William Osler’s hospital residency system may have been an advance when he invented it. But it is far from perfect. We need lighter regulations so that medical entrepreneurs can create institutional innovations.
(p. D3) Medicine is full of young recruits writing veterans’ books, war stories full of hopes and fears for the next in line.
. . .
None in recent memory has wielded a set of intellectual and writerly tools to such dazzling and instructive effect as Dr. Nussbaum’s “The Finest Traditions of My Calling: One Physician’s Search for the Renewal of Medicine.”
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. . . Dr. Nussbaum steers his narrative directly to the hard questions about 21st-century medicine, a profession just about as variously troubled as his patients.
. . . None of the usual medical heroes apply. Even the enduring William Osler, who started the hospital residency system at the turn of the 20th century and is routinely worshiped as a medical saint, comes up short. Osler was all about the physical evidence of illness, and Dr. Nussbaum faults him for seeing the body primarily as a collection of diseased parts, “a decidedly incomplete view.”
Few of Osler’s heirs strike Dr. Nussbaum as free of their own shortcomings.
He notes that partisans of today’s much promoted evidence-based medicine must determinedly finesse the fact that medicine is riddled with flawed, incomplete evidence. The leaders of genomic revolution trumpet a future that keeps being postponed. Quality-control gurus abound, but their work often fails to yield actual quality.
And those who would update and streamline medical routines offer up paradigms Dr. Nussbaum finds simply bizarre. He points to Atul Gawande, the Harvard surgeon and health policy writer who in a New Yorker article lauded the ability of large chain restaurants like the Cheesecake Factory to serve a uniform, reproducible product thousands of times over. Dr. Gawande charged medicine to do likewise, but that image of the physician as a line cook feeding faceless strangers does not inspire Dr. Nussbaum.
Still, if a doctor is to be neither parts mechanic nor line cook, then what? Dr. Nussbaum considers some alternatives.
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Dr. Nussbaum considers the alternatives in a flowing, complex stream of anecdotes and reflections, all the stronger for its frequent uncertainty. He writes beautifully, in a lucid prose as notable for its process as its conclusions: The reader can actually watch him think.
For the full review see:
(Note: ellipses added.)
(Note: the online version of the review has the date April 4, 2016 [sic], and has the title “Book Review: ‘The Finest Traditions of My Calling’.”)
The book under review is:
Nussbaum, Abraham M. The Finest Traditions of My Calling: One Physician’s Search for the Renewal of Medicine. New Haven, CT: Yale University Press, 2016.