Like most neurosurgeons, I have experienced thrill and exhilaration when my healing efforts succeeded and desolation when they failed. I give equal time to both. In spite of much progress in diagnostic tools and surgical technology, neurosurgery is still a very personal human endeavor. We are vested with a unique responsibility the moment we take a scalpel in our hands, for the fine line between a life with dignity and the devastation of humanity in our patients can be incredibly thin. Throughout my autobiography, Listen to the Patient, Of Life and Neurosurgery, I emphasize the importance of listening to our patients, both out of respect for their dignity at a critical time in their lives and as a means of obtaining a thorough history which, together with a detailed neurological examination, remains the corner stone in deriving a correct clinical impression and in formulating a sound, anatomically-based and humanly tailored treatment strategy.
I have witnessed many changes in health care during the half-a-century spanned by my career as a neurosurgeon. The most glaring has been the intrusion of a variety of extraneous agents such as the law profession, governmental and institutional regulations and yes, of digitized technology, into the sacred relationship between the patient and the healer. The cumulative effect of these intrusions has led to the depersonalizing of the doctor-patient relationship. Nevertheless, neurosurgeons have remained faithful to the ethos of their exalted profession, a calling and certainly not an industry.
Another important change has been the merger of health care delivery institutions and the acquisition of physician practices with the stated goal of making health care more efficient, safer and more affordable. Without going into criticism or praise of the Affordable Care Act (ACA), let me say that the devil is in the details as to the financing of this gargantuan program in the face of ever-escalating U.S. healthcare costs. Until the early 1980s, these costs were progressing along a mildly increasing curve parallel to Western European countries and other industrialized nations. However, over the last 30 years, our healthcare expenditures have taken off along a steeply inclined curve that is out of proportion to other industrialized nations.
Among the multitude of possible causes contributing to the ever-escalating cost of U.S. health care are over utilization, medicolegal issues surrounding the practice of medicine and an inappropriate allocation of healthcare resources at the end of life. These stand out as the greatest culprits. Without entering into a discourse on the ethics of life and death, unconditional support of life under any and all circumstances, regardless of the patient’s age or the insurmountable ravages of the disease, oftentimes has the unintended consequence of forsaking the dignity of life for the sake of life with no dignity.
My book titled Listen to the Patient, Of Life and Neurosurgery will be published by Archway Publishers, a subsidiary of Simon and Schuster. The book is a memoir in which I weave together the story of my life with the meaning, secrets and ethical aspects of neurosurgery, including the unique privilege and daunting responsibility of navigating through the human brain and spinal cord. I hope that my colleagues at all levels of training and experience will find these reminiscences meaningful.
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