Summary:

A woman medical student finds herself in a hierarchical dilemma while rotating through her internal medicine clerkship. She is helping to take care of a middle-aged man who has been hospitalized for a diagnostic work-up. As a consequence of invasive procedures ordered by his physicians to determine the cause of his symptoms, the patient has suffered serious complications and is moribund. The doctors are evasive with the patient and his family, who beseech the medical student for an explanation. Even though she has been instructed by the physicians to refer all issues back to them, she follows her own convictions and tells the truth: "Your father is dying."

As a result of this "insubordination," she is called in to see the head of the department, a man of "legendary diagnostic skill" with a long tenure at the hospital. He says that he will have her dismissed, and launches into a long diatribe, making the case for a paternalistic medicine in which the patient needs to believe that the physician is omniscient and possesses quasi-magical healing powers. "Miracle, mystery, and authority," he says, are at the heart of what physicians can do for their patients and to undermine these is to do harm to the vast majority of the sick. Having made his point, he terminates the interview but reinstates the student, who, it is suggested, is so grateful (for his advice or for not being dismissed?) that she kisses him.

View full annotation

Summary:

William Morton first introduced ether anesthesia in 1846. This was followed shortly by nitrous oxide and chloroform. Within a few years, surgical anesthesia was being used throughout the United States. However, widespread acceptance did not mean universal usage. Physicians and surgeons debated the risks and benefits of anesthesia. Anesthesia was thought to be dangerous. Some argued that pain was a necessary part of life, that it made people stronger, and/or that it was a punishment from God. Others argued that anesthesia constituted an abuse of medical power.

Surgeons took care to select appropriate patients for anesthesia, while performing surgery without anesthetics on others. Women, people of higher social and economic classes, and people of the white race were thought to be more sensitive to pain than men, the poor, and Negroes and American Indians. Likewise, the young experienced pain more than the elderly. Certain procedures (e.g. major limb amputations and prolonged tissue dissection) were also thought to require more anesthetic than others (e.g. natural childbirth or ENT surgery). These beliefs carried over into practice, as evidenced by records from the Massachusetts General Hospital and other hospitals in the mid-19th century.

View full annotation

Summary:

In his study, Professor Starr examines the evolution of the practice and the culture of medicine in the United States from the end of the colonial period into the last quarter of the twentieth century. His major concerns are with the development of authority, and the Janus image of professionalization as medicine has gained power, technical expertise, and effective modes of diagnosis and treatment and at the same time seems to be getting further from the patient.

At the time of publication, our society had finally begun to take a hard look at the impracticality and the inhumanity of continuing on the trajectory of American medicine developed one hundred years ago. Starr invites the reader to consider the impact of modern stress on the profession and, more intently, on the constituency it is dedicated to serve.

View full annotation

Summary:

This short narrative is told in the first person, the person of the quack. The tale opens with the narrator in the public hospital ward, suffering from what his doctors say is Addison's disease, composing the tale of his adventures which makes up the bulk of the work. The narrator tells us about his training as a physician and his first practice, which was sufficiently non-lucrative that he determines to alter his career direction.

He moves through a series of increasingly seamy scams in search of quick and easy money--including claiming to be a homeopathic physician, then an expert in vegetable remedies and "electromagnetic" treatment, falling through a multitude of suspect activities culminating in his setting up shop as a spiritualist. His shady career is cut short by his illness, from which he abruptly dies, thus ending the narrative.

View full annotation

Summary:

This study explores the history of physician-patient relationships, especially as it relates to the ascendancy of science in medicine. The book begins by describing traditional physician-patient relationships in the 18th century. The focus, however, is on the "modern" doctor (beginning in the 1880's) and the "postmodern" doctor (beginning in the 1950's).

The author describes the transition from modern to postmodern doctor and a corresponding transition from modern to postmodern patient. A "sympathetic alliance" between physician and patient was essentially a development of the modern period (1880's - 1950's).

View full annotation

Summary:

Dr. Hertzler leads the reader, topically and generally chronologically, through the nature of the practice of medicine in rural America from the 1880's through the 1930's. His early narratives are those of a child observing the ravages of epidemic diseases in the face of medical futility.

The remainder of the work, divided into subject headings, is devoted to anecdotes and observations on such things as horse and buggy home visits, kitchen surgery, the proprietary hospital and physician education. Having served not only as a rural practitioner, but as a professor of pathology at academic centers and a consulting surgeon, Hertzler draws on a wide experience over a period of time known for rapid advances in basic biological science which would, near the end of the narrator's life, open the way for technological medicine as we know it today.

View full annotation

Summary:

This collection of vignettes follows the growth and development of one internist as he reflects on some of the critical experiences that shaped him as physician. The common thread of the work is the celebration of the relationship that can, and perhaps should, be built between the physician and his or her patient in the course of caring: this relationship is the sacred space of the title.

The author accomplishes his self-imposed task of describing this space by presenting situations in his practice life that illustrate the concept. The chronological structure of the collection enables the reader to study the maturation of the author as a self-reflective practitioner over the many decades of his professional life. Many of the stories are very funny; others are wrenching; all are gently told.

View full annotation

Summary:

An intern in internal medicine is frustrated by his weekly clinics; he seems unable to understand why most of his patients come to see him, why they seem happy when they leave, and wonders when he is going to have the chance to do "real" medicine, such as ordering tests and making sophisticated diagnoses. One day, he sees an elderly woman who had been worked up over the years for "heart pain" without finding a diagnosis. In the past she had seen other residents for no discernible reasons.

At this visit, the author recognizes that she seems upset, encourages her to talk, realizes that she reminds him of his grandmother. The woman reluctantly admits she has fallen in love with a younger man. The resident is respectful towards her, and recognizes the beautiful woman she had once been. He begins to realize that she has experienced much that he hasn't, and that she has much to teach him about life and about being human.

View full annotation

Summary:

The writer, a comparative literature professor, elected to spend one full semester as an up-close observer in a medical school anatomy lab during the student dissection experience. He approached the experiment with the clearly articulated intention of writing about the lab, the instructors, the students, and their subjects. The book takes the reader dissection by dissection through the socialization process, as well as the technical content, of the class--from the first cut to the final memorial services for the cadavers at the closure of the term.

View full annotation

Summary:

The author is a fourth year medical student dealing simultaneously with the rigors of medical training and the difficulties of living with diabetes. She has discovered that when she tries to interact with patients she over-identifies with them. When she reads about diabetes in medical textbooks, which present a rigid equation for balancing diet, exercise, and insulin need, she tries to adopt this approach to her personal diabetes management, convincing herself that emotions, fatigue, stress and other factors have no effect on her diabetes control. When this biomedical approach fails, she feels deep shame and frustration.

Only over time does she develop the confidence to realize that it is not shameful to admit one's personal needs even in medical training, that disease is a part of all humans and is not an enemy, that she need not be defined solely by her disease (or her profession), and that blurred boundaries between doctors and patients are not as dangerous as she was first led to believe.

View full annotation