The DO Book Club, May 2023: “Endurance,” “Practicing from the Heart” and “Uncaring”

Welcome back to The DO Book Club! For May, I am reviewing “Endurance,” by Alfred Lansing, “Practicing From the Heart (In the Age of Technology),” by Reza Ghadimi and “Uncaring: How the Culture of Medicine Kills Doctors & Patients,” by Robert S. Pearl, MD.

“Endurance,” Alfred Lansing, McGraw-Hill, 1959 (1^st U.S. Edition), 357pp.

I like to use this column to highlight books that might not pop up on everyone’s radar, ones readers might find interesting. Grant me a little leeway here because I think we can learn things from books that aren’t necessarily about medicine or physicians.

Perhaps if there is one quality that physicians would most benefit from it would be durability. We endure a lot to get where we are and to keep moving ahead, including much adversity along the way. For every day of smooth sailing and fair winds, there is a storm, a submerged obstacle or an unforeseen calamity. We are not only the “captain of the ship” (according to our lawyers), but we are also its doctor and navigator, dutifully charting the correct position and keeping a log in the form of progress and procedure notes.

I know, I know… you might be saying, “C’mon, I’m pretty sure I already read this book back in the day.” Well, even if you did, I humbly suggest reading it again. I didn’t know about it until I was a year into cardiac surgical practice and a colleague gave me his well-thumbed copy. But since then, I’ve re-read it often and lately have thought about it even more. Unless you never expect to have a tough day, situation or patient, it’ll help to read this story.

Endurance is the name of the ship captained by Sir Ernest Shackleton in 1913. It embarked on one of the last great polar expeditions to Antarctica and became trapped in, then crushed by the pack ice and sunk, marooning its entire company on the ever-shifting floes without hope of rescue. The book recounts how Shackleton went about making sure every one of his officers and crew made it home alive. It’s a tale well told and, thankfully, without a lot of distracting literary flourishes. The drama speaks for itself. If you want to understand leadership, commitment to those in your charge and the sheer power of persistence in the face of overwhelming odds, this is great place to start.

We must often take our patients on hazardous and sometimes unexpectedly long journeys. When things start to go south and everyone turns to us for guidance, it would be good to have a little inner-Shackleton to call upon.

“Practicing From the Heart (In the Age of Technology),” Reza Ghadimi (Foreword by Humayun (Hank) Chaudhry, DO, MACP), The Pulse/PAPulse, LLC (2021) 264pp.

This enjoyable, self-published volume arrived in the mail on the very same day I first saw something about ChatGPT^®. It took me awhile to read the collection of essays and reminisces. By the time I was done, Bard^® (Google) had arrived and, as of this writing, there are a half dozen or so more on the way. As a New Jersey native, I’m a diehard fan of Bruce Springsteen, but we might have to tweak one of his lyrics to, “Is that me, baby, or just some brilliant A.I.?”

Now, I don’t think a chatbot, even on a good day, could do what Ghadimi has done. He has organized his musings (vignettes might be a better word) in 12 chapters headed by the calendar months, although the stories told are not in chronological order. He’s been a practicing physician assistant for decades, and even though he’s not a physician, his close professional association to physicians provides a unique observational perspective on where we are and, just maybe, where we’re heading. We’re all prone to parallax, and so a take from another angle can be illuminating.

Ghadimi does not rail against technology or progress, instead he readily admits to using one of the first home computers (from Radio Shack!) to write. He provides dozens of heartfelt reflections on what is central to everything we do — the simple act of caring for another person.

Some of the stories are less than a page, others are much longer. I was struck by the unique voice of each one even though the subjects are many and varied. This would be a good book to keep in your office and maybe read a bit between cases or patients.

Skip around the story selections if you’d like — short or long, each is a stand-alone piece. They’re all personal observations, steeped in the experience of a long career in patient care. Perhaps, in the end, what will separate us from purely programmable authors is our ability to contextualize. I certainly hope so.

Author’s note: No robots were used or harmed in the writing of this column.

“Uncaring: How the Culture of Medicine Kills Doctors & Patients,” Robert S. Pearl, MD. PublicAffairs Publishing (2021), 400pp.

Not exactly a title that makes you want to jump in, is it? But it’s worth it. I came across the book while reading a lengthy review of it by an osteopathic physician in a The Intima, a journal of narrative medicine.

There is certainly a surfeit of books, essays, podcasts, etc., decrying the broken healthcare system and the effect it’s having on physicians. What separates this one, in my opinion, is that while it rightly takes aim at the profiteers and business school graduates who have taken over medical care in this country, it also rightly takes physicians to task for their part in the ongoing debacle.

Pearl is a former CEO of the giant Kaiser Permanente healthcare organization and had a clinical career as a plastic surgeon in California. His book is a disturbing take on what we’re eager to point out and, perhaps more to the point, what we are loathe to admit.

His analysis of physician “culture” alone is worth the read and points the finger at us both individually and collectively—from individual practitioners to medical and specialty societies and the collaborations (and collaborators) that advance profits and prestige ahead of patient care.

You may not find anything new in these pages, at least anything you probably haven’t already realized. But it’s refreshing (or possibly appalling) to see it spelled out — bright light is shone in some of medicine’s dark corners. If we are truly the co-authors of our own misery, the willing architects of our own undoing, then perhaps a day of reckoning for physicians is on the near horizon.

As someone who has crossed the bridge from being a practitioner to being a patient, I’ll admit to losing some sleep after reading this book. The system that will care for me, for all of us eventually, is the one we collectively created, the one we allowed to take hold and dominate our health needs. There are many who fought back and many who continue to fight the system — just not quite enough, it would seem. Point your finger in a mirror and it points right back.

Dr. Pearl suggests solutions, but I was reminded of the debate around climate change. The concepts would require sacrifice, a true cultural shift away from profit-first models and unprecedented levels of collegial cooperation, not to mention visionary governance. Most doctors I know can’t agree on lunch. What are the odds, you ask? Is it even worth trying? Do we just throw up our hands and endure it?

I know what Sir Ernest would say.

Related reading:

The DO Book Club: “On Becoming a Healer: The Journey from Patient Care to Caring about Your Patients”

The DO Book Club: ‘Pathological: The True Story of Six Misdiagnoses’