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

Since its inception, I’ve thought of this column not so much as a place for in-depth reviews, but rather as a way to shine a spotlight on books that we, as a community of medical professionals, might want to read and might not be aware are out there.

I do come across and am sometimes sent books for review that I just don’t think are broad enough in subject matter, appeal or quality to warrant inclusion. This isn’t about literary criticism so much as it is about highlighting titles that seem relevant, thought-provoking and, hopefully, useful in helping us better understand our patients, our profession, our colleagues and, in the end, ourselves.

In that spirit, the three books in this review look at where modern medicine’s been and may be heading, how our emotional processing of what we see and do affects us and the care we deliver and given the approaching season, reminds us what our real business is. God (however you perceive Him or Her) bless us, everyone.

“The Rise and Fall of Modern Medicine,” James Le Fanu, MD, Basic Books (2012), 608 pp.

If you took Western civilization in college and were assigned “The Rise and Fall of the Roman Empire,” you might be tempted to pass on this one, but that would be a shame because there are many interwoven parallels. Modern Medicine is a veritable world of kingdoms more complex than even George R. R. Martin could fathom.

The author is a British primary care doctor and newspaper columnist. Thus, his take and his worldview should be taken into consideration. The book’s prologue is probably the best part, a good recapping of how medicine has advanced and the milestones and timeline that many younger physicians may not appreciate. After the prologue, however, the plot tends to thin. The author’s premise is that medicine’s Golden Age peaked in the 1970s and has been in decline ever since.

It’s a bit of a startling assessment. What’s worth reading is not his Nostradamus prognostications, but rather what has come to pass and what has turned out rather differently than predicted.

It’s an old saw that you need to know where you’ve been to appreciate where you’re going. There are some well-done discussions and some valuable take-home arguments here, but the value of this read is not what has come true but what has not. In my next column I’ll suggest a “companion” book to this one that may be more applicable to how we probably need to understand medical progress.

“What Doctors Feel,” Danielle Ofri, MD, Beacon Press (2014) 232 pp.

Having previously reviewed “How Doctors Think” by Jerome Groopman, MD, I thought this would be worth a look. When I was young (‘60s and kind of the ‘70s), doctors, especially surgical specialists, were so often portrayed (or caricatured) as the equivalent of Tom Wolfe’s “steely-eyed missile men” from The Right Stuff – nonfeeling automatons with computers for brains and ice water in their veins. That characterization may have changed and softened over the years, but the harsh realities of dealing with patients and their problems have not.

The subtitle of this book is “How Emotions Affect the Practice of Medicine.” Well, you might say, they don’t. Or at least they shouldn’t. But as we all know, even if we won’t admit it, they most certainly do. Fear, uncertainty, insecurity, overconfidence, arrogance, misogyny, misanthropy, imposter syndrome, malignant narcissism – it’s like a horror movie version of Pixar’s “Inside Out.”

And what do we do, what are we taught to do with all these ticking emotional IEDs? We stuff them down, lock them up, or, worse, we detonate them, often with considerable personal, not to mention collateral, damage affecting our coworkers, colleagues and patients.

This isn’t really a book about burnout, or moral injury or emotional exhaustion, or any of the currently popular neologisms running wild in the literature. It’s a very well-done examination of how inextricable our emotional state is from the quality and kind of care we provide. Looking at it in one way, being a physician is pretty much an impossible job to ever be perfect at, and yet that’s what we try to be every day. What we’re expected to be.  If you don’t see yourself or your colleagues in these pages (I certainly did), I’d suggest reading it twice.

“A Christmas Carol. In Prose. Being a Ghost Story of Christmas.” Charles Dickens, Chapman & Hall (1843), 96 pp.

First of all, forget Alistair Sim, Jim Backus (as Mr. Magoo), George C. Scott, Albert Finney, Patrick Stewart or even Bill Murray – movie and television adaptations have permanently, irrevocably and perhaps irreparably altered the popular perceptions of this story and this book – unless, that is, you’ve actually read it. And I would strongly urge taking the relatively short time it takes to do that.

The truest part of the original title (show of hands – how many knew there was more?) is that it is a ghost story. A very good one. Christmas and the spirit of the holiday season are the narrative framing devices, for sure, and they are very effective ones. But it’s really not about Christmas, not about religion, not even about ghosts for that matter. At heart, it’s about what we do.

The giveaway comes early on when the recently deceased Jacob Marley confronts Ebenezer Scrooge in his cold, dark and drafty London flat. Scrooge compliments the fearful apparition of his former partner on the business acumen he exhibited during life. Marley immediately rebukes him with a thunderous, chain-rattling zinger: “Mankind was my business!”

Mankind, like it or not, is our business. Always has been. It’s our only business. And whether you’re a good-hearted healer or an entrepreneur with a medical degree, that part doesn’t change.

This is a novella, and so it makes its point rather quickly and elegantly. And even after almost 179 years, you can still find modern parallels. Plug in any big health care corporation or hospital CEO for Scrooge and his money-changing business; Bob Cratchit stands in for every belittled and beleaguered physician; and Tiny Tim, well, Tiny Tim is the Everypatient. You can figure out the rest.

If you haven’t had the experience of reading this in a quiet room, holding a real book on a cold night, I think you might really be missing something.

December’s books

For December, Joan Naidorf, DO, will review “On Rotation” by Shirlene Obuobi, MD, and “The White Coat Diaries” by Madi Sinha, 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 What Doctors Feel, The Rise and Fall of Modern Medicine, A Christmas Carol 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, Oct. 2022: The Doctors Blackwell

The DO Book Club, Sept. 2022: Letter to a Young Female Physician, Ask Me About My Uterus, Practical Management of Pain