Nursing Book Club
One Doctor: Close Calls, Cold Cases and the Mysteries of Medicine
Reviewed By Christine Contillo, RN, BSN
Brendan Reilly, M.D., refers to himself as a dinosaur and he probably is just that: an old-fashioned internist who has played many roles for his patients over the years, from general medicine and house calls to making polite small talk in social situations with patients whose deepest secrets he already knows. That experience enables him to offer us a bird’s eye view of how medicine is changing in today’s high-tech world.
Reilly’s book, One Doctor: Close Calls, Cold Cases and the Mysteries of Medicine, describes two weeks of his career during the winter of 2010, during which time he juggled his work as a weekend hospitalist and the care of his elderly parents, who live on an island hours away. He uses the events of that period to contrast his life and work today with his earlier career and help us understand the directions he and the medical profession have taken.
Tried and True
Like many of my contemporaries, Reilly believes that providers were better able to care for patients in the years before computers and paperwork took over healthcare. He puts his trust in what he calls the “age-old tried and true method to clinical medicine,” which relies less on cookbook algorithms and more (though not exclusively) on intuition.
Reilly reminds us that “history is 90 percent of the diagnosis” and bemoans the fact that many patients no longer have a single primary care doctor or even a single caregiver. The world of medical care has changed, he says, and not necessarily for the better.
The book follows the course of several patients during Reilly’s weekend stint in a large New York City teaching hospital. Especially on weekends, the hospital’s patients tend to be older and sicker than a decade ago. We all know that hospitals are pressured to discharge patients more quickly in order to save money, but that doesn’t answer the question of who cares for these aging patients when they arrive home.
That’s a question with personal significance for Reilly, who has a bedridden father and a mother with dementia, both of whom are determined to remain at home. As the good son, Reilly tries to make that possible, but putting together a patchwork of care long distance is not easy and trying to do so while also caring for critically ill patients would wear down anyone’s resolve.
Who Is to Blame?
What Reilly does best in this book is give us a glimpse behind the hospital curtain while offering his perspective on what it all means. We peek over his shoulder as he helps his team of medical residents come to their own conclusions and we trail behind as he examines patients whose care makes no sense at all in the buyers’ market that is American medicine. Reilly is not optimistic about the state of modern healthcare, which he feels is too often fragmentary and directionless. “Sadly, medicine has become increasingly unaccountable,” he says. “[T]oday it is often unclear who is responsible for the inexplicable way patients are treated.”
What’s even less clear is what is to blame for that chaos. Is it the high cost of medical education or the move away from primary care physicians? Is it insurers and pharmaceutical companies or is it just the mistaken assumption that we are all entitled to live forever if we have the money to make that happen? I don’t know the answers, but after reading this book, I feel like I understand the questions a little bit better.
Photo above: Dr. Brendan Reilly believes that healthcare was better when doctors relied on their own judgment and were not micromanaged by insurance companies. Such a bygone era is represented in this photograph by W. Eugene Smith published in Life magazine in 1948.
Christine Contillo, RN, BSN, is a public health nurse who suggests joining a book club as a reason to put down trashy magazines and look smart on the subway.
This article is from workingnurse.com.