Book Review

Educating Doctors: Crisis in medical education, research and practice

N Engl J Med 1997; 336:1617May 29, 1997

Article

Educating Doctors: Crisis in medical education, research and practice
By Stewart Wolf. 197 pp. New Brunswick, N.J., Transaction, 1997. $32.95. ISBN: 1-56000-301-4

Educating Doctors is a somewhat deceptive title, because in the end, this book presents Stewart Wolf's philosophy of life and his critique of the ills of the present medical system and rehashes his years of research on a variety of issues.

As someone keenly interested in the issue of education, I eagerly opened the book and was immediately impressed by the degree to which Dr. Wolf and I were in agreement. I particularly liked his idea that the most important diagnostic test we physicians have is the medical history, yet tests and procedures have replaced careful history taking. Reading how the art of history taking has been replaced by impersonal data bases, I recalled having once completed a 70-page health questionnaire from an overly compulsive internist. Questionnaires may save time, but they exclude the nuances of personal communication. Numerous studies have shown that patients are more willing to disclose personal issues in a face-to-face encounter than over the telephone or on a questionnaire.

Dr. Wolf also discusses health care, differentiating it from patient care, as others have in this age of changing finances. Catherine De Angelis, of Johns Hopkins University School of Medicine, has commented that we are dealing not with “managed care” but with “managed cost.” Wolf observes that a proliferation of administrative managers stifles the leadership of physicians.

Wolf's nostalgia for the good old days occasionally smacks of the when-I-was-a-resident syndrome. For instance, he suggests that patient care was better when residents were prohibited from marrying and were available 24 hours a day to attend to all the needs of their patients. I maintain that physicians who have had more life experiences, including marriage, bring a level of maturity and humanism to their role in the doctor–patient relationship.

Some of Wolf's other comments are also naive. His belief in the benefits of dehydroepiandrosterone and melatonin seems premature, especially his statement that there are no side effects of either medication. His assessment of the reasons for the difference in mortality associated with myocardial infarction in Utah (strong family ties) and Nevada (dysfunctional relationships) is simplistic and fails to account for differences in lifestyle (use of alcohol, tobacco, and caffeine) in these two states.

The section on placebos, on the other hand, is particularly illuminating, although I have often wondered why anyone is surprised that subjects experience side effects of placebos, especially since many placebos contain lactose.

Overall, Educating Doctors is a refreshing return to the credos that attracted some of us to medicine.

Carol D. Berkowitz, M.D.
Harbor–UCLA Medical Center, Torrance, CA 90509