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—Sir William Osler (1904)
Despite this famous advice from a legendary physician, most doctors don’t live a simple life. All of us, seduced at an early age by Osler’s mistress, conduct our own lifelong affair with medicine. This book is about mine.
One Doctor is a true story about real people—most of which took place during two weeks in the winter of 2010. It recounts, in sometimes intimate detail, my doctoring of patients in the wards, emergency department, and intensive care unit of a renowned teaching hospital in New York City. These experiences exemplify many of the challenges doctors and patients face today in the dramatic, high-tech world of modern medicine. But doctoring has changed, not just since Osler’s time but during my own time, too. For this reason, my story flashes back to long ago when I worked as a primary care physician in a small New England town. There, I did a different kind of doctoring, now largely forgotten or obsolete, when physician-patient relationships were deeper and more enduring than in today’s “provider-consumer” medical culture. This difference—the contrast between doctoring then and doctoring now—lies at the heart of my story. It is a cautionary tale, but a hopeful one, too.
My story is unusual in three ways. First and foremost, I am a dinosaur, an old-fashioned internist, a species of doctor on the verge of extinction. Although every doctor’s perspective is unique, mine reflects the passing of a notable era in medicine. During my career, doctors like me served not only as their patients’ primary care physician but also as an expert in the many subspecialties of internal medicine. As Osler did in his time, we cared for our patients whenever they needed us, day or night, and wherever they were—in the office or intensive care unit, in nursing homes and in their own homes. Such a task, daunting in the past, is impossible today. Medicine has changed irrevocably—on balance, I believe, for the better—and I harbor no hope of saving dinosaurs like me. But I am convinced that, as medicine continues to evolve, future doctors (and their patients) will do well to remember my medicine, my mistress. She is a goddess, her power and charms divine. But, like Osler’s mistress, she is also a gadfly—a principled, perfectionist pain-in-the-ass—which my profession (and, I believe, modern society) can ill afford to lose. It is her spirit that I try to capture, and preserve, in this book.
Second, I tell my story in an unconventional way, in the first person in real time. I describe my own actual in-the-moment, minute-to-minute experiences as seen through my own eyes. With this you-are-there approach, I try to bring the reader “inside” one doctor’s world; I try to show you—not merely tell you—what I do, how I do it, what it feels like. In recent years, many people have told stories—some with happy endings, some not—about their experiences as a patient in the U.S. health care system. This book tells the doctor’s side of those stories, up close and personal.
Finally, an accident of timing motivated me to write this story. The events came together when disparate challenges in my own life—personal and professional, past and present—collided at one serendipitous point in time. This collision happened when challenges facing me mirrored similar ones facing my profession and my country. Most of the patients you will meet in these pages are older people with chronic diseases (including my own ninety-year-old parents) who don’t have one doctor and who exemplify stormy issues roiling medicine today and for the foreseeable future. I focus on these patients (who, for various reasons, required urgent medical care) because most of us—you and I and our loved ones—will be one of them someday. Not only do these folks comprise the great majority of patients whom I (and most doctors) see today, they also “consume” the lion’s share of all U.S. health care resources. One cannot begin to understand modern American medicine—or, increasingly, medicine around the globe—without understanding the challenges (and rewards) of doctoring such people.
I interrupt my story occasionally to comment briefly about its historical background or future implications. These commentaries claim no special expertise about their subjects (each of which could justify a book of its own); rather, their purpose is to deepen the reader’s understanding of my story. To paraphrase Hamlet, in this book the story’s the thing: What actually happened to me and my patients during the time described was the wellspring for everything written here. For this reason, just as one physician’s experience could never embrace the full sweep and complexity of modern doctoring, this book addresses only some of the many contentious issues facing medicine today.
Whether my story will, as Hamlet hoped his own would, “catch the conscience of the King” is for you to decide. As I write this, politicians and policy makers in the United States are debating the form, function, and financing of smart new models of “accountable” health care. (Sadly, medicine has become increasingly unaccountable; today, it is often unclear who is responsible for the inexplicable way patients are treated.) Little good can come of these promising new ideas unless doctors step up, help to make them right, and take responsibility for implementing them well. But doctors can’t do this alone. Ultimately, it is you—our patients, the body politic—who will be decisive in these matters. That’s why I’d like you to meet my mistress and learn more about her kind of doctoring.
All true tales contain errors. I have tried hard to minimize my own. All persons, events, and settings depicted here are factual. Most names and a few details have been changed to protect individuals’ privacy or their confidential medical information. Reproduction of conversations is approximate, not verbatim, as best my memory allows. Any other misrepresentation of actual fact is unintentional.
That said, let the story begin.
One Doctor is a book rich with information about the medical field. Every page is educational and informative. Here, Brendan Reilly tells of his career on the front lines of medicine. A splendid memoir to say the least.
3 out of 3 people found this review helpful.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
Posted September 21, 2013
Posted September 17, 2013
Reading this book is like going on rounds with the author, Dr. Brendan Reilly, an outstanding physician and role model to thousands of doctors in the US and around the world. How lucky we are! We get to actually see how he approaches, interviews, examines, and treats his patients. He includes asides that explain the science behind how he is thinking about the patients, how he is teaching his residents and medical students, and how his personal life tries to interfere with his doctoring. As a physician, I was reminded about the things I need to be doing regularly in my job. As a person, I was swept along by the story of a humble man, juggling his job and his family responsibilities, caught up in the high drama that sometimes comes into the lives of ordinary people. Dr. Reilly is quite a storyteller! I certainly look forward to reading more of them!
1 out of 1 people found this review helpful.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
Posted December 28, 2013
Fabulous! Dr. Reilly tells it like it is. I would make his book required reading for anyone that ever may need the U.S. medical system(everyone), and especially our politicians in the policy setting area, and all the budding doctors, residents, interns and students in the pipeline.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
Posted December 26, 2013
Posted November 25, 2013
Insightful, well-written, engaging, compassionately critical - I can't think of enough superlatives. The fact that my wife (fiction) and I (non-fiction) not only each read One Doctor but found ourselves talking about it should be sufficient testimonial. To us, this work is far more than a memoir. Rather, it is a carefully crafted journey through and critique of our healthcare system, as told through one doctor and many patient experiences. Prior to reading One Doctor, I had just waged a "Free Dad" campaign for my wonderful 96 year old father to allow him to "die with dignity" - sure wish I had read the book first. I now insist my Mom's 96 year medical team(s) read One Doctor. I hope the author pens another book soon - the man can write!Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
Posted October 25, 2013
Very easy read. His personal relationships with his patients was the interesting part. His review of how medicine has changed since he became a doctor was insightful. His assessment of ethics in medicine was brave. I enjoyed the book.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
Posted October 23, 2013
Having been in healthcare for over 40 years, I truly appreciated this book. It tells the need for your internist to have input into the care the "hospitalist" who cares for you during a hospital admission should have. Costs do increase with duplicate studies, and the hospitalists' decisions are not based on any personalized information. We must be assertive and speak for our personal decisions and rights. The cost of healthcare may benefit the hospital but what about the final condition to you/me for their decisions?Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
Posted September 15, 2013
Excellent book, which most of my article "Pros and Cons of Cardiopulmonary Resuscitation (CPR)" is based on. It has debunked many myths in today's medical practices.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
Posted September 18, 2013
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Posted October 5, 2013
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