, eyewitness, “as it happened” account of those formative years. And they are formative.

Despite its rather limited frame, readers at every stage should find something that resonates. As a DME for twenty years, I know that medical school is nothing like it was when I sat down in that seat in 1978. At least that’s what I thought. The details and the characters may have changed but the plot remains pretty much the same. Even if you’re retired or late in your career, you’ll find yourself laughing at things you’ve forgotten or, perhaps, tried to forget.

It’s a good book to read if you teach or train students. It’s a good book to read if you are a student. It’s even a good book to read if you’re an intern, resident or fellow – it’s easy to forget that the author was you (more or less) not all that long ago. When you take that diploma and walk off the stage you are a person with a doctorate. This book will remind you just how far you were at that moment from being a doctor.

How Doctors Think, Jerome Groopman, MD, Houghton Mifflin Harcourt, 2007; 336 pp.

How does one think like a doctor? A fair question, wouldn’t you say? I have, as I’m sure you have as well, scratched my head at some of the pronouncements, assessments and recommendations of learned colleagues. Case in point:

A veteran cardiologist once strongly urged me to perform heart surgery on a frail nonagenarian. His logic was based on the coronary anatomy and the statistical likelihood of an imminent morbid or mortal event. I declined. I was hectored about it several more times.

“Without surgery he’ll be dead in six months,” my colleague finally said, trying to persuade me with a referring physician’s favorite hole-card: guilt. I had done several thousand cases by this time in my career, so I replied “With surgery, he won’t live six weeks. And those six weeks will be miserable.” He died peacefully at home seven months later.

Which of us was right?

To some degree, both of us. And that’s the crux of this excellent book. How do we arrive at our conclusions about what is the problem, the diagnosis, the best treatment? The answers will surprise you. Because how one doctor thinks can be diametrically opposed to what another equally intelligent, equally educated, and equally well-trained colleague thinks. And, as Alexander Pope once asked, “Who shall decide when doctors disagree?”

You’ll recognize both yourself and your colleagues as you read (I know I did). And not always in the best light. You’ll see how easy it is to turn rational decision-making into something else entirely. You’ll perhaps have a better understanding of how easy it is to be, as I liked to say, sometimes wrong but never in doubt.

The book also functions as a prompt for some serious reflection on how each of us handles the responsibility for the care of others as medicine increasingly becomes a true team sport.

Primary care doctors will be heartened to read how vital they are to sophisticated patient care, and how decades of misperceptions and hubris have conspired to discount their contributions (not to mention their reimbursement). Specialists (like me) might find themselves a little deflated at how those same misperceptions and egos can work to poison the roots of the decision tree.

This book is kind of like a compass – one I would strongly recommend checking very early and then at regular intervals during our career voyage. The physician’s journey is fraught with changeable winds and confused seas. And we often must alternate between acting as captain on one trip and crew on the next. In either role, reading and re-reading this may be a good way to stay on course.

Wet My Hands, Albert H. Yurvati, DO, Fulton Books, 78 pp.

I really like to see books authored, edited or significantly contributed to by our osteopathic colleagues. And there are more of them out there than you might think.

This slim volume is a mix of autobiography, heavily annotated CV, and reflection. Dr. Yurvati has had one of the more distinguished surgical careers in our profession, but this book is not a brag or a boast – it’s simply a retelling of how the transformation from simpler beginnings to high achievement came about. Its tone is conversational and circumspect. And although it’s highly personal, Dr. Yurvati narrates in an evenhanded manner without ever becoming either detached or overly emotional.

Especially poignant is the author’s description of how quickly we or our loved ones can transit from being a skilled provider of medical care to a grateful recipient. Whether you’re an OMS or a seasoned veteran, it’s a good story well told.

August’s book

For August, Joan Naidorf, DO, will review Every Deep-Drawn Breath: A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the ICU by Wes Ely, MD. 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 How Doctors Think, Playing Doctor Part 1, Wet My Hands 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, June 2022: In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope

The DO Book Club, May 2022: The English Patient, Flying Blind and Patients at Risk