A deeply concerned physician reflects on today’s doctor-patient relationships and offers a compelling vision of a better way to practice medicine Patients and doctors alike are keenly aware that the medical world is in the midst of great change. We live in an era of continuous healthcare reforms, many of which focus on high volume, efficiency, and cost-effectiveness. This compelling, thoughtful book is the response of a practicing psychiatrist who explains how population-based reforms have diminished the relationship between doctors and patients, to the detriment of both. As an antidote to failed reforms and an alternative to stubbornly held traditions, Dr. Abraham M. Nussbaum suggests ways that doctors and patients can learn what it means to be ill and to seek medical assistance. Using a variety of riveting stories from his own and others’ experiences, the author develops a series of metaphors to explore a doctor’s role in different healthcare reform scenarios: scientist, technician, author, gardener, teacher, servant, and witness. Each role influences what a physician sees when examining a person as a patient. Dr. Nussbaum cautions that true healthcare reform can happen only when those who practice medicine can see, and be seen by, their patients as fellow creatures. His memoir makes a hopeful appeal for change, and his insights reveal the direction that change must take.
Abraham M. Nussbaum, M.D., is the Chief Education Officer at Denver Health and is an associate professor of psychiatry at the University of Colorado School of Medicine. He lives in Denver, CO.
Table of Contents
Introduction: Parts and Money 1
1 Seeing Wisely 10
2 Occult Findings 26
3 The Book and the Coat 38
4 Full Responsibility 52
5 Duty Hours 67
6 Efficient and Effective 84
7 Checklists and Dance Lessons 99
8 Famous Factory Meatloaf 114
9 Sickbeds and Garden Beds 131
10 Committed 146
11 Impatient Attending 162
12 Muscle Ups 176
13 Doctors Without Silver 191
14 Red Cards 207
15 Witnesses 223
16 Hope 239
Epilogue: Luster 258
What do you hope readers will take away from the experience of reading The Finest Traditions of My Calling? I hope readers will learn that healthcare reform is not just a question of who should have access to care and who should pay for it, but also of our desire for a favorable outcome when a physician meets a person as a patient. Reformers believe the problem with medicine is that it does not consistently and safely deliver the best treatments. And the solution is to transform the delivery of medical care using processes pioneered in high-risk industries like aviation, mining, and automobile manufacturing: run hospitals like factories, optimized for efficiency and effectiveness. But factories make things, not people.
How might your book help change the practice of medicine? I hope to shift the conversation from the reform of healthcare systems to the renewal of medical practice. We need to envision hospitals and clinics not as factories but as cultural spaces such as schools and gardens, restaurants, and gyms, all of which require human relationships for their operation.
What are examples of the roles physicians and patients assume when they interact? Physicians are like scientists who want to know how the body works; technicians who control it; authors who tell its story; gardeners who carefully tend it; teachers who help patients achieve what they could not on their own; and servants who give of themselves for the sake of their patients.
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