The Finest Traditions of My Calling: One Physician's Search for the Renewal of Medicine

by Abraham M. Nussbaum

Overview

Patients and doctors alike are keenly aware that the medical world is in the midst of great change. We live in an era of continuous healthcare reforms, many of which focus on high volume, efficiency, and cost-effectiveness. This compelling, thoughtful book is the response of a practicing psychiatrist who explains how population-based reforms have diminished the relationship between doctors and patients, to the detriment of both. As an antidote to failed reforms and an alternative to stubbornly held traditions, Dr. Abraham M. Nussbaum suggests ways that doctors and patients can learn what it means to be ill and to seek medical assistance.
 
Using a variety of riveting stories from his own and others’ experiences, the author develops a series of metaphors to explore a doctor’s role in different healthcare reform scenarios: scientist, technician, author, gardener, teacher, servant, and witness. Each role influences what a physician sees when examining a person as a patient. Dr. Nussbaum cautions that true healthcare reform can happen only when those who practice medicine can see, and be seen by, their patients as fellow creatures. His memoir makes a hopeful appeal for change, and his insights reveal the direction that change must take.

Product Details

ISBN-13:	9780300220919
Publisher:	Yale University Press
Publication date:	03/22/2016
Sold by:	Barnes & Noble
Format:	eBook
Pages:	320
File size:	433 KB

About the Author

Abraham M. Nussbaum, M.D., directs the adult inpatient psychiatry unit at Denver Health, where he also trains medical students and residents. He is assistant professor, Department of Psychiatry, University of Colorado School of Medicine, and author of the best-selling The Pocket Guide to the DSM-5 Diagnostic Exam. He lives in Denver, CO.

Table of Contents

Preface xi

Acknowledgments xiii

Introduction: Parts and Money 1

1 Seeing Wisely 10

2 Occult Findings 26

3 The Book and the Coat 38

4 Full Responsibility 52

5 Duty Hours 67

6 Efficient and Effective 84

7 Checklists and Dance Lessons 99

8 Famous Factory Meatloaf 114

9 Sickbeds and Garden Beds 131

10 Committed 146

11 Impatient Attending 162

12 Muscle Ups 176

13 Doctors Without Silver 191

14 Red Cards 207

15 Witnesses 223

16 Hope 239

Epilogue: Luster 258

Notes 269

Credits 285

Index 287

Interviews

What do you hope readers will take away from the experience of reading The Finest Traditions of My Calling?
 I hope readers will learn that healthcare reform is not just a question of who should have access to care and who should pay for it, but also of our desire for a favorable outcome when a physician meets a person as a patient. Reformers believe the problem with medicine is that it does not consistently and safely deliver the best treatments. And the solution is to transform the delivery of medical care using processes pioneered in high-risk industries like aviation, mining, and automobile manufacturing: run hospitals like factories, optimized for efficiency and effectiveness. But factories make things, not people.
           
How might your book help change the practice of medicine?
I hope to shift the conversation from the reform of healthcare systems to the renewal of medical practice. We need to envision hospitals and clinics not as factories but as cultural spaces such as schools and gardens, restaurants, and gyms, all of which require human relationships for their operation.
 
What are examples of the roles physicians and patients assume when they interact?
Physicians are like scientists who want to know how the body works; technicians who control it; authors who tell its story; gardeners who carefully tend it; teachers who help patients achieve what they could not on their own; and servants who give of themselves for the sake of their patients.

Editorial Reviews

Medicine is full of young recruits writing veterans' books, war stories full of hopes and fears for the next in line. As in the military, a couple of years' service provides fodder for a thick volume, a decade enough material for a boxed set…None in recent memory has wielded a set of intellectual and writerly tools to such dazzling and instructive effect as Dr. Nussbaum's The Finest Traditions of My Calling…a flowing, complex stream of anecdotes and reflections, all the stronger for its frequent uncertainty. He writes beautifully, in a lucid prose as notable for its process as its conclusions: The reader can actually watch him think…Many medical memoirs are one-shot deals, offered to the public purely to unburden the author. From these books, readers and writer all move on with some relief. In Dr. Nussbaum's case, we will eagerly await the next volume in the set.

The New York Times - Abigail Zuger M.D.

02/01/2016
For more than a century, veteran physicians have written reports deploring the state of their profession, and in this earnest account, Nussbaum, director of adult inpatient psychiatry at Denver Health, argues that doctors have become unfeeling scientists dedicated to efficiency and income. He says that medical schools, aware of the problem since the 1990s, have begun teaching ethics, cultural sensitivity, and communication, as well as assigning readings outside of medicine. Nussbaum sees these efforts as admirable, but he suggests this attempt to produce physicians who are both scientists and humanists reinforces their distance from patients, whom they should see as suffering fellow humans. Nussbaum describes current campaigns for evidence-based treatments, checklists, quality-improvement guidelines, and reduced hours for residents as misguided efforts to apply industrial standards to medicine. These efforts aim to improve outcomes (i.e., increase patients’ chances of survival, reduce mishaps) at the expense of care. Nussbaum maintains that medicine differs from all other industries, and that the way a doctor cares for a patient matters more than the outcome. Patients might value outcomes more, but they certainly yearn for the respectful, empathetic treatment that Nussbaum proposes and that is so often lacking. His insightful polemic reveals that current reforms in medicine are missing an essential element. (Apr.)

Publishers Weekly

"A less ambitious writer would have contented himself with the details. But Dr. Nussbaum steers his narrative directly to the hard questions about 21st-century medicine, a profession just about as variously troubled as his patients. . . . He writes beautifully, in a lucid prose as notable for its process as its conclusions: The reader can actually watch him think. . . . Many medical memoirs are one-shot deals, offered to the public purely to unburden the author. From these books, readers and writer all move on with some relief. In Dr. Nussbaum’s case, we will eagerly await the next volume in the set."—Abigail Zuger, M.D., New York Times

"His insightful polemic reveals that current reforms in medicine are missing an essential element."—Publishers Weekly

"A revealing and stirring directive aiming to heal medicine from the inside out."—Kirkus Reviews

"Readers of various vocations are likely to find resonances in the book’s attempt to balance professionalism with human relationship."—Christian Century

"Intelligent and beautifully written."—Suzanne Koven, Los Angeles Review of Books

"In a time when hospitals threaten to become factories and doctors seem no more than factory farmers, Nussbaum helps us see that there is an alternative. That alternative turns out to be exemplified in the stories he wonderfully tells of what he has learned from the sick. Hopefully his book will be widely read because it has important practical as well as theoretical implications."—Stanley Hauerwas, author of The Work of Theology

"A clear-eyed and thoughtful (and interesting!) analysis of where medicine is right now, how it got here, why an alternative 'vision' is preferable, and some gestures toward what that alternative might be and might promise. The stories are presented respectfully . . . and as real stories, not just case study examples."—Margaret Mohrmann, M.D., Ph.D., University of Virginia

"Occasionally someone speaks up in the midst of our clamoring arguments about social problems and manages to do the simple and extraordinary thing that makes all the difference: they ask the right questions. Reading The Finest Traditions of My Calling, I couldn't help but see Nussbaum as a Martin Luther of health care and this book is his 95 theses. May true reform ensue."—Rev. Nadia Bolz-Weber, author of Accidental Saints: Finding God in All the Wrong People

"An eye-opening journey into the rapidly industrializing world of modern healthcare. Nussbaum steadfastly reminds us that true 'quality' needs to include the humanity of the patient and the caregiver. A compelling read."—Danielle Ofri, M.D., Ph.D., author of What Doctors Feel: How Emotions Affect the Practice of Medicine

"The author has produced a work that addresses the 'fall from grace' of the medical profession. It is rich with nuanced details and stories of physician and patient lives. He moves through his territory with delightful stride."—Thomas Duffy, M.D., Yale University School of Medicine

From the Publisher

Intelligent and beautifully written.”—Suzanne Koven, Los Angeles Review of Books

Los Angeles Review of Books - Suzanne Koven

Readers of various vocations are likely to find resonances in the book’s attempt to balance professionalism with human relationship.” —Christian Century

Christian Century

The author has produced a work that addresses the ‘fall from grace’ of the medical profession. It is rich with nuanced details and stories of physician and patient lives. He moves through his territory with delightful stride.”—Thomas Duffy, M.D., Yale University School of Medicine

Thomas Duffy

In The Finest Traditions, the psychiatrist Abraham Nussbaum searches for what it means to be a true physician. By turns passionate, smart, funny, horrified, and disconsolate, Nussbaum takes you into the embattled world of contemporary medicine where patients and doctors still, somehow, mostly triumph.”—Victoria Sweet, author of God’s Hotel

Victoria Sweet

Abraham Nussbaum has written a wonderful book. It is at times deeply moving, at times delightfully funny, always insightful, and deliciously subversive of the elite medical establishment that believes it can reform medicine by passing laws, tweaking policy, manipulating behavior, or offering courses in medical humanism. He joins the ranks of Atul Gawande and Abraham Verghese as a superlative-physician commentator on the state of twenty-first century medicine, and he is probably the best diagnostician of the three. A must-read for physicians, medical ethicists, policy makers, and anyone concerned with what it means to be a physician today.”—Daniel Sulmasy, M.D., Ph.D., University of Chicago

Daniel Sulmasy

An eye-opening journey into the rapidly industrializing world of modern healthcare. Nussbaum steadfastly reminds us that true ‘quality’ needs to include the humanity of the patient and the caregiver. A compelling read.”—Danielle Ofri, M.D., Ph.D., author of What Doctors Feel: How Emotions Affect the Practice of Medicine

Danielle Ofri

Occasionally someone speaks up in the midst of our clamoring arguments about social problems and manages to do the simple and extraordinary thing that makes all the difference: they ask the right questions. Reading The Finest Traditions of My Calling, I couldn't help but see Nussbaum as a Martin Luther of health care and this book is his 95 theses. May true reform ensue.”—Rev. Nadia Bolz-Weber, author of Accidental Saints: Finding God in All the Wrong People

Nadia Bolz-Weber

A clear-eyed and thoughtful (and interesting!) analysis of where medicine is right now, how it got here, why an alternative ‘vision’ is preferable, and some gestures toward what that alternative might be and might promise. The stories are presented respectfully . . . and as real stories, not just case study examples.”—Margaret Mohrmann, M.D., Ph.D., University of Virginia

Margaret Mohrmann

In a time when hospitals threaten to become factories and doctors seem no more than factory farmers, Nussbaum helps us see that there is an alternative. That alternative turns out to be exemplified in the stories he wonderfully tells of what he has learned from the sick. Hopefully his book will be widely read because it has important practical as well as theoretical implications.”—Stanley Hauerwas, author of The Work of Theology

Stanley Hauerwas

A less ambitious writer would have contented himself with the details. But Dr. Nussbaum steers his narrative directly to the hard questions about 21st-century medicine, a profession just about as variously troubled as his patients. . . He writes beautifully, in a lucid prose as notable for its process as its conclusions: The reader can actually watch him think. . . . Many medical memoirs are one-shot deals, offered to the public purely to unburden the author. From these books, readers and writer all move on with some relief. In Dr. Nussbaum’s case, we will eagerly await the next volume in the set.” —Abigail Zuger, M.D., The New York Times

The New York Times - Abigail Zuger

2016-01-09
A career physician ponders the positive and negative aspects of how health care reform is transforming the delivery of care and the medical profession itself. Nussbaum's (The Pocket Guide to the DSM-5 Diagnostic Exam, 2013) passionate appeal for the "renewal of medicine" stems from his clinical career and psychiatry directorship at Denver Health and the many incarnations he's embodied there as a patient, educator, student, and ethicist. Clinical professionals view health care reform as a "series of competing initiatives," and the author cleverly equates it to sailing at sea following an unmarked course of undetermined duration rather than a "well-organized race" toward the goal of cost-efficient, effective, quality care. Nussbaum begins with memories of his time in medical school, clinical residency, and his early career as a physician, when he learned, however detachedly, "to see people as a compendium of parts and a source of income" and to step back to view modern health care through the lens of both the everyday consumer and caregiver alike. He relates wonderfully to an esteemed array of medical intellectuals such as disheartened doctor Abraham Verghese, who advocated for the integration of heart into health care. Nussbaum also relates prophetic metaphors of Canadian physician Sir William Osler and the proposals of radical health pioneer Archibald Cochrane. Nussbaum even considers noted surgeon and public health advocate Atul Gawande's suggestion of boosting generalized health care's productivity by using the Cheesecake Factory's operational business model. Particularly striking is the author's keen if underdeveloped commentary on the medical marijuana conundrum, which begs for further introspection. In sharing the many tribulations of real-life patients and physicians, Nussbaum unveils a thoughtful, well-rounded, yet thorny vision of the current state of medicine. His generous narrative offers clarity and direction on how the industry can avoid sacrificing humanity to the trappings of an industrialized, unsympathetic, automated version of health care. A revealing and stirring directive aiming to heal medicine from the inside out.

Kirkus Reviews