The goal of this book, deep in the Oslerian tradition, is to improve patients’ health. Patients must trust the doctors’ recommendations, and to earn that trust, doctors should behave in a way that shows respect for the patients’ dignity. No matter how skilled or schooled, without the manners and professionalism necessary to exhibit compassion, empathy, and respect for a patient’s dignity, no one can practice quality care.
The book was edited by Dr. Barry Silverman and Dr. Saul Adler. After a 2-year cardiology fellowship at Johns Hopkins Hospital, Dr. Silverman was recruited by Emory to start a cardiology teaching program at Northside Hospital in Atlanta. He was editor for many years of Atlanta Medicine and was also a member of the Osler Society. Dr. Saul Adler was a founding director of the pediatric intensive care unit at the Scottish Rite Children’s Hospital in Atlanta.
The book originated from a series of conversations between Dr. Barry Silverman and his late older brother, Dr. Mark Silverman (who was my mentor at Piedmont Hospital in Atlanta). Both Silvermans directed cardiology departments at two separate hospitals in Atlanta. They discussed many cases of patient dissatisfaction and poor outcomes arising from a breakdown in physician-patient communication, often resulting from a lack of civil behavior. The authors felt that medical schools needed to offer more on manners and professionalism. They often heard of patients complaining that their health care workers were uncommunicative, arrogant, or sarcastic. Patients also said that the doctor was unfriendly or even rude and avoided talking to them. In contrast, many patients love their doctors when they are not rushed in the examining rooms and try to listen to questions and are practical with common sense. Doctors should see and speak with the patients and avoid using the computer continuously. The electronic medical record can interfere with doctor-patient interaction. The authors felt that rude professional behavior is one of the most common problems in caring for patients—leading to mistakes and anxiety and delaying patient recovery.
This book is a textbook for medical students. Each chapter is similar, with opening cartoons, followed by themes, examples, pictures, and biographies of medical leaders, questions, and references. Some biographies related to doctors I have known: Philip Tumulty, Nanette Wenger, Eugene Braunwald, Louis Sullivan, Cliff Cleveland, and Abraham Verghese. Dr. Barry Silverman focuses on Dr. Charles Wooley, a “celebrity” at Ohio State (where he completed his bachelor’s and medical degrees), and Dr. Thomas E. Brittingham, a legendary teacher at Vanderbilt. Dr. Philip Tumulty was my mentor at Johns Hopkins Medical School in 1962–1963, where he was chairman of the private medical service. He was known for his excellent skill as a diagnostician and teacher. At a talk for his third-year students at Hopkins in 1970, he described a good clinician:
He is meticulous in accumulating the historical and physical data from the patient…. His analysis of the clinical evidence is methodical and disciplined, so that no diagnostic or therapeutic possibility can be overlooked…. His thoughtful management of the total problems of the sick person make mere treatment of a disease or a symptom seems woefully inadequate. He is inexhaustibly capable of infusing into his patients insight, self-discipline, optimism and courage…. The things he works with are intellectual capacity, unconfined clinical experience and the perceptive use of his eyes, ears, hands and heart.
My favorite chapter in this book was the last one, “The Joy of Medicine.” There is much joy in the practice of medicine—many ways to experience this happiness. It may be the enjoyment of a personal relationship with your patient, saving a life, making a difficult diagnosis, completing a procedure or surgery, or working with intelligent colleagues to care for patients. Practicing medicine requires tenacity but is also fun, rewarding, and satisfying.
This book is an enjoyable and informative reading experience. It should be read by all medical students.
The reviewer, S. Robert Lathan, MD, practiced primary care and pulmonary medicine at Piedmont Hospital in Atlanta for 40 years. He is a member of the Osler Society and has published numerous editorials and historical articles in Proceedings.