One Doctor: Close Calls, ColdCases, and Mysteries of Medicine by Brendan Reilly MD (Atria
Books - Random House, 2013, 464 pages, $28.00) is an important,
substantive, gripping story about the inner life and challenging
medical practice of one of the country's leading medical clinicians,
teachers, and administrators. Drawing on over forty years of practice
in top hospitals undertaking the toughest cases and jobs, Brendan
Reilly accomplishes what few people who write doctor books for the
general reader can or are willing to do. He takes an on-call period
in his current job as Executive Vice Chair of Medicine at New York
Presbyterian Hospital (one of the finest teaching hospitals in the
world) to frame the challenges faced by the nation in its medical
system, by individuals doctors seeking to practice medicine within
this new world of changing technology and economics in medicine, and
his own personal experiences as he faces intractable medical problems
with his students and the impending deaths of his own parents.
During a harrowing week on call, doing rounds with his students while
he manages his parent's illnesses and infirmities, Reilly explores
with courage and insight his own life and learning experience in
medicine and the medical crises faced by key patients. He does this
with a style of personally exploring his own reactions, feelings, and
actions which is rare among doctors. The result is a gripping story
that often reads like a novel (or, for those with a visual
imagination, looks like the TV program ER, which was conceived and
filmed during his tenure at Cook County Hospital) while examining
issues facing the larger medical community and the nation.
The major thesis of this fine book is
that in the increasingly complex world of possibilities placed before
us by medical technology it becomes essential that individuals have a
physician they see as “their” doctor, a doctor who knows and
understands them as a human being in addition to as an organism
requiring treatment. Meanwhile, today's world of medical practice
places greater and greater emphasis (and rewards for young
physicians) on specialties and sub-specialties which treat a part of
the body rather than the whole person. This leads to a separation
between disease and illness, with illness being the complex
interactions of the physical problem combined with the background,
experience, and feelings of the person suffering from the disease to
be treated. Just as the need for a person who can view the big
picture becomes more necessary, the ability to do so is disappearing
because of the incentives driving young doctors to specialize.
Working with brilliant young residents in a range of specialties,
Reilly seeks to find not only what will solve the problem, but what
the patient wants in terms of quality of life and is willing to
endure in terms of suffering and pain to get to his goal. As might be
expected in this great hospital, most of the patients Reilly's team
encounters are very sick, on the verge of death, making these
decisions increasingly complex and difficult and calling even more on
compassion and understanding to complement knowledge and skill.
Sometimes Reilly's style seems
discursive and confusing as, in the middle of a case, he jumps to
another patient somewhere in his past or a different story within his
present practice. And then it becomes clear that he has bigger fish
to fry than medical stories, no matter how riveting and fascinating
each one might be. Reilly is concerned with the big questions of
contemporary medical practice in a world seemingly governed more by
money than by compassion. How can we be sure that the patient's
needs are being met when the patient is too sick to communicate? How
has the power of medical directives changed when a feeding tube or a
ventilator might be temporarily necessary to help achieve a larger
goal? How can doctors tell the difference between temporary delirium
and worsening dementia? Who has the courage to take responsibility
for decision making in life or death situations? How can we break out
of a setting where a patient's economic background determines the
quality and extent of the medical care they receive? What is the role
of medical error, and how can it be reduced? What is the role of
personally becoming invested in determining and owning medical error
for physicians? How does fee-for-service medical payment distort
effective decision making? What is the role of insurance companies in
rationing health care? These are some of the big questions standing
behind the sick and dying people we meet and come to care about
throughout this book as Fred and Martha, Mr. Warner, Mr. Principo,
Ms. Finch, and Reilly's elderly parents face the realities of their
illness.
Brendan Reilly, MD
Dr. Reilly received his medical degree
in 1973 from Weill Cornell Medical College (formerly Cornell
University Medical College) and completed his residency training at
Dartmouth, where he served as chief medical resident. He subsequently
was named chief of the Division of General Internal Medicine and
served on the Board of Governors of the Dartmouth Hitchcock Clinic
until 1989. He then moved to the University of Rochester to become
professor of medicine, chair of the Department of Medicine at St.
Mary's Hospital, and founder and director of Rochester Health Reach.
In 1995, he was appointed to lead the Department of Medicine at Cook
County Hospital in Chicago. He is now serving as executive vice
chair for clinical affairs in the Department of Medicine at
NewYork-Presbyterian Hospital/Weill Cornell Medical Center and Weill
Cornell Medical College. He is known for his advocacy of evidence-
based medical practice, and he was featured in Malcolm Gladwell's
popular book Blink. Reilly's
narrative links each case to lessons learned from specific previous
ones throughout his long career inevitably leading towards his
championing the need for a skilled internist acting as the patient's
advocate and directing care. For patients, this means that while
still healthy it has become even more essential to build a
relationship with a specific doctor who can assemble a treatment team
treating the patient's best interests rather than just his disease.
This doctor's job is to partner with patients to help decide what is
best for them, to recognize that the most care is not necessarily the
best care.
One Doctor: Close Calls, Cold Cases,and Mysteries of Medicine by
Brendan Reilly MD (Atria Books, 2013, 464 pages, $28.00) is a
fascinating and engaging book carefully structured to merge personal
and the professional, the technical with the clinical, research with
experience to present the opportunities and challenges presented by
modern medical practice. In doing so, he attempts to examine many of
the issues attacked by the Affordable Care Act (Obamacare) from the
point of view of a practicing physician and hospital administrator.
It is carefully annotated with interesting additions to the main
text. It stands as one of the most readable and comprehensive
(comprehensible, too) books on medicine I've read. The book was
provided to me by the publisher as a digital download through
Edelweiss: Beyond the Treeline. I read it on my Kindle.
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