The Best of Herb Fred, MD

As our careers in medicine advance, it is to be hoped that each of us encounters the teacher—the doctor whom we internalize—who is forever checking our work and reinforcing our dedication. This teacher becomes the voice we must answer when it asks, “Have you done enough, and have you done it right?” This encounter need not take place during medical school, residency, or fellowship; this teacher may even be a colleague met after formal training has ended. For me, those teachers were Dr. Thorpe Ray, an 80-year-old, Galveston-trained cardiologist who said, “Let's go listen to that heart” after every patient presentation, and Dr. Robert Hall, who taught the principle that “If you don't know the diagnosis, you haven't finished your history and physical examination.”

As the director of a training program, I have been fortunate to see a number of physicians trained by Dr. Herb Fred. Each and every one of these young men and women retains and can quote his teaching—teaching that begins with the responsibilities of a physician and ends with the concept that diagnosis is established at the bedside, not at a computer terminal. Dr. Fred's trainees are recognizable in their comportment as professionals who show little concern for their work hours or “lifestyles.”

In person, Dr. Fred is the curmudgeon who will always ask the question that you forgot, point out the physical finding that you overlooked, or note the subtle deficiencies in your clinical approach that differentiate between merely good medical care and excellent medical care. He is the angel on your shoulder who elicits guilt when you allow technology to make a diagnosis in your stead, and he is the talented teacher who bestows the skills that make that technology less necessary.

The loss of physicians of this kind is slowly creating an intellectual anemia in the profession. For this reason, a collection of his aphorisms is of value. The Best of Herb Fred, MD: His Insights, Observations, and Everyday Reminders offers a return to real “doctoring,” for it emphasizes professionalism, duty to your patient, and bedside diagnosis. This concise assemblage of advice will serve physicians in any field of medicine.

With keen intellectual observations, pointed sarcasm, and an excellent sense of humor, Dr. Fred draws attention to the foibles, fables, and romance of clinical patient care. This well-edited collection of his teachings, handsomely produced in hardback on high-quality paper, neatly organizes concepts and sustains the reader's interest. Essentially a compilation of Dr. Fred's “sayings,” the book touches on a host of topics. Each statement cuts to the bone, but with a deft humor that makes you wish that you had said it. (Perhaps, after reading this work, you will.) Dr. Fred's medical wisdom, gained over a lifetime, is also well-referenced, enabling readers to investigate the context of each statement.

In this review, I have made a great effort to avoid “acronymesis”—another great “Fredism,” meaning the annoying use of acronyms. Although I didn't train under Dr. Fred, his young trainees have given me an immense respect for Dr. Fred's dedication to medicine and teaching. The angels sitting on my own shoulders, Drs. Ray and Hall, would welcome Dr. Fred and his teachings into their fold. As professionalism in medicine and respect for physicians erode, this slim volume reminds us of what we are supposed to be. I will close by quoting my favorite statement from this collection: “Physicians do not have the privilege of shirking responsibility.”