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Sci-Fi, Fantasy, Alternate History
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Sci-Fi, Fantasy, Alternate History
Sci-Fi, Fantasy, Alternate History
An epic story told by a unique voice in American medicine, One Doctor describes life-changing experiences in the career of a distinguished physician. In riveting first-person prose, Dr. Brendan Reilly takes us to the front lines of medicine today. Whipsawed by daily crises and frustrations, Reilly must deal with several daunting challenges simultaneously: the extraordinary patients under his care on the teeming wards of a renowned teaching hospital; the life-threatening illnesses of both of his ninety-year-old parents; and the tragic memory of a cold case from long ago that haunts him still.
As Reilly's patients and their families survive close calls, struggle with heartrending decisions, and confront the limits of medicine's power to cure, One Doctor lays bare a fragmented, depersonalized, business-driven health-care system where real caring is hard to find. Every day, Reilly sees patients who fall through the cracks and suffer harm because they lack one doctor who knows them well and relentlessly advocates for their best interests.
Filled with fascinating characters in New York City and rural New England - people with dark secrets, mysterious illnesses, impossible dreams, and many kinds of courage - One Doctor tells their stories with sensitivity and empathy, reminding us of professional values once held dear by all physicians. But medicine has changed enormously during Reilly's career, for both better and worse, and One Doctor is a cautionary tale about those changes. It is also a hopeful, inspiring account of medicine's potential to improve people's lives, Reilly's quest to understand the "truth" about doctoring, and a moving testament to the difference one doctor can make.
Live a simple and temperate life, that you may give all your powers to your profession. Medicine is a jealous mistress; she will be satisfied with no less.
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 werein 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 irrevocablyon balance, I believe, for the betterand 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-asswhich 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 younot merely tell youwhat I do, how I do it, what it feels like. In recent years, many people have told storiessome with happy endings, some notabout 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.
Excerpted from One Doctor by Brendan Reilly. Copyright © 2013 by Brendan Reilly. Excerpted by permission of Atria Books. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
January, 2010. A wealthy architect in his early fifties lies in bed at New York Presbyterian Hospital. He has a rare kind of pancreatic cancer that has spread to his liver. Within days, maybe hours, he'll be dead. The senior physician by the patient's bedside asks him the name of his regular doctor.
The question vexes the patient, so he looks at his wife.
"You mean like a family doctor?" she asks.
"Yes," the physician says.
The wife explains there's no family doctor; all her husband's doctors are cancer specialists.
The physician recalling this scene, Brendan Reillyand the author of One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicinewonders how this is possible, that an intelligent man of considerable financial means, whose cancer has previously failed treatment at several of the world's most renowned hospitals, finds himself in this situation: not having a single doctor who knows him well, watching out for his best interests.
Patients' preferences in the morass of today's medical landscape, coupled with the accelerated decline of primary care doctors, are two of the many issues Reilly confronts in his illuminative and deeply moving book: part memoir and part expert commentary about the changes both good and badin health care during his 40 years in medicine. Early in his career, Reilly was a primary care physician in New Hampshire and later served as the chief of medicine at Chicago's Cook County Hospital, the basis of the popular TV show ER. Currently he is executive vice chair of medicine at New York-Presbyterian Hospital/Weill Cornell Medical Center.
The cancer patient and his wife believed he was receiving optimum care by having several specialists, despite the absence of a general practitioner. This kind of mindset is increasingly commonand troubling, Reilly contends. In his view and experience, people need one doctor who knows them, has followed their medical history over time before they end up in the hospital and, depending on the case, will resume care after they leave the hospital.
Although these "one doctors"those who have devoted their careers to family medicine and other primary care specialties like pediatrics and internal medicinedo, of course, still exist, Reilly worries that they may one day become extinct precisely when their services will be more necessary than ever before. Modern medicine is complicated enough. Odds are it won't become much easier to navigate in the foreseeable future. One doctor, or one advocate, Reilly writes, is needed to oversee and coordinate care, to help patients make informed decisions that are personally right for them.
Why the threatened extinction? One reason is that this kind of doctoring isn't nearly as lucrative as medical subspecialties. It's no secret that medical students amass enormous debts. As a result, in many U.S. medical schools and teaching hospitals, Reilly explains these physicians-in-training are "actively discouraged from, even ridiculed for, pursuing careers as primary care doctors." Reilly's insightful ruminations make for a fascinating read, further strengthened by fast-paced, first-person accounts of challenging cases, most of which take place during two weeks in 2010. Among numerous patients, we meet a Croatian man with metastatic bladder cancer and heart distress as well as a homeless, mentally ill woman who rants that Halley's Comet caused her liver problem and that her breast cancer is actually good for her.
A self-described "dinosaur, an old-fashioned internist," Reilly's voice remains consistent with equal shades of humility and authorityeven remarkable honestyespecially when he recounts a haunting case from 1985: the death of an 80-year-old patient named Fred whom Reilly knew well and respected. Years later, Reilly learns the truth about Fred, whether he took his own life because he was declining into dementia, or if there was more to his story. This discovery, both humbling and educational for Reilly, makes him a better doctor.
Without compromising the more personal narrative that runs throughout the entire book, Reilly smoothly weaves in useful (and sometimes alarming) information, not just about the primary care challenge but other contemporary health concerns. One example is that, today, at least 20 percent of the 12.5 million people aged 65 years or older who are hospitalized annually in the United States develop delirium. (Delirium occurs when patients with predisposing conditionsincluding elderly age, dementia and immobilizationare afflicted by precipitating events such as drugs, infections, sleep deprivation and surgery).
Reilly also offers sobering advice, particularly about planning end-of-life care. In the latter part of the book, he must grapple with these wrenching decisions himself, as both doctor and son to his ill and elderly parents. The resulting prose provides some of his most personal reflections. One of five children, Reilly reveals his parents' struggles with alcohol and "the splintering of the family." Thinking about his parents' deaths, he wonders who will miss them. He wonders if anyone will even come to a funeral service.
"Feelings matter in medicine," Reilly writes, an opinion that pervades this entire work. One Doctor is gutsy and heartfelt, a recommended read for anyone interested not only in modern medicine but also one man's professional and personal journey, as instructive as it is inspirational.
Reviewed by Suzanne Reeder
Rated of 5
Real world drama and excitement from a humble modern hero
This book would be great even if it weren't a true story, but being a true story makes it even more outstanding. The reader goes with Dr. Brendan Reilly, a modern master of medicine, as he rounds in a big-city hospital and his small-town office, meeting patients and teaching residents and medical students, treating each one of them as an individual with his/her own story. He teaches medicine to the reader and to his younger colleagues, and he shows us how he guides patients through their illnesses, sometimes to wellness and other times not. This book is unique in how it blends clinical medicine and scientific research with overarching stories about his patients and himself. It is truly a gripping read and I highly recommend it.
Somatization—the conversion of a mental state (such as depression or anxiety) into physical symptoms—is extraordinarily common, according to Dr. Brendan Reilly, who writes about it (among other health concerns) in his book One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine.
This broad medical term encompasses many illnesses, including recognized "somatic symptom and related disorders" described in the fifth, and most recent, edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.
Somatization affects women and men of all ages and cultures. It's common for people suffering from somatization to complain, over a period of years, of multiple symptoms that have little or no physical cause, but because they either don't recognize the root origin of their symptoms or because they associate a negative stigma with mental health issues, they tend not to seek help from mental health professionals.
Somatic symptoms include—but aren't limited to—abdominal, back, or chest pain; diarrhea, headaches, dizziness, sexual problems, shortness of breath, palpitations and vision changes. These symptoms can cause considerable distress and may interfere with work and personal relationships.
A panic attack—which the Mayo Clinic defines as a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause—frequently occurs with somatic symptoms such as shortness of breath, palpitations and chest pain. These symptoms often land people in the hospital, and can be mistaken for heart attacks.
Unfortunately, once a heart attack is ruled out, many doctors tend to minimize the distress of someone having a panic attack—and somatization in general. As a result, a patient may seek help with other health care providers. These visits may lead to unnecessary, perhaps costly tests—and more frustration by the patient, family members, even the practitioner.
Empathy, awareness and understanding can help a doctor's intuition with somatic patients. Diagnosis may involve tests to identify or rule out possible diseases. For treatment, The New York Times Health Guide recommends that patients should have only one primary care provider, to avoid having too many procedures. If a patient is amenable, consulting a mental health professional can also help with the management of symptoms.
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