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One Doctor: Close Calls, Cold Cases, and the…

One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

by Brendan Reilly MD

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727166,644 (4.06)12



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A throwback philosophy to the times when Doctors made house calls, and KNEW their patients. Reilly makes the case that Doctors today could do a much better job of tending to their patients' needs if they could take the time to actually follow their patients' lives.

Reilly is on staff at a large metropolitan hospital, and we follow him on his rounds. But, as he visits the various patients, he inserts his thoughts about the larger issues in medicine today.

Immensely readable. I recommend this to everyone ( )
  ElizabethLynnPrice | May 27, 2016 |
I really liked ths book. Dr. Reilly is an experienced, thoughful, and intelligent physician. He allows us to see into his occupation and his head. After he discusses his cases he provides his thoughts on policy and present practice. I learned alot about how medical doctors think and about their jobs. This also helped me to see my role as a decision maker regarding the care appropriate for myself and my relatives. ( )
  GlennBell | Feb 14, 2016 |
Each of us needs to have at least one doctor who knows us well. ( )
  Suzieqkc | Oct 1, 2015 |
Very interesting, wide ranging, very personal view of medicine. Dr Reilly does not spare anyone, even himself, in this view of how medicine works now. It is both an overview of his history in medical practice and an overview of how medical practice has changed in his lifetime. It makes me wish for a closer relationship with my doctor, one that is not possible in the 5-10 minute slots she has to see each patient. ( )
  bgknighton | Mar 9, 2015 |
"For centuries, medicine had been considered more than a “helping profession,” it was a vocation, akin in many respects to religious ministry. But, in our increasingly secularized society, even the (non-religious) “Samaritan” role of doctors – empathizing with and helping others, has been devalued, sometimes even ridiculed in the ascendant business culture of medicine. This new culture has even changed our vocabulary. Doctors and nurses have become “providers” of medical care, itself now a “commodity.” Patients have become “customers,” the “consumers” of medical care.”

One of my long-term reading goals is to read more books about medicine, specifically more about doctors. NielsenGW had posted an excellent review of this book on his thread of this one and I immediately requested it from my library. This book was just what I wanted: a look inside the mind and heart of a doctor. Dr. Brendan Reilly, the senior attending physician at New York Presbyterian teaching hospital, takes us with him through a few weeks in the not-so-recent past of seeing patients. There is a real-time moment to moment “you are there” feel to the patients and cases presented. In contrast to popular shows like “House,” where it seems the doctors get to focus on one (or maybe two) hard to diagnose and/or treat patients, Dr. Reilly and his team of interns are faced with multiple patients, and multiple decisions to make, in a short period of time. They seem to, quite literally, bounce from one patient – and one decision - to another. It’s not always easy to decide what is best for the patient; one course of action may cause more hurt than harm – every course of action has its drawbacks - but no action at all may have fatal consequences.
We bounce this around, too, decide to try this, then that, we’ll see. …. On days like this, doctoring feels like pinball: nonstop random events – intercepted here, altered there, prolonged or postponed by this or that, the bells and boinks sounding all around – and sometimes you can’t be sure whether you’re the guy pushing the buttons, manipulating the levers, and bumping the machine, or whether you’re inside the machine, whether you’re the pinball itself.”

Dr. Reilly talks a lot about decision making, a subject he has researched himself, and the “intuitiveness” a doctor develops over time. As advanced as our medical technology is, there are still things CTs, MRIs, and EKGs can miss. Even a simple test can come back “inconclusive,” or with a “false/positive or negative” result. A sharp doctor will rely on his intuition and experience, not solely on lab results. It takes a lot of courage to do so. Missing something can be just as devastating to patient care as testing for something that doesn’t exist. We want our doctors to be perfect – and any doctor, I’m sure, wants to be right 100% of the time. Simply put, doctors are human and make mistakes. That’s another point Reilly brings up: doctors need to learn from their mistakes, certainly most doctors do, but so often, they’re afraid to even confess to themselves that they’ve even made a mistake. When they do have the courage to face an error, there seems to be nowhere to go for support. Reilly quotes Dr. David Hilfiker’s article, “Facing Our Mistakes” in the New England Journal of Medicine:
“There is no permission given to talk about errors, no way of venting emotional responses. Indeed … I lapse into neurotic behavior to deal with my anxiety and guilt. Little wonder that physicians are … defensive about our judgments … blame the patient or the previous physician when things go wrong … yell at nurses for our mistakes … have such high rates of alcoholism, drug addiction, and suicide. At some point we … need to find healthy ways to deal with our emotional responses to those errors.”

The main focus of Reilly’s is not inevitable medical error, though, but a lack of general practitioners, those old-fashioned doctors who get to know their patients well. There’s an inherent risk, Reilly argues, for patients who lack a primary care physician, the one doctor who has a better view of a patient’s big picture of health. A “perpetual intern” (according to his wife), Reilly practices what he preaches. During rounds at New York Presbyterian, a patient asked Dr. Reilly who her doctor would be over the weekend. “I told her that I cover my own weekends, because, if you’re sick enough to be a patient in the hospital, it’s safer if you’re seen every day by the doctor who knows you best.” He goes on to point out the risks of hospitalized patients being cared for by doctors who don’t know them:
“… the early recognition of delirium – by definition an acute change in the patient’s mental status – requires familiarity with the patient’s usual mental status. In acute care hospitals, where so many patients are cared for by doctors and nurses who have never met them before, hospital staff will be far less likely to recognize the telltale changes in affect or behavior that herald the onset of delirium. Worse, when elderly hospitalized patients develop florid delirium – agitated, wandering, disruptive behavior – hospital staff often assume that the patient has dementia (that is, long standing irreversible cognitive impairment). A vicious cycle then ensues. Psychoactive drugs … are given to calm the “demented” patient’s agitation, which drugs often only make the patient’s delirium worse… It happens all the time.”

Old fashioned general practitioners seem to be a dying breed; more med students are choosing to specialize because that’s where the money is. There is quite a disparity between the compensation a general practitioner receives for his/her service and the rate of pay a specialist receives. While nobody can argue that specialists aren’t necessary, for they certainly are, a general practitioner is just as necessary, Reilly argues, so why shouldn’t they be paid the same? It’s our business model of medicine that Reilly seems to be bothered by. The reason more med students choose to specialize is pretty apparent – and practical, when you consider the costs of medical school and how indebted a new doctor finds himself upon graduation. But, a human body cannot be divided into bits and pieces; everything needs to work together and without that one doctor who knows a patient well, who has a big picture view of his/her patient, a patient’s healthcare may suffer.

I really enjoyed this book and am very glad to have read it but I do have some complaints. The flaws Reilly points out in our present day healthcare system, the human side and the business side, are made very clearly without offering any clear solutions. The writing here bounces around heavily from present, to past, to present, to past, with a discourse on decision making or healthcare insurance, etc. (depending on the chapter) inserted between all this, made it hard to follow at times. For instance, if I was “going” with Dr. Reilly to see Mr. X, a hospitalized patient during his rounds at New York Presbyterian, it may take us quite a few pages to get there! By the time “we” got there, I was thinking “Now, who is this guy again and what’s his problem?” As a trained medical coder, I had no problem with the medical terminology included here, but readers without a background in medical terminology may find themselves a bit stymied at times since Dr. Reilly (usually) doesn’t explain them. One Doctor is not a long book, I was never bored, and finished it in less than week but there seems to be so much information here and so much Dr. Reilly wants to talk about it seemed like it was hard to see the forest for the trees, so to speak.

My diagnosis: 4 1/2 stars. Highly recommended. ( )
6 vote avidmom | Oct 14, 2013 |
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"A first-person narrative that takes readers inside the medical profession as one doctor solves real-life medical mysteries"--Provided by publisher.

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