Many of us can be doctors: some taping and healing ideas, some repairing all kinds of contraptions, or monitoring bytes, so that they would behave normally and let us write down whatever it floats on our mind. But I have serious doubts that I'll be able to work, for example, with an idea that has feelings of its own. This thought should make us consider the differences between different kinds of doctors — namely, taking in account that working with human beings requires some additional qualities than knowing shelves of treaties, or being able to perform complicated maneuvers. For example, seeing the other (person involved in the medical act) as man or woman with feelings, idiosyncrasies, leanings, etc., not just as some other ill body, that needs due repairing.

The book edited by Erin Egan and Patricia Surdyk has an outstanding quality: it covers some of the most delicate problems of the medical practice by inviting us to reflect.

I will sketch a short synthesis here, only to give the reader a faint idea about the thrilling (not in the medical sense) of these stories. I've tried to condense the stories, in order to mention all of them, for it would have been unjust to let aside any of them.

There are many stories and many studies cited in the articles. The difference between the two types of narrative support is not defined by importance, but by perspective. That's why the stories built around personal experiences should be greeted with the same appreciation.

In the first article Gwen L. Nichols writes about the importance of narrative reflections. Simply put, the idea is that doctors shouldn't be focused on "their" questions, neglecting the patients' answers, which falls "between" the searched ones.

Norma E. Wagoner and Alison S. Clay present some important aspects of the "generational clash." Here we find some serious problems, and in order to go ahead with the "good practice," one should reflect more on what it takes to become a doctor today, in the era of strong competition and chronic lack of time.

Justin M. List and Christian J. Krautkamer approach an important (technical or bureaucratic) aspect of medical world: costs, payments, insurances and all the problems behind the practice. These too require moral reflection, for it is not a good idea to turn the bedside manner in walletside manner. The authors put it this way: To stumble on the sign "Copayments are due at time of check-in" is in a way similar to a scary salute like "Good morning, open your wallet and I'll be right with you."

The first story of personal involvement is that of Andrew P. Jacques. How many chances are there to have to tell your first patient that he's going to die? Here comes the reflection: "If all our medical technology failed, I reasoned, just maybe physical touch could produce a miracle no chemotherapy could furnish." It is sad, but it is also caring, and one should not wait for extreme situations to observe that.

Sometimes it may be even harder to cope with the relatives of a dying person. W. Richard Boyte had an experience like that, which was complicated by the fact that his mother is Japanese. Unfortunately, this can be a good point to discharge the painful energies of despair. Even so, continuing to act professionally and human can establish the peace of civilized relationship.

In the operating room things can go worse, as Sandra McNeal tells us, impartially describing the nightmare of a senior resident fallen victim to the surgeon's bad moods. Not at all professional — just human, but in the end, it has at least the advantage that one can realize this: team work is human, all too human.

After these first reflections, the core of the book steps in with the problems of teaching medicine and professionalism. David G. Doukas is tapping slightly the material of the "envelope of knowledge": the practical wisdom (phronesis, as the author mention the Greek term used in philosophy) necessary for perceiving one's own limits of competence. Mark J. Brennan writes about the Developing Professional Skills Program, and urges doctors to take time out, spend it with colleagues, and "consider and discuss the purpose of medicine and their own place within profession." Amy Baernstein warns us that teaching professionalism can have its failures, and makes a plea for the "real stories, the ones that are not appropriate for prime time," but which can teach the students "to respond to similar situations with behavior we can applaud." The final article of this section is Denise Gibson's selection of excerpts from student's reaction papers after a course on professionalism. The quotes "speak volumes about the course," and the collection is closed by a poem of one student, resembling a roll of commandments.

Then the personal experiences come to the foreground.

Mona Ahmed writes about her painful trip from the veil — which should cover the Muslim women; and she wants to wear it! — to the throat-exposing, short-sleeved and mentally uncomfortable scrub required in OR. I won't tell you what the solution was, but I can tell the lesson of this short and moving story: in the surgery, the job is done with the hands; making one an outlier for her clothing habits may leave magic hands outside OR.

The traumatic experience of Kathy Stepien, a medical student herself, is also touching. Surely Kathy will be a special practitioner. But one does not need to live such an experience for being special in this way; it would be of great help to learn from others.

The problem of choosing the patients (as one does with one's friends) is addressed by Bonnie Salomon, who tells us the impressive story of "there I was, a second-generation Jewish-American, treating a neo-Nazi at Cook County Hospital," citing then poems and creeds that led her to step over the despicableness and unpleasantness of the sufferer, and to consider him (or her) a human being. "If I can do that, I can live up to the standards of my profession, and I can be a true physician," concludes Bonnie.

Last in the line of personal stories comes the patient's voice (being not singular, as Kathy Stepien). Thomas Schindler, victim of a traffic accident, writes about "the seven Cs" of medical professionalism he detected on the course of a very long staying at health care facilities: caring, comedy, competence, cooperation, comprehension, courtesy and communication. Well, there may be problems with the order, or with the adequacy, but Thomas' list must be read by all doctors who want to get in patient's shoes.

If tempted to classify the problems from the beginning ("hard" — those implying death, severe injuries, etc. — and "soft" — the trifles of manners and scrubs), maybe you'll reconsider this strayed position after reading the book: the problem is not the hardship of the outlet, but the way we consider this work. Beyond every short or long, dramatically laden or not story there is a lesson to grasp. And one doesn't have to be medical student or to have a M.D., to read this book. Anyone reading it can get a better idea about what it takes to be a good physician.

If I have to underline something "negative" about the book, that would be the title, which is not quite appropriate, but it is repaired somehow by the subtitle. Don't let it fool you: there are professionalisms and professionalisms, but first of all we (have to) have humanism. And this, I'm afraid, cannot be a profession, technically speaking. In this case, under the cold notion of professionalism (which at first sight inspires a do-not-get-emotionally-involved attitude) lies the very essence of being human, with all what it takes for that.

This approach has to be used again and again, being extended on the medical science field (not to speak of the pharm-world, where it seems that "the others" are mere clients). For as the editors notice in the final chapter, values "such as honesty and integrity cannot be taught in lectures and probably cannot be taught to adults who are genuinely unfamiliar with them". And also, "the process of reflection needs to be valued for itself, and not its product."  Of course the book doesn't teach a lesson, but it prompt us instead to reflect — that's how one can teach himself or herself many lessons, which is much more important than attending sophisticated courses.

© 2008 Viorel Zaicu

Viorel Zaicu, Ph.D., Bucharest, Romania

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