Brendan Reilly MD
Author of One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine
About the Author
Brendan Reilly is executive vice chair of medicine at New York Presbyterian Hospital and Gladys and Roland Harriman Professor of Medicine at Weill Cornell Medical College. He was profiled at length in Malcolm Gladwell's Blink when he served as chair of medicine at Chicago's Cook County Hospital, show more the inspiration for the hit television series ER. Reilly and his wife live in New York City and Newbury, New Hampshire. show less
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Medicine is simultaneously one of the most rewarding and heart-breaking fields to work in. Every day, millions of physicians are tasked with managing the livelihoods of countless injured or sick patients. They can have an infinite number of backgrounds and come in with a dizzying array of issues. In relatively little time, they have to assess their patient, diagnose them, and pursue a course of treatment that takes many factors into account. I do not envy them one bit, but neither do I show more bemoan their profession or their pay. Brendan Reilly’s One Doctor gives us a peek into a two-week window of the life of a primary care physician and his team at New York Presbyterian Hospital.
Dr. Reilly, normally a hospital administrator, is on a two-week rotation at New York Presbyterian. He readily admits that he is a dinosaur in the field of medicine, a 60ish internist. Nowadays many doctors are pushed to become specialists (because, apparently, that’s where the money is). He tries to get a complete picture of each patient and then use an entire body of symptoms to diagnose and treat. The members of his training team are each on their way to different fields, but still try to learn from each other. In many ways this book is like an episode of House but without all the drug use and incessant snarkiness. While some of the cases presented are easily worked, many involve a complicated mixture of testing, medical history, and personal experience.
Reilly’s tales cover the entirety of the human condition. There is sadness, relief, joy, bewilderment, life, and, yes, death. When you treat a person for the first time, everything they’ve ever gone through has brought them to that moment, and the doctor has to comb through all that to properly treat them. The author also goes into details about how modern hospitals and health care regulations have shaped the field of medicine and how that affects patients. Luckily, he a scientist at heart and all this statistics and assertions are supported by bibliographic notes. Like everyone else, he is frustrated at the current condition of medicine, one that values money over mankind, but in the end, he tries his hardest to treat everyone fairly and respectfully. I found this book to be very illuminating and not overly schlocky. It’s a bit thick, but you’ll get absorbed in each case fairly quickly. An enlighening read. show less
Dr. Reilly, normally a hospital administrator, is on a two-week rotation at New York Presbyterian. He readily admits that he is a dinosaur in the field of medicine, a 60ish internist. Nowadays many doctors are pushed to become specialists (because, apparently, that’s where the money is). He tries to get a complete picture of each patient and then use an entire body of symptoms to diagnose and treat. The members of his training team are each on their way to different fields, but still try to learn from each other. In many ways this book is like an episode of House but without all the drug use and incessant snarkiness. While some of the cases presented are easily worked, many involve a complicated mixture of testing, medical history, and personal experience.
Reilly’s tales cover the entirety of the human condition. There is sadness, relief, joy, bewilderment, life, and, yes, death. When you treat a person for the first time, everything they’ve ever gone through has brought them to that moment, and the doctor has to comb through all that to properly treat them. The author also goes into details about how modern hospitals and health care regulations have shaped the field of medicine and how that affects patients. Luckily, he a scientist at heart and all this statistics and assertions are supported by bibliographic notes. Like everyone else, he is frustrated at the current condition of medicine, one that values money over mankind, but in the end, he tries his hardest to treat everyone fairly and respectfully. I found this book to be very illuminating and not overly schlocky. It’s a bit thick, but you’ll get absorbed in each case fairly quickly. An enlighening read. show less
This book reads like part House, part Grey’s Anatomy and part diary, yet much, much more informative. By bringing us into his every day life and meeting his various patients at New York Presbyterian Hospital’s emergency department, Dr. Brendan Reilly explains, by example, why US healthcare, or more precise, ER care, has evolved into the complicated, hard-to-navigate maze that we see today; why most young med school graduates decide to to become specialists instead of primary physicians, show more which our country desperately needs.
The title, One Doctor, was used. Due to the regulation and involvement of the health insurance industry, most of us do not have a doctor who deeply concerns about us, who knows us well, who rallies for the right care in our behalf. On the other hand, we all have a battery of specialists. We have a cardiologist for our heart, a rheumatogist for our arthritis, an urologist for our prostates...and so on. Specialists make much more money, and where we are referred to once our ailment is out of our primary care’s scope. But, they usually do not know our complete health history since they only focus on a specific part of us. Dr. Reilly claimed that the patient with the one doctor that truly care for him, follows him over time and know him well would win this rat race of so-called American healthcare. It’s the difference between life and death sometimes…or worse, between death and insufferable life.
Sometimes when a patient or family says, “Do everything for me, doctor,” it unnecessarily that they want to try everything possible to live. Sometimes they do not want to hurt the family members who can’t let go, or they’re scared, or they have no idea hanging on could be worse than death. It’s the doctor, a good doctor’s job to find out what these patients really want, since some scenarios can be really worse than death. We all have a different trade-off limit between how much we are willing to suffer to prolong our life, it’s also a responsible doctor’s job to find out. From the various cases we encounter along with Dr. Reilly, we acquire a better understanding of the end of life, terminal illness, palliative care (which is not used enough), the quality of life, letting go, who to assign as surrogate and all other choices we might face in the future which we most likely never prepared ourselves for. We also will learn about the not perfect, but needed advanced directives as well.
As Dr. Reilly stated, “Most of the sad stories happen when this process doesn’t start until it’s too late. That’s how all those folks wind up comatose in nursing home and intensive care units, fogged with drugs and flogged by machines, not a prayer of getting better. It’s a living hell—and the only hyperbole in that phrase is the ‘living’ part.”
Dr. Reilly is a brilliant storyteller and great writer, and also a rare doctor that deeply cares for his patients. I can feel his real concern and love for life and the world. I could also feel the empathy he has for his patients and their families by reading the way he put his thoughts on paper. Several of these stories were deeply moving: Mr. Gunther, who endured a progressive form of cancer earlier in life who now faces another one; Mr. Atkins with a rapidly progressive terminal illness, who does not have time to prepare his family for his death; Ms. Rhodik, who refused to speak, but her family’s decisions are endangering her health. Others were down right disturbing: Fred, who decided that “losing his marbles” was never an option…and many more. We also learn about the cost of a misdiagnosis, as well as the cost of doing too much.
This is a deeply moving book with many though-provoking stories, and lots of useful information from a good and genuinely caring doctor who has over 40 years of experience. Read this book, for your elders, for yourself, for your children…and for the hope of a better health care system in the near future. This book will make you a better patient, advocate, caretaker, healthcare consumer and....human.
Thanks to Netgalley and the publisher for providing an advance reading copy. show less
The title, One Doctor, was used. Due to the regulation and involvement of the health insurance industry, most of us do not have a doctor who deeply concerns about us, who knows us well, who rallies for the right care in our behalf. On the other hand, we all have a battery of specialists. We have a cardiologist for our heart, a rheumatogist for our arthritis, an urologist for our prostates...and so on. Specialists make much more money, and where we are referred to once our ailment is out of our primary care’s scope. But, they usually do not know our complete health history since they only focus on a specific part of us. Dr. Reilly claimed that the patient with the one doctor that truly care for him, follows him over time and know him well would win this rat race of so-called American healthcare. It’s the difference between life and death sometimes…or worse, between death and insufferable life.
Sometimes when a patient or family says, “Do everything for me, doctor,” it unnecessarily that they want to try everything possible to live. Sometimes they do not want to hurt the family members who can’t let go, or they’re scared, or they have no idea hanging on could be worse than death. It’s the doctor, a good doctor’s job to find out what these patients really want, since some scenarios can be really worse than death. We all have a different trade-off limit between how much we are willing to suffer to prolong our life, it’s also a responsible doctor’s job to find out. From the various cases we encounter along with Dr. Reilly, we acquire a better understanding of the end of life, terminal illness, palliative care (which is not used enough), the quality of life, letting go, who to assign as surrogate and all other choices we might face in the future which we most likely never prepared ourselves for. We also will learn about the not perfect, but needed advanced directives as well.
As Dr. Reilly stated, “Most of the sad stories happen when this process doesn’t start until it’s too late. That’s how all those folks wind up comatose in nursing home and intensive care units, fogged with drugs and flogged by machines, not a prayer of getting better. It’s a living hell—and the only hyperbole in that phrase is the ‘living’ part.”
Dr. Reilly is a brilliant storyteller and great writer, and also a rare doctor that deeply cares for his patients. I can feel his real concern and love for life and the world. I could also feel the empathy he has for his patients and their families by reading the way he put his thoughts on paper. Several of these stories were deeply moving: Mr. Gunther, who endured a progressive form of cancer earlier in life who now faces another one; Mr. Atkins with a rapidly progressive terminal illness, who does not have time to prepare his family for his death; Ms. Rhodik, who refused to speak, but her family’s decisions are endangering her health. Others were down right disturbing: Fred, who decided that “losing his marbles” was never an option…and many more. We also learn about the cost of a misdiagnosis, as well as the cost of doing too much.
This is a deeply moving book with many though-provoking stories, and lots of useful information from a good and genuinely caring doctor who has over 40 years of experience. Read this book, for your elders, for yourself, for your children…and for the hope of a better health care system in the near future. This book will make you a better patient, advocate, caretaker, healthcare consumer and....human.
Thanks to Netgalley and the publisher for providing an advance reading copy. show less
'One Doctor' by Brendan Reilly is a moving and brave paean to the generalist, family doctor the state of American health care - both its funding and distribution - and an array of mystery diagnoses that would make for a good episode of 'House'. His cry for more GPs with a friendly, concerned relationship with their patients is powerfully compelling. He honest candor for admitting mistakes is courageous and refreshing. This feeds into a support for more autopsies as a way of continuous show more improvement and validation of diagnoses.
Helping give continuity to this professional biography is Reilly's treatment of aeronautical engineer Fred Hooven and relationship with the family. As a small-town doctor in rustic New Hampshire, his willingness to do house calls, even on his days off, strained his marriage, but drew him deeper into his patients' lives, especially that of Fred, who had worked with Amelia Earhart in the 1930s. Fred died suddenly after he began to see angels and hear voices. Fred was renowned for many inventions, including the Hooven Radio Compass, an Automatic Direction Finder (or ADF), that was removed from Amelia Earhart’s plane before she took off on her last flight. This is both an inspiring and concerning read. show less
Helping give continuity to this professional biography is Reilly's treatment of aeronautical engineer Fred Hooven and relationship with the family. As a small-town doctor in rustic New Hampshire, his willingness to do house calls, even on his days off, strained his marriage, but drew him deeper into his patients' lives, especially that of Fred, who had worked with Amelia Earhart in the 1930s. Fred died suddenly after he began to see angels and hear voices. Fred was renowned for many inventions, including the Hooven Radio Compass, an Automatic Direction Finder (or ADF), that was removed from Amelia Earhart’s plane before she took off on her last flight. This is both an inspiring and concerning read. show less
"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, show more 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.
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:
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. show less
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. show less
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