Doctoring: The Nature of Primary Care Medicine

By Eric J. Cassell

Book Overview

American medicine attracts some of the brightest and most motivated people the country has to offer, and it boasts the most advanced medical technology in the world, a wondrous parade of machines and techniques such as PET scans, MRI, angioplasty, endoscopy, bypasses, organ transplants, and much more besides. And yet, writes Dr. Eric Cassell, what started out early in the century as the exciting conquest of disease, has evolved into an overly expensive, over technologized, uncaring medicine, poorly suited to the health care needs of a society marked by an aging population and a predominance of chronic diseases. In Doctoring: The Nature of Primary Care Medicine, Dr. Cassell shows convincingly how much better fitted advanced concepts of primary care medicine are to America's health care needs. He offers valuable insights into how primary care physicians can be better trained to meet the needs of their patients, both well and sick, and to keep these patients as the focus of their practice.
Modern medical training arose at a time when medical science was in ascendancy, Cassell notes. Thus the ideals of science--objectivity, rationality--became the ideals of medicine, and disease--the target of most medical research--became the logical focus of medical practice. When clinicians treat a patient with pneumonia, they are apt to be thinking about pneumonia in general--which is how they learn about the disease--rather than this person's pneumonia. This objective, rational approach has its value, but when it dominates a physician's approach to medicine, it can create problems. For instance, treating chronic disease--such as rheumatoid arthritis, diabetes, stroke, emphysema, and congestive heart failure--is not simply a matter of medical knowledge, for it demands a great deal of effort by the patients themselves: they have to keep their doctor appointments, take their medication, do their exercises, stop smoking. The patient thus has a profound effect on the course of the disease, and so for a physician to succeed, he or she must also be familiar with the patient's motivations, values, concerns, and relationship with the doctor. Many doctors eventually figure out how to put the patient at the center of their practice, but they should learn to do this at the training level, not haphazardly over time. To that end, the training of primary care physicians must recognize a distinction between doctoring itself and the medical science on which it is based, and should try to produce doctors who rely on both their scientific and subjective assessments of their patients' overall needs. There must be a return to careful observational and physical examination skills and finely tuned history taking and communication skills. Cassell also advocates the need to teach the behavior of both sick and well persons, evaluation of data from clinical epidemiology, decision making skills, and preventive medicine, as well as actively teaching how to make technology the servant rather than the master, and offers practical tips for instruction both in the classroom and in practice.
Most important, Doctoring argues convincingly that primary care medicine should become a central focus of America's health care system, not merely a cost-saving measure as envisioned by managed care organizations. Indeed, Cassell shows that the primary care physician can fulfill a unique role in the medical community, and a vital role in society in general. He shows that primary care medicine is not a retreat from scientific medicine, but the natural next step for medicine to take in the coming century.

• Format: Hardcover
• Language: English
• ISBN: 0195113233
• ISBN13: 9780195113235
• Release Date: July 1997
• Publisher: Oxford University Press
• Length: 224 Pages
• Weight: 1.20 lbs.
• Dimensions: 0.8" x 6.4" x 9.4"

Customer Reviews

The doctor 's retirement

I remebered Dr. Cassell after 25-30 years after I had given up on the medical profession and he is still contributing like he always did.

A Pediatrician's view

This is a remarkable presentation of the vast difference between what is taught in most medical schools in which the enphasis is on "What disease does the patient have?" versus the role of the primary physician who is concerned with how does this person adapt to what ever disease he has and how does it affect his life. Pediatricians are rated highly in this task in that they are so often involved on an ongoing basis with children and parents thru minor and major illnesses...as well as during life's normal challenges!. This is a great book written in a thought provoking and challenging manner. . Morris Wessel.

This book explores what the "art of medicine" means

As a primary care physician old enough to have experienced the deficiencies of fee-for-service payment, the attenuation of relationships induced by technology, and the intrusions of "managed care," I resonate with Dr. Cassell's return to "the basics," the primacy of the personal engagement between two unique individuals, and how it must predominate regardless of the overlying system. It is unfortunate that the publisher failed to match Dr. Cassell's attention to detail with their own. Mispellings, errors in punctuation, and simply sloppy proofreading abound. These defects constitute a serious, though nonfatal, shortcoming.