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On Doctoring: New, Revised and Expanded Third EditionFrom Free Press
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Few subjects hold more universal appeal than that of medicine, and surely few books have evoked medicine's drama and magic more powerfully than "On Doctoring." In its many forms, from age-old ritual to the cutting edge of modern science, medicine concerns us all. It is a human profession, practiced by people who have dedicated their lives not only to science but also to humanity. In the words of the great physician-writer Sir William Osler, "The physician needs a clear head and a kind heart; his work is arduous and complex, requiring the exercise of the very highest faculties of the mind, while constantly appealing to the emotions and higher feelings." It is the humanity in medicine that has inspired the pens of countless writers, and that has now been captured in this remarkable anthology of medical literature.This newly expanded edition of "On Doctoring" is an extraordinary collection of stories, poems, and essays written by physicians and non-physicians alike -- works that eloquently record what it is like to be sick, to be cured, to lose, or to triumph. Drawing on the full spectrum of human emotions, the editors have included selections from such important and diverse writers as Anton Chekhov, W. H. Auden, William Carlos Williams, John Keats, John Donne, Robert Coles, Pablo Neruda, Ernest Hemingway, Raymond Carver, Alice Walker, Kurt Vonnegut, and Abraham Verghese. Among the new authors included in this edition are Rainer Maria Rilke, Lisel Mueller, and May Sarton.In this era of managed healthcare, when medicine is becoming more institutionalized and impersonal, this book recaptures the breadth and the wonder of the medical profession. Presenting the issues, concerns, and challenges facing doctors and patients alike, "On Doctoring" is at once illuminating and provocative, a compelling record of the human spirit.
- Sales Rank: #445203 in Books
- Published on: 2001-08-07
- Released on: 2001-08-07
- Ingredients: Example Ingredients
- Original language: English
- Number of items: 1
- Dimensions: 1.19" h x 6.38" w x 9.54" l, 1.61 pounds
- Binding: Hardcover
- 416 pages
From The New England Journal of Medicine
Few physicians and fewer medical students read novels. Nonetheless, literature has much to teach physicians and medical students about the type of work they have chosen. This anthology, aimed primarily at first-year medical students, is made up of bite-sized offerings. It includes 130 pieces (mostly poems, but also stories, essays, and one short play) by 81 authors, with all the pieces chosen because they illuminate an aspect of the practice of medicine. Although it is labeled as a third edition, the collection remains substantially similar to the 1991 first edition (about a dozen authors from the first and second editions do not appear here, and a few more than that have been added). Nonetheless, there is no better place than this book to begin an exploration of what literature tells us about physicians and what physicians have written that can qualify as literature.
The core of the collection is made up of selections from writers whose stories will be familiar to many readers of the Journal; these include W. Somerset Maugham, William Carlos Williams, Ernest Hemingway, Flannery O'Connor, Jorge Luis Borges, and Raymond Carver. Nor will the poets (writing mostly about death and suffering) surprise the reader; they include Emily Dickinson, Robert Frost, Archibald MacLeish, Dylan Thomas, Denise Levertov, and one of the book's coeditors, John Stone. The best essays on medical practice in the collection were originally published in the Journal and include pieces by physician-writers Lewis Thomas, Robert Coles, Carola Eisenberg, Joseph Hardison, and David Hilfiker. Other contemporary physician-writers are also well represented, including Lawrence Altman, Melvin Konner, Abraham Verghese, Perry Klass, Jon Mukand, and Ethan Canin.
Since 1991, when the first edition was published, the Robert Wood Johnson Foundation (of which coeditor Richard Reynolds was executive vice president at the time) has distributed the book free to all first-year medical students. The goal of trying to develop in physicians a lifelong habit of reading literature is a good one, since much of the practice of medicine involves understanding patients' narratives and listening to their stories. It is also difficult to quarrel with this book's content, although many of the selections over-romanticize the practice of medicine, and few hint at its economic and bureaucratic aspects. The inclusion of some less reverential pieces would have provided more insight into medical practice. Kurt Vonnegut's devastating short play, Fortitude, is the only entry with much humor. At least one excerpt from the novel that is most widely read by medical students, The House of God (New York: Dell, 1978), by Samuel Shem (the pen name of physician Stephen Bergman) and almost anything on medicine by Mark Leyner would have been welcome additions.
Most of the fiction and virtually all the poetry is universal and aims deep. Nonetheless, it is the essays in this collection that will attract medical students the most, since they speak directly to the experience of being (and becoming) a physician. Those included are all strong, but the addition of something like David Rothman's essay on medical professionalism, which appeared in the Journal (2000;342:1284-86), would have made the collection both more contemporary and more challenging to medical students.
The introduction to the book insists that "physicians and patients must continue to talk and listen together -- and literature can help in that exchange." But I doubt that this book will have a readership among patients. It is much more an insider's book. Moreover, reading is a solitary activity, and as Jay Katz has eloquently argued in The Silent World of Doctor and Patient (New York: Free Press, 1984), there is seldom much in the way of real communication between doctor and patient. Reading literature will not change this situation, although group discussions about readings (including medical school seminars on literature and medicine) could help. In addition to medical students, then, the other major target audience for this book should be medical school faculty members.
The book does have one glaring problem. Although it includes selections by women writers, the collection is dominated by white male physicians. This domination -- something literature should help to expose and correct -- is reinforced (but unexplained) by the titles given the editors themselves; the two male physicians are called "editors" and the two female Ph.D. humanists (Lois LaCivita Nixon and Delese Wear) are described (in much smaller type on the cover) as "associate editors." The photographs and biographies of the two male physician-editors appear on the book jacket; there are no photos or biographies of Nixon and Wear. The message to medical students is unmistakable and perverse: even in the world of literature, only physicians matter.
Finally, the editors treat all their selections equally, and organize them (with no explanation) according to the author's date of birth. It does not help new medical students simply to be told to read this book because it is good for them. They should be told where to begin. I think they should be told explicitly to begin with Richard Selzer's story "Imelda," Robert Coles's essay "Medical Ethics and Living a Life," David Hellerstein's story "Touching," and two poems: Rafael Campo's "What the Body Told," and Gregory Edwards's "The Shot." They can figure out the rest by themselves.
George J. Annas, J.D., M.P.H.
Copyright � 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
About the Author
Richard C. Reynolds, M.D., is Courtesy Professor of Medicine at the University of Florida College of Medicine. He was formerly Executive Vice President of the Robert Wood Johnson Foundation. A graduate of Rutgers University and the Johns Hopkins University School of Medicine, he did postgraduate training at the Johns Hopkins Hospital. After spending a number of years in private practice of internal medicine, he held academic appointments at the University of Florida College of Medicine and the University of Medicine and Dentistry of New Jersey.
Excerpt. � Reprinted by permission. All rights reserved.
Introduction
It's the humdrum, day-in, day-out, everyday work that is the real satisfaction of the practice of medicine; the million and a half patients a man has seen on his daily visits over a forty-year period of weekdays and Sundays that make up his life. I have never had a money practice; it would have been impossible for me. But the actual calling on people, at all times and under all conditions, the coming to grips with the intimate conditions of their lives, when they were being born, when they were dying, watching them die, watching them get well when they were ill, has always absorbed me.
In these few sentences from William Carlos Williams's autobiography, he has captured very well the human splendor of medicine. We have tried to do the same in compiling this anthology, which contains stories, poems, essays, excerpts, and memoirs. In the process of caring for their patients, physicians have a unique -- and privileged -- window on the full range of human emotions. Literature, too, is rich in its descriptions of individual illnesses and plagues, in its capacity to reveal patients' reactions to illness and doctors' dilemmas in providing care. In its own way, literature defines the medical profession and fits into the larger society. Legacies and traditions, which are an important part of medicine, are often best manifested in the literature of a given period of history. Many of our selections were written by physicians. Williams and Anton Chekhov, W. Somerset Maugham and Lewis Thomas are only a few of the physician-writers who have relied on their medical backgrounds to help them understand better the frailties and strengths, the wonderment of the human condition. Some carried on a lifelong practice of medicine while simultaneously achieving literary recognition. Dr. Williams is a fine example -- his work, it seems fair to say, changed the face of American poetry, even as he carried on a large medical practice (he delivered over three thousand babies, for example). Somerset Maugham, although he discontinued his medical practice after internship, gave full credit to the experience in his autobiographical The Summing Up: "I do not know a better training for a writer than to spend some years in the medical profession." Others, so well known for their writing, were also trained in the medicine of their day. It is not generally known, for example, that the Romantic poet John Keats did a five-year apprenticeship with a surgeon. During those years he delivered so many babies that he was not required to take obstetrics and gynecology during the hospital phase of his training.
Of course, one need not be trained in medicine in order to make cogent and crucial observations about what it is like to be sick, hence vulnerable; to witness and record the isolation and alienation that comes eventually to all of us -- finally, we are all patients. Consider the poems of the late Jane Kenyon and her husband, Donald Hall. Their writings poignantly describe the time before their ultimate separation by her death, in 1995. Their poems are human documents without parallel. In his compelling short story "The Immortals," Jorge Luis Borges (also not a physician) comments trenchantly and presciently on some of the major ethical dilemmas of our time, those centering on organ transplants and utilization of scarce medical resources.
We have included many poems in this anthology. Poems recommend themselves to the editors of such a work because of their economy of form: in a few words a poem can communicate a complete experience. Read aloud Margaret Atwood's "The Woman Who Could Not Live with Her Faulty Heart." In its rhythms one can hear the heart, first regular, then skipping. Or listen to the courage embodied in James Dickey's "The Cancer Match." Read Emily Dickinson's short poems, which transcend time and place to speak to us in completely modern -- and human -- terms. And share with Patricia Goedicke (in "One More Time") the universal experience of having an X ray taken: "When the technician says breathe / I breathe."
Nor have we neglected the wisdom gathered in essays from major clinical figures and teachers over the years; hence, Lewis Thomas's "House Calls" is included. We begin this book, in fact, with just such an essay, one that impressed us from the first time we encountered it in the pages of the New England Journal of Medicine: Carola Eisenberg's "It Is Still a Privilege to Be a Doctor." The reader will find his or her own favorites among the many others we have included.
This third edition of On Doctoring provided us with the chance to add other voices to those previously included: remarkable writing from physician-writers Mikhail Bulgakov and Susan Onthank Mates, for example. Many writers new to this anthology are well known and widely published: Rainer Maria Rilke, Mary Oliver, Paul Zimmer, Donald Justice, Derek Mahon, and Jenny Joseph. We note with pride that our youngest author ever is included in these pages: Gregory Edwards was ten years old when he wrote his insightful -- and humorous -- poem called "The Shot."
Each one of us, of course, has a vast and vested interest in what goes on in the myriad arenas of medicine -- and in the nature of the individual doctor-patient encounters explored within the pages of this book. This is all to the good: physicians and patients must continue to talk and listen together -- and literature can help in that exchange. As editors, we are pleased to have had some part in this dialogue: prior editions of On Doctoring have had a combined readership of two hundred thousand.
Henry David Thoreau wrote, "To affect the quality of the day -- that is the highest of arts." Both medicine and literature have the capacity to affect the quality of the human day. Resonances between these two disciplines offer us a unique view of the human condition that neither one alone can provide. Read. And enjoy.
The Editors
Copyright � 1991, 1995, 2001 by The Robert Wood Johnson Foundation
Most helpful customer reviews
4 of 4 people found the following review helpful.
The Art of Medicine...
By yygsgsdrassil
...the science of health. The art and science of the human spirit.
These are given every year to first year students by the Robert Wood Johnson Foundation, and in my opinion, it is like a trusted physician's black bag in which you have the practitioner's stethoscope and blood pressure cuff and plenty of simple pharmacies for a house call--one in which the doctor is not in a hurry to run.
Let not the title catch the layperson off kilter--it's chocked full of good stuff for the rest of us humans who just like to read classic and near-classic works. Like some of my favorites: Because I Could Not Stop for Death by Dickinson, Larynx by Neruda, House Calls by Lewis Thomas and A Summer Tragedy by Arna Bontemps. There's a superb essay on wonder and the evolution of the human spirit by Melvin Konner. There's a Vonnegutian reworking of Frankenstein ( "a crass medical genius" with my real supervisor's first name--I'm grinning as I type this). There's a Chekhov piece on the loss of hope and sadness when one loses a child. Then there's copies of art--Munch, Rockwell, Fildes. Plus, lots, lots more.
First year medical students who usually are to busy to read anything for enjoyment, are missing out on a great collection if they don't stop to smell some of these literary roses. We lay folk with a taste for a great read or two will take us this slack and pass the word on how superb is this collection.
6 of 6 people found the following review helpful.
Medicine & Literature - the promise fulfilled
By tommayo
Reynolds, Stone and (new to this edition) Nixon have produced an almost magical book. I've used the previous two editions of this anthology in a seminar with third-year law students and fourth-year medical students ("Law, Literature & Medicine") and look forward to using this new edition in 2002. The impressive literary range represented here -- from the ancients to the most modern (including a little gem from an 11-year-old poet) -- captures the perspectives of patient, healer, family member and others who must deal with illness or death. Many of the classics are collected here (Dylan Thomas (Do not go gently), John Donne (Death be not proud), O.W. Holmes (The Stethoscope). In addition, the editors' command of modern texts -- especially short stories and poems -- gives fresh voice to up-to-the-minute versions of ancient concerns. This book gives new meaning, and new signficance, to the idea of "the art of medicine." Anyone who is facing or may face illness or death, or knows someone else who will face these inevitabilities (that is: ALL OF US) will be enriched by this unique and valuable collection.
2 of 5 people found the following review helpful.
Fair Attempt to Expound Literary Art in a Medical Paradigm
By A Customer
I, along with all my other classmates, received this book at the beginning of medical school at our white coat ceremony. It was presented to us as a collection of anecdotal stories and poems that would help us maintain our focus on the humanistic side of medicine and keep our passions for the practice alive while toiling away at arduous scientific study and long clinical hours. There are some excerpts and short works in the book that do just that. I found myself inspired and feeling enlightened after reading these parts of the book. However, this did not comprise the majority of the book for me. Most of it kept me on the verge of reading and sleep. Several of the poems failed to grip me in the way a select few of the stories had done. Although much of health care deals with the elderly, the book seemed to drone on and on with the experiences of the geriatric to the extent that at times, it felt a more apt title would be On Being Old. For the most part, I felt this work tried to pressure literary art on to medicine. There is a lot of rich and passionate literature related to medicine, but I felt that mostly only less than great works were included here. It was an o.k. experience to read through On Doctoring which did have its gripping pages, but I would probably not recommend it.
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