The DO Book Club, November 2023: ‘The Peter Principle,’ ‘How to Improve Doctor-Patient Connection,’ ‘Aging Optimally’ and ‘This to Me’

Welcome back to The DO Book Club! For November, I am reviewing “The Peter Principle,” “How to Improve Doctor-Patient Connection,” “Aging Optimally” and “This to Me.”

Doctoring is a tough business, regardless of which specialty you practice. I chose these books because they might make caring for patients easier or at least more understandable. This is especially true as control over how we practice slips further out of reach.

“The Peter Principle,” Laurence J. Peter and Raymond Hull. Bantam Books (1972), 170 pp.

WARNING: Do not read this book on the ‘quiet car’ of a commuter train lest you risk being kicked out by your fellow travelers.

You will find yourself laughing out loud, yes, but also exclaiming “Yes!” throughout most of its chapters. Laurence Peter did the research and Raymond Hull wrote the text. If you work, as a statistical majority of physicians now do, in or for a corporate hospital system, this small, 54-year-old book—the first edition was published in 1969—will show you that depressingly little has changed in the way hierarchical organizations function.

The authors’ premise is that in any given organization, a good employee or manager will be sequentially promoted until he or she reaches their “respective level of incompetence.” Simply put, they will do a very good job until they are given one in which they are doomed to do a very bad job. Often with disastrous consequences for themselves, the people around them and, extrapolated to the health care arena, the doctors, nurses, the staff and the patients they care for.

You’ve seen it. I’ve seen it. Unless you’re cocooned in your own self-owned and self-managed practice, you’ve probably lived or are currently living it.

Someone who did a fine job of running the hospital’s facilities management department (housekeeping, trash removal, HVAC) is rewarded with a new job overseeing the zillion-dollar cardiac catheterization laboratory. A physician who can’t hack the rigors of patient care finds a new home as an institution’s chief medical officer, putatively in charge of much more experienced and accomplished colleagues. A successful flag football coach is elevated to helming an NFL team. [Note: Only one of the previous examples is made up.]

When you’re done laughing and/or crying, do allow yourself some time for righteous indignation. It’s a system error that’s still being replicated five decades later, like damaged organizational DNA.

As I mentioned, this book is 50 years old; as you might expect, some of the language and references, particularly pertaining to women, are outdated. However, the book’s core tenets remain disappointingly relevant.

If you serve in any clinical administrative capacity, please read this book. It won’t suddenly make you the smartest person in the room—but it just might make you the most helpful.

“How to Improve Doctor-Patient Connection: Using Psychology to Optimize Healthcare Interactions,” Christine J. Ko, MD. Routledge/Taylor & Francis (2022), 296 pp.

There are always unhappy patients. And, to paraphrase the author Fyodor Dostoyevsky, every unhappy patient is unhappy in their own way.

So, what’s a doctor to do?

Christine Ko, MD, a clinical professor of dermatology and dermatopathology at Yale, has some ideas.

This is a very interesting book. I’ll admit it took me a chapter or two to understand what the author was doing and how she was doing it, but once I did, the book just became more and more enjoyable.

Years ago, I first became intrigued by the field of narrative medicine as pioneered by Rita Charon, MD, at Columbia University. I believe what Dr. Ko has done here is taken the original premise of how we can and should interact with patients and advanced it. Sure, you might roll your eyes and say “Another book on how to deal with patients?” but I believe if you do, you’ll be missing out on her rather unique and highly sensible approach.

Perhaps the most quoted line from the 1967 film “Cool Hand Luke” has Strother Martin drawling, “What we’ve got here, is failure to communicate.” Dr. Ko highlights the fact that in clinical interactions, that communication goes both ways. Her analysis and advice on how to use both sides of the conversation to mutual benefit is highly relevant for clinicians of any stripe at any level.

Her book takes a gently academic approach, but it is not an academic (i.e., dry and boring) read. Quite the contrary. There is a strong but not overly rigid overall framing structure to each chapter. And there are repeated sections titled “Key Takeaways” and, refreshingly, “My Implicit Bias.” I liked the personal writing style and the narrative voice of someone sharing what they’ve learned as opposed to someone telling you what they know.

Every unhappy patient may be different—but that’s just one more clinical challenge. It’s really not just the patient’s problem, as I’ve heard some colleagues say; it’s also our problem. Dr. Ko’s book offers some very practical and, more importantly, applicable strategies that we can use to solve it.

“Aging Optimally: Essential Tools for Healing Pain of Body, Mind and Spirit,” Carol L. Monson, DO, MS. 2023, 326 pp.

Ever think to yourself, “With all my experience, I could write a book?” Trust me, it’s harder than you might imagine.

Dr. Monson is an experienced family physician in Michigan. In her book, she has successfully integrated both her experience and her philosophy on healing, aging and the things traditional and non-traditional medicine have to offer. And she’s done it in such a way that you can read any of the 30-plus chapters in any order and walk away with something practical.

It’s a book about aging but it’s not just about aging. The author takes on subjects great and small and doesn’t shy away from anything. Whether she’s writing about sexuality or supplements, she provides useful clinical analysis leavened with real-world advice. I was impressed by the breadth of the subject matter and the fact that, although none the chapters are overly long, they seem to cover their intended material quite thoroughly. She even provides an extensive list of references at the end, in case you thought she was just dispensing off-the-cuff anecdotal advice.

Dr. Monson has written a book that is not only good and readable, but also extremely useful—a trifecta that is often underappreciated in its degree of difficulty.

For those readers to whom aging is now more than a concept (this reviewer included), there’s a lot in here worth considering. And even if you’re not there yet, it’s a book you could confidently recommend to your patients who are.

NOTED: “This to Me,” Al H. Yurvati, DO. Fulton Books (2023), 52 pp.

For those of you who enjoyed Dr. Yurvati’s “Wet My Hands,” he’s followed up with another slim volume of inspiring personal stories interspersed with interesting cases from his storied surgical career. It’s a good mix, nicely written, and might be of particular interest to students interested in pursuing a surgical career path.

Related reading:

The DO Book Club, September 2023: ‘The Algorithm Will See You Now’

The DO Book Club, August 2023: ‘Only the Paranoid Survive’ and ‘The Ottava Method: Take Your Life Up an Octave’