Please join us on Tuesday July 23 and Wednesday July 24 to discuss Andrew Bomback’s, Doctor.
I loved Bomback’s series of essays that made up Doctor (Object Lessons). Reading the book I was regularly stunned at his honesty. Bomback wrote, without pulling any punches, about all of the little lies and shortcuts that we make as physicians in order to survive in Generation EMR. He admits to all the things I hide in the dark corners of shame that are part of doctoring in an increasingly cynical and wrote profession. Reading the book is simultaneously intimate and uncomfortable. Much of what he discusses with brutal honesty are the aspects of my life that I think are better left unsaid.
I like reading doctor books. None have resonated as truth like this one has.
As a third year medical student I read House of God. Shem’s portrayal of medicine never rung true to me. There was some insights from his internship that were recognizable but in the twenty years between his and my experience, medicine had moved on. It reads like an fairground caricature of medicine full of cynicism and despair (and alot of sex with nurses). Shem’s world was not one I experienced.
On the other end of the spectrum was Sinclair Lewis’ Arrowsmith. Arrowsmith took all the heroism and inspiration of ER and showed it from an early twentieth century perspective. It was a great read and it is a book I think about, the hero was too grandiose and plot too far from my life to be affect me personally.
From the distant past to the near furture (always 5 years away, right Eric?) was Topol’s The Patient will See You Now. This is a future-looking view of a world where technology inevitably benefits patients and empowered doctors. It was intriguing like a great issue of Wired was before Steve Jobs was found to cheat engineers, before Bezos strong armed Zapos, and before YouTube became home of Nazi’s and Flat Earthers. The world is hard and unbridld optimism feels at best corny and at worst out of touch.
Hundreds of Interlaced Fingers by Grubbs told her personal juorney of becoming a nephrlogist and then falling in love with a kidney patient and donating him a kidney. It is extraordinary and peppered with patient stories not that different from the I had encountered repeatedly in my career. The experiences were familiar but the story is a very much her. It is a unique and inspirational but that makes it less generalizable
Siddhartha Mukherjee's Laws of Medicine was an inspirational series of essays on how to navigate medicine and though the stories had a familiar feel, I was able to read it with academic detachment. It lessons were clear and I was happy to be his student, but it didn’t grab my soul.
Part of the reason the book resonated with me the most, is like Bomback, I also have a father who is a better physician than me. I live in a town where the name Dr. Topf does not bring up the image of Kidney_Boy but rather an endlessly talented oral and maxillofacial surgeon. Like Bomback’s father, my dad has adapted to an EHR-world by avoiding it. He has residents and fellows write notes and input orders. He uses a combination of reputation and moxie to stay one step ahead of the computerization police. He also has out-practiced almost all of his contemporaries. He is the rare surgeon that has been able to remain busy despite his peers (and primary referral sources) having nearly all retired. While a generation of oral surgeons have retreated to the office to focus on the high value extractions and implants he still does the big cases in the hospital despite the requirement to take trauma call and other indignities of being on the hospital staff.
One of the strengths of the book is how Bomback uses the trope of doctor as patient. In the book, Bomback’s infant son has persistant blood in his stool. Between discussions of seeing patients and balancing home and work life we see him navigate the medical field as he and his wife try to determine the correct amount of medicine and diagnostic power to apply to an otherwise healthy and growing child. Bomback is very conscious of this duality of both doctor and patient and his recognition and self-awareness is some of the best writing in the book.
The book is good and is by far the best examination of our generation of medicine. A generation adjusting to an electronic health record that encourages sacrificing patient familiarity and trust for deeper and more thorough documentation.
I hope people join us for this discussion, it should be great.
Book Review by Joel Topf