NYRB Classics kindly sent me their reissue of David Mandel's Proper Doctoring: A Book for Patients and Their Doctors. It's full of sharp, opportune musings - based on fact and experience, and some curmudgeonly ideology - on the value of deliberation, kindness, and wide-angled listening in the care of human beings. I look forward to tweeting and blogging about it in the days ahead.
I am reading the introduction, now, and other thoughts came to mind, provoked by the introduction of Jerome Groopman:
"Over the course of their careers, physicians build a library. During the early years of medical school, they acquire foundational textbooks[. ...] Later, in their cinical training, they add tomes on internal medicine, pediatrics, surgery, [etc.] If they pursue a specialty, doctors complete their collection with volumes from that field. ..."
Not controversial, but what struck me was the obvious presence of books, qua books, in Groopman's medical education - while they really haven't played that much of a role in mine. Sure, there was always the much-venerated but little-read Harrisons glowering down at me from a distant shelf; and the strictly utilitarian test-prep books I will no doubt buy again when I retake the internal medicine boards in fewer years than I would like to admit.
But books? Bound paper? No, we're all about the quick fix. The UpToDate lookup. The guilty Googling of a symptom cluster. The email to a colleague.
If this anecdotal experience is correct, then I can see two implications to be drawn. One is false - the assumption I tried to slip by just a paragraph ago. No, we are not into the quick fix. There is plenty of depth in written medicine today, from lengthy think pieces in Theoretical Medicine and Bioethics, to essays in JAMA or New England Journal, to deeply researched aticles for the lay public in The New York Times Magazine. And if you want long articles dense with empirical medical data, the Annals of Internal Medicine is your beach read.
The other implication one can draw, I think, is absolutely true, and revolutionary, and heart-stoppingly scary if you are a doctor. With the freeing of words from the page comes a promise of democratized knowledge. Perhaps I am naive, and the Evgeny Morozovos of healthcare are giggling at me as they read these words. Think of it though: would any doctor have read a patient's musings 20 years ago? Now I do it all the time.
Where does scientific medicine stand on all this? Is it asleep in a tent on shifting sands? Who gets to decide what empirical knowledge is - especially when so-called professional guidelines are susceptible to their own biases?
Perhaps we should use this democratizing opportunity for patients and providers, together, to make their own evidence-based guidelines for treatment. Wipe the slate clean and start over.
What do you think?
I am reading the introduction, now, and other thoughts came to mind, provoked by the introduction of Jerome Groopman:
"Over the course of their careers, physicians build a library. During the early years of medical school, they acquire foundational textbooks[. ...] Later, in their cinical training, they add tomes on internal medicine, pediatrics, surgery, [etc.] If they pursue a specialty, doctors complete their collection with volumes from that field. ..."
Not controversial, but what struck me was the obvious presence of books, qua books, in Groopman's medical education - while they really haven't played that much of a role in mine. Sure, there was always the much-venerated but little-read Harrisons glowering down at me from a distant shelf; and the strictly utilitarian test-prep books I will no doubt buy again when I retake the internal medicine boards in fewer years than I would like to admit.
But books? Bound paper? No, we're all about the quick fix. The UpToDate lookup. The guilty Googling of a symptom cluster. The email to a colleague.
If this anecdotal experience is correct, then I can see two implications to be drawn. One is false - the assumption I tried to slip by just a paragraph ago. No, we are not into the quick fix. There is plenty of depth in written medicine today, from lengthy think pieces in Theoretical Medicine and Bioethics, to essays in JAMA or New England Journal, to deeply researched aticles for the lay public in The New York Times Magazine. And if you want long articles dense with empirical medical data, the Annals of Internal Medicine is your beach read.
The other implication one can draw, I think, is absolutely true, and revolutionary, and heart-stoppingly scary if you are a doctor. With the freeing of words from the page comes a promise of democratized knowledge. Perhaps I am naive, and the Evgeny Morozovos of healthcare are giggling at me as they read these words. Think of it though: would any doctor have read a patient's musings 20 years ago? Now I do it all the time.
Where does scientific medicine stand on all this? Is it asleep in a tent on shifting sands? Who gets to decide what empirical knowledge is - especially when so-called professional guidelines are susceptible to their own biases?
Perhaps we should use this democratizing opportunity for patients and providers, together, to make their own evidence-based guidelines for treatment. Wipe the slate clean and start over.
What do you think?
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