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

This month’s recommendations are decidedly distaff, so if you’re a dyed-in-the-wool misogynist you should stop reading now. These books won’t save you.

They will make you think, though. Think about the journey women physicians have made to achieve some measure of equality and parity, and how long that has taken. Think about the dangers of dismissing or minimizing complaints based on the gender of the complainant. Think about the contributions women physicians have made and continue to make to elevating our profession. So, like Aretha sang, “Think (think, think), let your mind go, let yourself be free.” You might just think differently after reading these.

Letter to a Young Female Physician: Notes from a Medical Life, Suzanne Koven, MD; W.W. Norton (May 2021), 320 pp.

Full disclosure: my daughter is a young female physician. I thought maybe this book would resonate with me because of that fact – but there’s more here. This is in the tradition of Richard Selzer, MD’s Letters to a Young Doctor (1996), updated for the current era. You don’t need to have a physician daughter, spouse or partner to enjoy this often poignant reflection.

The book springs from a letter penned by the author to the NEJM in 2017. The reaction and positive reception of her thoughts blossomed into this series of essays which stretch (in non-chronological order) from Dr. Koven’s med student days to her later years in practice. She specifically, and sometimes painfully, shares her and her female colleagues’ struggle with imposter syndrome. She recounts how she and a friend nicknamed themselves “the asterisks” – as if anything they accomplished required a footnote that diminished that success. For those of a certain age, this will bring to mind baseball legend Roger Maris and the 61* that he carried to his grave.

The title might make you think this is a book only for young female physicians. It’s obviously the narrative framing device, but the wisdom and humor imparted really do transcend that implication. It’s an engaging read no matter your gender or where you are on the physician’s journey. From med students to seasoned practitioners, there’s something worthwhile, if not revelatory, to be gleaned in almost every essay.

I will make the bold statement that this would be an especially helpful read for male physicians and med students. Many of our physician colleagues are women; women physicians occupy many leadership positions and will occupy even more in the future. But despite all the changes and advances, a woman physician’s road is still paved with different stones, some of them sharp and many uneven. This is as close as it gets to walking in their shoes.

Ask Me About My Uterus: A Quest to Make Doctors Believe in Women’s Pain, Abby Norman, Bold Type Books (2018), 288 pp.

I’m usually not one for “it happened to me” patient narratives, but I randomly came across this title shortly after reading a quote from a state lawmaker opining that a woman’s womb “serves no specific purpose to her life or well-being.” It’s safe to say the author of this book would beg to differ.

Probably not since Sigmund Freud theorized that the uterus was responsible for “hysteria” in women has one internal organ been at the center of so much debate. The author suffers from endometriosis – although the road to that diagnosis was long, torturous and marked by disbelief, dismissal or assignment to a nonphysical origin.

I won’t lay out the specifics – the value of this read is in the experiences and encounters described. Certainly male patients have run across the same roadblocks, but the gist of the narrative is that this is much more common for women. This is a first-person account and so we see things through the author’s eyes and from her emotional perspective. But the event that finally piques a consultant’s diagnostic interest will enrage some physician readers but likely surprise none.

For doctors, this is more of a cautionary tale. We can empathize with the author’s plight and, to some degree, also with the physicians trying (admittedly, some not very hard) to make sense of her symptoms. If nothing else, reading the book might serve to ratchet up our sensitivity as to how quick we sometimes are to look for the easy or non-diagnosis way out.

Unlike some books, this is not an indictment of male physicians, physicians in general or of the medical system. There is a lesson here, however, and it’s one worth learning.

Practical Management of Pain, 6^th Edition, Honorio Benzon, MD (ed.), multiple co-editors and contributing authors; Elsevier Medical Publishing, May 2022, 1200 pp.

If roughly half of our patients are or will be women, it’s a fair bet that all of our patients will present with pain at some point in their care. And perhaps never before has the management of pain been under such intense scrutiny. In many cases we can diagnose and ameliorate pain successfully – but not always. Then we are left with a more daunting task – managing it.

I know I promised no “bricks” but I’m going to sneak by on a technicality here: I reviewed the eBook version of this impressive volume. Placed on a flash drive or a handheld with enough storage, you could literally carry it around in your pocket. This text lives up to its title – practicality and management strategies are highlighted in every discussion, and it includes 400 illustrations.

I chose this new edition for a specific reason – among a veritable who’s who of MD and PhD editors and co-authors is our very own Katherine E. Galluzzi, DO, CMD. For those unfamiliar with her, Dr. Galluzzi is as much a “who” as any of the other luminaries listed. She is a respected clinician, a highly sought-after national speaker and a well-regarded expert, especially in opiate prescribing (and malprescribing). As a long-time geriatrician and palliative care specialist, her experience with chronic pain, cancer pain and their impact in the elderly and those at the end of life is well-respected.

In her chapter on pain management in primary care, Dr. Galluzzi highlights low back pain as an example of how multimodal therapies can be effective; she also addresses the question of whether pain is a diagnosis or a symptom and then works to show how it can be both.

While this may not be a book you take to the beach, it probably belongs in your practice’s library, where it will be consulted frequently.

October’s book

For October, Joan Naidorf, DO, will review The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine to Women and Women to Medicine by Janice P. Nimura. 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 Letter to a Young Female Physician, Ask Me About My Uterus, Practical Management of Pain 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, Aug. 2022: Every Deep-Drawn Breath: A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the ICU

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