Book Review

Treatment Kind and Fair: Letters to a Young Doctor

N Engl J Med 2007; 357:2096November 15, 2007

Article

Treatment Kind and Fair: Letters to a Young Doctor
By Perri Klass. 233 pp. New York, Basic Books, 2007. $24.95. ISBN: 978-0-465-03777-3

In her new book, Perri Klass brings literary depth to bear on the ambiguities of medicine and family. Written to her son Orlando as he applies to medical school, the book belongs to the long tradition of books titled Letters to a Young ______. By choosing this genre for her reflections, Klass implies the confluence of medicine with history, government, and poetry while staking out proper ground for herself as a wise elder commissioned not only to impart her own opinion but also to subjoin her wisdom to a brief history of the universe of medicine.

The brief history of medicine the reader finds here is revelatory. Klass asks us to consider medicine at its best and its worst, from organ transplantation miracles and triumph over polio and other pediatric infectious diseases, to iatrogenic deaths, high-stakes errors, and self-sacrificing overwork that is tinged with arrogance. She addresses with great tact and courage the conflicts between medical practice and private life, facing up to the costs that our professional commitments incur on our families. She uses a loose associative process to show, rather than tell, that in the mind and heart of the doctor, thoughts and worries about patients are inevitably up-front, distracting, and privileged.

Lay readers will appreciate the access this book provides to the interior of medicine. Written as much for all the mothers, fathers, siblings, and friends of aspiring medical students as for the students themselves, Treatment Kind and Fair opens a comforting and instructive door to our profession, letting newcomers know — and letting veterans overhear — why one would want to make such a rash, overwhelming, and exquisitely rewarding choice in one's life, while warning sternly of the pitfalls that must be avoided along the way.

“Medical training is transformative,” Klass declares rather early on. Maybe or maybe not, but her fear of this transformation and her certainty that it will occur figure high on her list of concerns. She knows, no doubt, how jealous is our profession, how it kidnaps our young, and perhaps her maternal claws are exposed to defend against it at the same time that her maternal arms are open wide to it. Perhaps she is as acutely aware of how her son's becoming a doctor will transform her — she will be no longer singularly Mom, but now one among many teachers, mentors, and medical colleagues. The mother asks her son to “imagine me, in the 1980s, a pediatric resident,” in what seems to be a plea for forgiveness. You will understand, we can almost hear in what Klass leaves unsaid, why your mother missed so many of your milestones when you were an infant and she was a house officer. This section is placed before the moving chapter on apology in medicine, and it seems to be a tender and powerful apology itself, with Klass seeking the understanding that her son will gain as he becomes more experienced in the field of medicine.

Treatment Kind and Fair alludes to many treatments. Klass hopes that her son the medical trainee will be treated kindly and fairly. She portrays medicine as offering treatment kind and fair (and, indeed, this book avoids mention of such unkind, unfair aspects of medicine as physician greed and global health inequity). The literary treatment that Klass chose as the vehicle for her thoughts carries with it the kindness and fairness of centuries of wisdom seasoned with doubt and of age yearning to be of use to youth. Her book animates the doctor's plight and gift: no answers, but always questions.

Rita Charon, M.D., Ph.D.
Columbia University, New York, NY 10032
rac5@columbia.edu