Book Review

The Healer's Tale: Transforming Medicine and Culture

N Engl J Med 1993; 329:1511November 11, 1993

Article

The Healer's Tale: Transforming Medicine and Culture
By Sharon R. Kaufman. 345 pp., illustrated. Madison, Wis., University of Wisconsin Press, 1993. $27.50. ISBN: 0-299-13550-0

With reform in the air, The Healer's Tale is a timely and thoughtful inquiry into the tremendous changes that have transformed medicine in the past half-century. Whereas the traditional role of the physician, once a diagnosis had been arrived at, was to provide care and comfort to the patient, and an occasional cure, the emphasis has now shifted to a technological understanding of disease and its control, as well as life and death. The result is often a conflict between technology and morality.

The author, Sharon Kaufman, a medical anthropologist at the University of California, proposes the following hypothesis: “As physicians have become able to save more lives, they have not, by and large, stopped to ponder the implication of their day to day activities for medicine's identity, or for its impact on the meaning of life, death, nature and culture.”

To examine this proposition she has chosen to interview at length seven outstanding and perceptive physicians whose professional careers have spanned the latter half of this century. The physician's responsibility was a known entity when these people entered medicine; now, its meaning is less clear as medicine has advanced beyond traditional boundaries of authority. Kaufman's exemplars are J. Dunbar Shields, a family physician in Concord, New Hampshire; Saul Jarcho, a scholarly physician in New York; Paul Beeson, an academic physician par excellence, whose career in many ways resembles that of Sir William Osler; Mary Olney, distinguished and beloved pediatrician of San Francisco; Jonathan Rhodes, professor of surgery at the University of Pennsylvania and past president of the American Surgical Association; C. Paul Hodgkinson, a surgical gynecologist and obstetrician at Henry Ford Hospital in Detroit; and John Romano, professor of psychiatry emeritus at the University of Rochester.

The interviews are recorded in remarkable detail and, taken individually, provide an excellent picture of the education of a doctor and the details of his or her practice. There is a common thread of hard work, persistence, and dedication. They also illustrate an increasing reliance on technological advances, which by their nature lead to fragmentation and a need to restructure the ethical basis of medicine to deal with myriad dilemmas. Some examples are the concept of brain death and how it affects the field of transplantation, the doctor-patient-family relationship and its impact on one's right to die, the effect on practice of truth telling and disclosure, and the ethical questions posed by genetic manipulation.

The Healer's Tale has a certain Chaucerian ring to it. It is carefully written and rewards close reading. The interviews in particular are sufficiently detailed that some degree of repetition is inevitable but not troublesome, since all the protagonists are interesting people. They are well and generously represented in the excellent illustrations. The book can certainly be recommended warmly to those who are concerned about the ethical climate that runaway technology has created in medicine. It is also an excellent biography of seven intriguing and important physicians.

J. Gordon Scannell, M.D.
Massachusetts General Hospital, Boston, MA 02114