Abstract
By Conrad Fischer. New York: Kaplan Publishing, 2009, 357 pages, $16.55.
History is often repeated. When Gustave Flaubert wrote his Novel Sentimental Education he intended to educate the moral attitude of his generation, to excite real passions. In his book Routine Miracles: Restoring Faith and Hope in Medicine, Dr. Conrad Fischer seeks to generate the same energy, but with a greater appreciation for the influence of modernity. Routine Miracles reminds us that medicine has rapidly developed technologies that have improved and will improve disease management. The book contains personal reflections, individual testimonies, and interviews with patients and physicians. The biographical components intersect with the accounts of breakthroughs in different subspecialties of medicine. Accounts of successes and personal narratives about the importance of these medical developments are anecdotal and colorful.
The book consists of 27 chapters which are divided into seven parts. The book begins with a dedication to Father John Collins. Friendship between the author and Father Collins is an important background to the book.
Part One, “The Heart of the Matter: Physician Dissatisfaction and How to Cure It” examines students and older disillusioned academic needs, placing more devotion to medicine and more hope in the future of medical developments. This section critiques the health care system, particularly the failures and advances of the specialties and lifestyles of certain specialties. Dermatology, radiology, and anaesthesiology are not for the best and the brightest, he states.
Part Two, “An Open Mind Save Lives,” consists of narratives containing patient interviews exploring the background of various specialties. This chapter recapitulates the basic topic of the book, how recent technological advances in medicine create choices in this new era.
Part Four, “No Hope is False “starts with an interesting history about a 36-year-old Jewish boxer with leukemia. It examines the incurable, the curable, and the sustained remission. Acute diseases have become chronic with targeted therapies.
Part Five, “Think Quality of Life Instead of No Cure” describes patients who take control of their disease including diabetic patients who have undergone oculoplastic procedures, patients with orthopedic and prosthetic implants, patients on dialysis, patients in rehabilitation, and cancer patients undergoing treatment for their cancer. Here we see optimism achievable on a daily basis. Medications and technologies are not just providing treatment, they offer hope for a longer life with quality.
Not surprisingly, Dr. Fischer's view of medicine is hierarchical. He elevates the medical researcher as the principally important figure in medicine. The medical community, however, is composed of researchers, clinicians, administrators, nurse researchers and practitioners, fellows, residents, students, and caregivers. It's the whole organism that is needed and requires all its various parts to function. Routine Miracles reminds us that medicine has rapidly developing technologies that improve disease management which is a step forward (but not the only step) in the care of suffering individuals. The book contains a mixture of engaging statements that are applicable to medicine in general, and at the same time Dr. Fisher creates momentum and hope for those who want to give meaning to their medical career.
Nevertheless, modern medicine still fails to focus enough on the patient and on the patient's illness narrative. Dr. Fischer's views of medicine are largely biomedical; diseases and illnesses are synonymous and at least implicitly individuals are “processed.” William Osler, a great diagnostician and medical educator stated, “There is a tendency among young men about hospitals to study the cases, and not the patients, and in the interest they take in the disease, lose sight of the individual. Strive against this.” Dr Osler's view of medical education is distinctively different from Dr. Fischer's. Modern Miracles is a polar opposite to Eric Cassell's The Nature of Suffering and the Goals of Medicine and Arthur Kleinman's The Illness Narrative; Suffering, Healing and the Human Condition, where illness and disease are not equated.
Routine Miracles might be best appreciated by medical students and residents, who are naturalized into a world of medical high technology. It might also be attractive to patients and families, who may be unaware of new developments in medicine and need encouragement. Palliative medicine has had a tendency to neglect, or not need, technologic developments for the care of patients. While, palliative care is not found as part of the text of Modern Miracles, perhaps, at times, we could also look for comfort and hope in the miracles of medical advancements. Compassion can be part of this miracle as well and if we know how to use it, it will work effectively.