Proper Doctoring by David Mendel

Synopsis:

15823470“People come to us for help. They come for health and strength.” With these simple words David Mendel begins Proper Doctoring, a book about what it means (and takes) to be a good doctor, and for that reason very much a book for patients as well as doctors—which is to say a book for everyone. In crisp, clear prose, he introduces readers to the craft of medicine and shows how to practice it. Discussing matters ranging from the most basic—how doctors should dress and how they should speak to patients—to the taking of medical histories, the etiquette of examinations, and the difficulties of diagnosis, Mendel moves on to consider how the doctor can best serve patients who suffer from prolonged illness or face death. Throughout he keeps in sight the fundamental moral fact that the relationship between doctor and patient is a human one before it is a professional one. As he writes with characteristic concision, “The trained and experienced doctor puts himself, or his nearest and dearest, in the patient’s position, and asks himself what he would do if he were advising himself or his family. No other advice is acceptable; no other is justifiable.”

Proper Doctoring is a book that is admirably direct, as well as wise, witty, deeply humane, and, frankly, indispensable.

Review:

The subtitle says this is “a book for patients and their doctors” but I disagree. It’s aimed squarely at doctors. Not nurses or pathologists, not those who may want to practice medicine someday, and definitely not lay people. Latin phrases are tossed off casually (“Primum non nocere”) and medical vocabulary is left as is:

Thus, if a patient has diplopia, whereas formerly one would have summoned up a list of causes of that condition, one nowadays prefers to think of the function of binocular vision and to picture a lesion, of no matter what nature, which could upset that system.

If you are not medically trained there are a lot of sentences like this that need to be taken on faith.

Proper Doctoring comes to us from a long ago, far away land: 1984 England. A lot has changed since then – cancer is not always the death sentence it used to be, screening tests of all sorts have been improved, and societal norms have changed. The NHS is also very different from the US healthcare system, and some things fail to translate. “Patients rarely sue,” Mendel says, but American doctors practice so-called defensive medicine because litigation’ is a very real threat. In another section Mendel says,

It is undoctorly to present the patient with a list of the complications of therapy and ask him to decide whether he is prepared to take the risks

but today that’s the very basis of informed consent.

If you can somehow manage to untangle this web of era and circumstance there are some gold nuggets. Any training doctor would benefit to hear advice like,

Generally, it is only bad doctors who are too busy to finish the job properly

and

Reliance on scientific medicine alone is like lying on a one-legged couch. The other three legs are wisdom, experience, and caring.

In its current form this work is of some interest to doctors but no interest to anyone else. Even then I’d like to see it updated to reflect the current state of medicine. Reading Proper Doctoring is like reading a 40-year-old copy of The Joy of Sex – accurate enough in its time with a gem here and there, but largely outdated in the modern age.

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