What defines an excellent physician? Compassion, dedication, respect, professional competence, humility. Those traits would make a good start.
All of these qualities shine through the many stories that make up the bulk of Brendan Reilly’s “One Doctor.’’ This book is much more than merely a gripping memoir written by an expert storyteller who also happens to be one of the nation’s most respected leaders of academic medicine. Spanning a 40-year career, the deftly woven tapestry of anecdotes and scholarly analysis also presents a troubling picture of the ways in which the practice of medicine has changed, and not always for the better insofar as patient care is concerned.
The book nimbly alternates between two time frames. The first is a two-week period in 2010 during which Reilly served as the attending physician at the head of a team that included residents and medical students in the internal medicine department at New York Presbyterian Hospital. The second takes place a quarter-century earlier, when most of Reilly’s time was spent as a primary-care physician at Dartmouth-Hitchcock Medical Center in New Hampshire.
Although a generation separates the two, certain things, such as Reilly’s dedication to his patients, remain unchanged. The young doctor making pre-dawn house calls in the frigid New Hampshire winters is the same senior physician checking in one last time on his patients before leaving the hospital late on a Saturday night to catch a few hours’ sleep before returning for rounds the next morning.
Over the course of the narrative, Reilly interacts with the medical system in two entirely distinct ways. The first, obviously, is as a practicing physician. But Reilly is also the son of two elderly and ailing parents whose increasing need for medical care as their conditions deteriorate is a constant source of stress for him. His struggles with this are never far from his consciousness and color his interactions with his own patients in ways that make him appear all the more human and humane.
One issue that troubles him greatly involves the frequent breakdown in communication between physicians and patients. Reilly recounts the story of a patient from early in his career who, unbeknownst to him, had been prescribed a medication by a colleague that caused an adverse reaction and led to tragedy. That he missed this is something that continues to haunt Reilly to this day.
While on duty 25 years later, Reilly meets another patient, admitted with metastatic liver cancer, who, along with his wife, believes he has come to receive treatment in preparation for a life-saving liver transplant. Despite having been cared for at some of the best medical centers in the country, this patient seems not to understand that his advanced disease was incurable, and that all that remained was to keep him comfortable as his life drew to an end. Commenting on the degree of miscommunication between this man and his physicians, Reilly observes that “[i]t happens every day. In fact, increasingly, it’s predictable.” The blame rests not just with the physicians who treated this patient prior to Reilly. It is almost the inevitable product of a system that relies upon increasing fragmented care provided by specialists who often hone in on their own specific niches without seeing — and providing the patient with — the big-picture view.
While reading “One Doctor,’’ I was reminded of many of my own teachers across the long years of my training, master clinicians who taught me through personal example what it means to be an excellent physician. But Reilly’s moving and eloquently written book will be sure to interest not just those working in the medical professions. “One Doctor’’ is simply a terrific read.Dennis Rosen is a pediatric pulmonologist practicing in Boston. His book about communication between physicians and patients, “Patient Listening,’’ will be published by Columbia University Press in 2014.