Saturday, May 27, 2023
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In a recent Medscape interview, journalist Malcolm Gladwell said that to close the gap between the reality of medicine and what people think about medicine, physicians must do a better job of telling their own stories. If storytelling is a way to set medicine back on the right course, then physician authors have made an excellent start during the past year. This year's book-themed slideshow features a selection of highly rated nonfiction titles written by physicians and published in 2015. We selected books that tell stories about medicine—where it has been and where it is going—and asked the authors of these books to tell us something about why they wrote them.
Image from Dreamstime
In Shrinks, Dr Lieberman traces the fascinating history of the field of psychiatry from dubious pseudoscience to evidence-based medical discipline, touching on, along the way, not only insane asylums and frontal lobotomies but even that hackneyed symbol of psychiatry—the psychoanalyst's couch. Psychiatry may have a dark past, but it also has a bright future, with technological advances in diagnosis and treatment, safe psychotropics, effective therapies, and the DSM.
Says Dr Lieberman, "I wrote the book because I could no longer tolerate the fact that more than 90 million Americans, and 1.7 billion people worldwide, suffer from mental illness and might not be able to get the care they need because of lack of awareness, shame over revealing their conditions, or not knowing where to find competent care. Shrinks is the story of the struggle of people with mental illness to receive care for their conditions and the efforts of psychiatry to gain knowledge to be able to provide effective care for these people."
Images courtesy of Little, Brown & Company; Jeffrey A. Lieberman, MD
Dr Forrester explains why he wrote The Heart Healers. "When I was thinking of entering medicine, we had no treatment for any form of heart disease, mankind's number one killer: no surgery, no devices, and very few drugs. Today we will unseat heart disease as our number one killer in the next decade. How this occurred is a story unlike anything you might imagine because it's equal parts triumph, courage, and human tragedy, driven by an unbelievable cast of characters, most of whom I knew personally. Beyond the human drama, the story gives us amazing insights about how great scientific breakthroughs occur."
"The book tells a story that every person touched by heart disease should know. After reading how seemingly insurmountable barriers were overcome, both patients and doctors agree that this is an amazing story. Young doctors say that the astonishing events that preceded their entry into medicine could never happen today."
Images courtesy of St. Martin's Press, James S. Forrester, MD
Dr O'Connell is president of the Boston Health Care for the Homeless Program, which provides healthcare services at more than 65 sites, including adult and family soup kitchens, detoxification units, and corrections facilities. His work with this program, spanning decades, provided material for this fascinating book. In Dr O'Connell's own words:
"These stories and essays, written in the quiet night hours that punctuate the long days and hectic clinics of the past 3 decades, attempt to capture a bit of the joy that surprises us while trying to care for the tragic and heroic individuals who struggle against insurmountable odds. My hope is that the humanity of each individual emerges. The background of each essay and story is occasionally an historical event, alongside the unfinished mosaic of the Boston Health Care for the Homeless Program and the wonderful people who have devoted their careers to serving this poor and vulnerable population."
Images courtesy of BHPCS Press, James J. O'Connell, MD
To put it mildly, Dr Stossel is no fan of the conflict-of-interest movement, which he characterizes as a "moral bullying campaign." In Pharmaphobia, he argues that the conflict-of-interest crusade does nothing but stifle innovation and progress in medicine. The drugs and devices that have prevented or cured countless diseases and extended human life dramatically originate with private drug and device companies at great expense. However, asserts Dr Stossel, "an ideological crusade has used distortion and flawed logic to make medical innovation even more difficult and expensive in a misguided pursuit of theoretical professional purity."
Physicians who take payments from industry, with whom they are partnering to bring new drugs and devices to market, are accused by of being corrupt, performing flawed research, or even harming patients. "The purpose of my book is to set the record straight," says Dr Stossel.
Images courtesy of Rowman & Littlefield Publishers, Thomas P. Stossel, MD
When Dr Tweedy was in his first year of medical school, he entered a lecture hall to have the professor mistake him for a janitor and ask him to fix the lights. His book, however, is not a litany of complaints about the racial discrimination that he personally experienced during his medical training. It is a thoughtful examination of historical patterns of racial inequality in the entire healthcare sphere and how this history influences the healthcare disparities in African Americans that persist to this day. In the United States, black individuals are more likely than white individuals to have diabetes, stroke, heart disease, prostate cancer, and AIDS and less likely to receive state-of-the-art healthcare. Infant mortality is higher, and life expectancy is shorter among black patients than among white patients. Dr Tweedy's memoir brings to the forefront the fact that "being black can be bad for your health."[1]
Now a psychiatrist, Dr Tweedy says, "When people refer to me as a physician-writer, it feels like they are talking about someone else. I am definitely an unlikely physician. And an even more unlikely writer."
Images courtesy of Picador, Damon Tweedy, MD
Dr Wachter explains why he wrote his book. "As a physician and patient safety expert, I've been waiting for computers to enter my world for over a decade. But once we finally went from analog to digital, it dawned on me that something was deeply wrong. Why were doctors no longer making eye contact with their patients? How could one of America's finest hospitals give a teenager a 39-fold overdose of a common antibiotic, despite a state-of-the-art computerized prescribing system? Why would a recruiting ad for physicians promote the absence of an electronic medical record as a selling point? The Digital Doctor represents my year-long effort to understand why health IT is not reaching its potential and what we need to do to turn things around."
Among the book's reviews, the New York Times said, "Janus is the god of medicine these days, and it is the great strength of Wachter's eloquent new book that it has captured these conflicting emotions, all powerfully felt and intelligently analyzed. Most previous authors have chosen sides, either mourning the old or hailing the new. Wachter is unusual for his equipoise."[2] Author Atul Gawande said, "The Digital Doctor is the eye-opening, well-told, and frustrating story of how computerization is pulling medicine apart with only a vague promise of putting it back together again. I kept muttering, 'Exactly!' while reading it, and that is a measure of Wachter's accomplishment in telling the tale."
Images courtesy of McGraw-Hill Education, Robert Wachter, MD
When smartphones first appeared on the scene, they rapidly became indispensable to healthcare by giving patients something other than outdated issues of Golf Digest with which to pass the time in doctors' waiting rooms. In The Patient Will See You Now, Dr Topol (@EricTopol) argues that smartphones are now poised to reach greater heights of utility. Smartphones, he predicts, will democratize medicine by bringing health and medical data and control directly to the people.[3] This future vision, which has already begun, puts the emancipated and engaged patient (the single most unused person in healthcare[4]) and his or her smartphone firmly in the center of the healthcare universe.
Dr Topol believes that both physicians and patients will benefit from this evolution in healthcare. "Now that medicine is becoming digitized, with eminently portable data and information, the next step is for patients to become far more actively involved by generating their own data and having algorithmic support to interpret it. These changes will affect the doctor-patient relationship by reducing information asymmetry and, hopefully, at some point, decompressing physician workloads."
Images courtesy of Basic Books, Medscape
The Man Who Stalked Einstein tells the little-known story of the antagonistic relationship between Albert Einstein and German physicist Phillip Lenard. Both men were brilliant scientists and Nobel Prize winners. Their ideals, however, were diametrically opposed, and their scholastic rivalry escalated into personal animosity as Lenard, a Nazi, spent his life trying to discredit Einstein. Their mutual antagonism influenced the direction of science long after 1933, when Einstein took flight to America and changed the history of both nations. The Man Who Stalked Einstein details the tense relationship between Einstein and Lenard during the eventful period between world wars.
About his book, Dr Hillman says, "I had three goals in writing The Man Who Stalked Einstein. First, I wanted to write an entertaining story. Secondly, I wanted the story to teach a moral lesson. Finally, as much as possible, I wanted Einstein and Lenard to speak for themselves as a way of defining their own characters."
"I enjoyed writing Einstein immensely, and readers' responses have been more positive than I could have imagined. With so much encouragement, I immediately set to work writing a book tentatively titled A Plague on All Our Houses, about the discovery of AIDS as seen through the experiences of the man who first recognized AIDS as a new and distinct disease. Scheduled for autumn 2016 publication, the book will give the readers an inside look into the world of academic medicine."
Images courtesy of Lyon's Press, Bruce Hillman, MD
Dr Mukherjee, Pulitzer prize-winning author of The Emperor of All Maladies, takes on the question of whether medicine is a science; and, if so, what laws govern the science of medicine. The 100-page book, based on an 18-minute TED talk, takes readers through the author's thought process on establishing three laws of medicine, the first of which he stumbled upon by chance.[5] Dr Mukherjee recently explained to Medscape's Eric Topol how he developed his thoughts on the laws of medicine. "I wanted to find a framework. I didn't want to make capital 'L' laws or commandments. I wanted some direction for myself as I navigated a field that was fundamentally uncertain and full of things that I didn't understand. And I wanted to ask the question, 'How do we imagine what principles hold true about medicine today and medicine in the future?' We hear about the 'science of medicine.' If there is a science of medicine, then science has laws. Physics has laws. Chemistry has laws. Biology has laws. If that's the case, then what are the laws of medicine?"
What are the laws? Briefly, a strong intuition is much more powerful than a weak test; normals teach us rules; outliers teach us laws; and for every perfect medical experiment, there is a perfect human bias. You will have to read the book to find out what these laws mean.
Images courtesy of Simon & Schuster/TED, Fredy Perojo/Medscape
You don't spend decades cutting and drilling into peoples' brains or performing delicate surgery with a half-millimeter margin of error between success and disaster and emerge unscathed.[5] The errors you make will change you, and you carry them with you to the end of your days. In his unflinching and eloquent award-winning book, Do No Harm, Dr Marsh writes, "It's one of the painful truths about neurosurgery that you only get good at doing the really difficult cases and you get lots of practice, but that means making lots of mistakes at first and leaving a trail of injured patients behind you."
Dr Marsh admits that much of the brain remains beyond his grasp. He likens the mystery of the brain to that of the big-bang theory. "We're all sitting on an equally great mystery within ourselves, each of us, in this microcosm of our own consciousness, and I find that a quite nice thought. The public need to understand that medicine actually is often a very uncertain process. It's not like going to a car dealer and buying a car or getting things fixed. It's very uncertain. It's very difficult. There is a lot of talk about duty of candor and guilt-free culture and transparency, and I thought, 'Well, I'm going to write a book,' (based on a diary I've kept all my life) that tells what it's really like with no holds barred, the good and the bad."[6]
Images courtesy of Thomas Dunne Books, Rex Features
This slideshow doesn't include every book written by a physician in 2015. Here are some other titles you might enjoy:
The Real Doctor Will See You Shortly: A Physician's First Year by Matt McCarthy, MD
Stoned: A Doctor's Case for Medical Marijuana by David Casarett, MD
Alpha Docs: The Making of a Cardiologist by Daniel Muñoz, MD, and James M. Dale
Last Night in the OR: A Transplant Surgeon's Odyssey by Bud Shaw, MD
Ending Medical Reversal: Improving Outcomes, Saving Lives by Vinayak K. Prasad, MD, MPH, and Adam S. Cifu, MD
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