The DO Book Club, March 2022: Heartsounds, Echoes of Heartsounds, Changing How We Think About Difficult Patients

Welcome back to The DO Book Club! This month, I reviewed Heartsounds and Echoes of Heartsounds, both by Martha Weinman Lear, and Changing How We Think About Difficult Patients by Joan Naidorf, DO, my copilot on The DO’s books column.

Heartsounds, Martha Weinman Lear, Pocket Books (1982), 528 pp.

Although a little over 40 years old, this memoir remains a classic. It also represents one of the early works in what we could today call narrative medicine.

We spend most of our professional lives as young or young-ish medical practitioners. Many of us will be practitioners for many years before we or our loved ones become patients. And so, we are often disconnected from what our own patients and their families are going through. We sympathize, we empathize, often without really understanding. We don’t know just how they feel because we’ve never had to feel that way ourselves.

This book vividly describes the author’s experiences and emotions as her husband, a urologist himself, suffers a myocardial infarction while she is out of the country. She rushes home and, with her spouse, jumps on the terrifying rollercoaster ride we know as “modern” medicine.

Procedures, explanations, non-explanations, complications, followed by more explanations. I couldn’t fully appreciate this book when I first read it in med school. Having now assumed the role of patient, re-reading it was a totally different and illuminating experience.

There’s a lot of raw emotion in this book. Both Lear and her husband might be classified as “difficult” patients. He knew so much, and she wanted answers. Granted, practice was different in the late 1970s as were technology and therapeutics but, unfortunately, much of what went on then still goes on today.

 One of the most memorable passages describes Harold, the urologist, listening to his own heart at the dinner table and drawing his own blood during anginal episodes, trying to “catch” another MI. All of us have had patients who suffered complications – this narrative heart-wrenchingly describes what it’s like to be on the other side of good intentions gone bad.

It’s a long read but it’s worth it, even if you’ve read it before. If you were young in 1981, you’re like me – not so young now, so reading this book will strike you differently than it did back then. If you’re young and healthy now, you’ll recognize the doctors in your colleagues and yourself. What this book can teach us is what we look like from the other side – it’s often quite different from what we imagine.

Echoes of Heartsounds, Martha Weinman Lear, Open Road Media (2014), 206 pp.

The subtitle of Heartsounds is: A Memoir of Love and Loss. This follow-up book bills itself as: A Memoir of Healing. The difference is important.

This book is not a sequel. Think of it is an update. If the original made the reader despair about the callousness and inhumanity of medical care, this read lets us know that things have changed for the better. Technology always advances, but in these pages we can see that caregivers have also advanced. The lessons of the first book have been learned, if not by all, at least by many.

The story follows the author’s own brush with heart disease and the now slightly safer rollercoaster of high-tech medicine. It’s fascinating to read the juxtapositions as she experiences current-day care, which she compares to the experiences she had witnessing her husband’s illness and treatment back in the ‘70s.

She ends up being admitted to the same hospital and seen by some of the same doctors who treated her late husband. There’s deja vu and then there’s this.

The book is an easier read, coming in at less than half the length of the original. It’s a great lesson in “that was then, this is now.” All physicians and med students would benefit from reading it. This book and the original Heartsounds should be required reading in any cardiology training program.

I did find the title ironic: while we still listen to heart sounds, it now seems like more of a ritual than a diagnostic tool. The “echoes” of heart sounds could be construed as the diagnostic study every heart patient gets – the echocardiogram.

We can even attach the transducers to our smartphones if we wish. I couldn’t help but think of Harold sitting at the dinner table looking at his own 2D echo app. The more things change, the more they stay the same. I highly recommend reading this book soon after reading the original.

Changing How We Think About Difficult Patients, Joan Naidorf, DO, American Association for Physician Leadership (2022), 108 pp.

I loved this book. Not just because its author is my partner in this book review column; not just because it represents another foray for a DO author into the world of mainstream medical publishing – I loved this book for the approach it takes and the lessons it teaches.

In the 1877 novel Anna Karenina, Fyodor Dostoevsky wrote “… each unhappy family is unhappy in its own way.” The same, as we all know, can be said of unhappy patients. And let’s face it, an unhappy patient is, by definition, a difficult patient.

And why shouldn’t they be? Almost no one sees a physician for the uplifting social interaction. Patients are sick, they’re worried, they’re sometimes suffering – not exactly a smiley-face moment for anyone.

What separates Dr. Naidorf’s book is her focus on the truly – read that the intentionally – difficult patient. The one who seems to revel in generating as much misery for the healing professional as possible. The psychology of this subset of patients is complex, obviously. But without a strategy, they can and often do rob practitioners of the inherent joy we entered medicine to find.

Dr. Naidorf’s approach blends a pertinent review of existing knowledge and informed opinions with the author’s 30 years of practical experience in the ED. It’s a volume that is long overdue – not just for physicians, but for nurses, PAs and the diverse array of modern medical professionals who must deal with difficult patients and situations every day.

It suggests to the reader tricks to avoid the self-springing trap that allows these patients – whose unhappiness is often ingrained and practiced – to steal the satisfaction from our role in caring for them. It should be mandatory reading for every hospital CEO and CMO as well.

April’s book

For April, Joan Naidorf, DO, will review Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine by Damon Tweedy, 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 Heartsounds, Echoes of Heartsounds, Changing How We Think About Difficult Patients or any previous Book Club selection and want to share your reflections, please leave a comment below or email [email protected].

Related reading:

The DO Book Club, Feb. 2022: It’s All in the Delivery and Motherhood, Medicine & Me

The DO Book Club, Jan. 2022: Lightning Flowers