The Good Doctor by Barron H. Lerner

Author:Barron H. Lerner [Lerner, Barron H.]
Language: eng
Format: epub
ISBN: 978-0-8070-3341-8
Publisher: Random House Publisher Services
Published: 2014-11-03T14:00:00+00:00

CHAPTER SIX

Treating the Whole Patient

As someone who was involved in promoting humanism in medicine and the doctor-patient relationship, I was well aware of several mantras: medicine had become too reliant on technology; doctors saw patients not as people but as specific diseases; physicians in training had become the equivalent of shift workers. Truth be told, I had heard the famous 1925 admonition by Harvard Medical School professor Francis Weld Peabody—“For the secret of the care of the patient is in caring for the patient”—so many times that it sounded almost hackneyed.

It was thus especially helpful for me to immerse myself in my father’s accounts of some of his most challenging cases. Here was someone who had trained in an era when devotion to clinical knowledge and patient care was intrinsic to both medical education and practice. And my father, due to his upbringing, personality, choice of specialty, and job flexibility, had become an especially fervid patient advocate. I found that reviewing his cases, without really knowing what specifically had made him such an outstanding physician, was a huge eye-opener for me—even though I was also a physician as well as a humanist.

The patients I encountered in my dad’s consultation files from the 1960s and 1970s, some of whom I mentioned in the second chapter, gave me insights into a type of clinical practice I had never really experienced. Exploration of some of his later cases—from the early 1980s to the mid-1990s, around the time that he prevented the initiation of CPR—provided even more intense revelations. The cases varied in certain ways. For example, as time went on, my father had to pay more attention to changing ethical norms that placed patients and families in charge of clinical decision making. But the cases all shared one characteristic: my father’s intense engagement in both his patients’ illnesses and lives. The more I read, the more I felt that the difference between my dad’s medicine and mine was almost epistemological. I cared for patients and treated their diseases but did not know them as he did. What was the value of his superior knowledge? And what, if anything, did it entitle him to do as a patient’s physician?

That several of his patients in the 1980s and 1990s had AIDS was particularly fitting. My father had entered infectious diseases during its early, heroic phase, just a few years after his mentors had been forced to watch young, vibrant patients dying of untreatable infections. Now, with the advent of AIDS, the same thing was happening. As my father approached his late fifties, he encountered perhaps the most challenging patients of his career. They tested both his scientific acumen and his skills at interacting with patients and families. When I opened one of his journals, a photograph of one of his AIDS patients, a gift from the man’s parents after their son died, fell out.

I certainly knew one case that I would find in my dad’s journals, perhaps his most memorable patient. Laura (not her real

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