“The Finest Tradition of My Calling: One Physician’s Search for Renewal of Medicine.” Abraham M. Nussbaum, MD. Yale University Press. New Haven and London. 2016.
This is a very thoughtful book written by a Denver psychiatrist who is convinced that “health care reform” is endangering the sacred physician-patient relationship. As the title suggests, he thinks that medicine is not just a job but a calling. Since it is a calling, it makes being a physician a tremendous privilege. This memoir is a plea for renewal of our vision for medicine. Physician burnout, early retirement and suicide are increasing. Nussbaum thinks that it is because we no longer see our patients as people. Health care reform has failed. The move towards quality improvement and checklist medicine has not proved to be the answer. Today’s evidence-based medicine is imperfect and is often characterized by evidence that is incomplete.
Health care is not like industry or aviation. Medicine is a human activity like dancing. In dancing, there is mutual responsibility. In psychiatry, the technical name for the relationship between the physician and patient is the “therapeutic alliance.” It implies a shared commitment between the doctor and a patient to seek the well-being of the patient. However, most physicians no longer see the patient as a person. When we understand ill people as customers, we alter the social relationship. We have become unfeeling scientists dedicated to efficiency and income.
The author is a wonderful storyteller who has an anecdote to support every conclusion he makes. He writes about how humanism and professionalism were taught in his training. Then, he shows how humanism loses out to professionalism in medical practice and finally how we eventually see patients as compendiums of parts and money.
Nussbaum’s solution for medicine’s ills is not rigid standardization but the renewal of wisdom and the communities that cultivate wisdom. He concludes “the renewal of medicine begins by opening cultural spaces for local particular communities where people can meet together like the irrational animals that we are.”
We all need to read this book. Our patients are real people. Make an alliance with them.
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