On Proper Doctoring


I miss doing the joint lectures that Jim Thimons and I did for a number of years on binocular disorders masquerading as disease and vice-versa.  We did the lecture for seven consecutive years at Vision Expo East, where we had a full room each year that verged on a cult following (occult disease with a cult following?).  The beauty of our joint lecture was the emphasis we placed on the doctor’s powers of observation combined with the importance of doctor/patient communication.  As part of my opening, I was fond of citing quotes from Jerome Groopman’s phenomenal book, How Doctors Think.

Groopman Cover

The following YouTube clip will give you a glimpse into Dr. Groopman’s sensitivity toward the Doctor-Patient partnership:

It was respect for his insights about the qualitative nature of successful doctoring that prompted me to take down a book off the shelves of Barnes & Noble that I hadn’t seen before, Proper Doctoring: A Book For Patients And Their Doctors, to which Dr. Groopman wrote the introduction.

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A pithy paperback that I’ve had on my desk for a few months, the book was originally published in 1984 in England, and did not appear with Dr. Groopman’s introduction in the U.S. until 2013.  While I began to savor it before I left for my springtime mini-sabbatical, I took it along in my rolling suitcase of books to read this month.  Groopman notes that over the course of their careers, physicians build a library.  During the early years these are typically foundational textbooks and they are progressively supplemented by stronger interests in one’s field of specialization.  Interest in foundational material gradually gives way to deeper reading into source material that helps the doctor stay current in her or his specialty field of endeavor.

Groopman continues: “Alas, another type of book often is missing from our shelves, a book like Proper Doctoring.  In it, David Mendel, a British clinician, distills an oral tradition, passed down from eminent mentors, like in a guild, where masters offer unique insights to their apprentices.  Such practical wisdom is as essential to the successful care of the ill as any formula about the contraction of the heart or knowledge about the behavior of blood cells in the bone marrow.  Proper Doctoring is written from the physician’s point of view, and pulls back a curtain to reveal the delicate balance clinicians seek in their art.  Mendel’s overarching theme is medical professionalism, whose cornerstones are intellectual honesty and self-knowledge.”

In his 1984 Preface, Mendel wrote: “Although a sound knowledge of the facts is essential, a good doctor differs from a bad doctor more by his attitude and craftsmanship than by his knowledge.  These important matters receive scant attention in the textbooks because the authors regard them as part of the spoken tradition which is taught at the bedside on in the clinics and is absorbed by watching clinicians while they are dealing with patients. … Many of the attributes which make or mar a doctor are acquired before he reaches medical school, but they can be changed by training.  Certainly techniques can be learned, and this book is an attempt to clarify and modify what he does, so that he can turn knowledge into effective treatment.”

Looks like we’re running out of room, and we’ll need a part two to specify some of Dr. Mendel’s pointers.

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