Review: One Doctor : Close Calls, Cold Cases and the Mysteries of Medicine by Brendan Reilly, MD

In One Doctor: Close Calls, Cold Cases and the Mysteries of Medicine, Dr. Brendan Reilly brings readers to the front lines of medicine today and exposes it's fractured, ailing state. A distinguished internist  at a major academic medical center in Manhattan, Dr. Reilly sees the spectrum of patients as they are admitted to his service and he navigates the healthcare system in trying to provide the best care to each patient. By weaving together his thoughts on the healthcare system, the mysteries of some of his most challenging patients and the very personal story of caring for his own parents at end of life, Dr. Reilly has created an informative but also gripping look at medicine today.

Dr. Reilly began his career as a primary care physician in small town New England and practiced medicine in a way one imagines it was practiced years ago - with house calls and an in-depth knowledge of each patient. This experience, though not without its own challenges and during which he encountered his most mysterious case which haunts him to this day, informs Dr. Reilly's approach to treating patients. In this quote he reveals his philosophy as a doctor:

For many doctors, the purpose of medicine is to cure disease. For these "curing" doctors, if you don't have a definable disase - panic attacks is not a disease - then you've come to the wrong place. But, for other doctors, the purpose of medicine is the same today as it has been for centuries: to relieve human suffering - sometimes by curing disease (when we can) but always by empathizing with, understanding, and trying to comfort the sufferer.

He laments the fact that the vocation of being a doctor and comforter to patients has been devalued in the current business culture of medicine with healthcare as a "commodity" and patients as "consumers" and "customers" while the doctors are "providers".

Although Dr. Reilly provides his opinions on the state of healthcare today, the book is not merely an examination of healthcare policy from within the industry. Perhaps it's greatest offering is in bringing the reader to the bedside as Dr. Reilly and his team of colleagues, interns and residents see patient after patient and try to solve their medical mysteries. In each case,  the doctors use a mix of basic physical examination, patient interviews and more advanced medical technologies like CT Scans to get to the source of the symptoms presented by the patient and land on a diagnosis. The reader sees the process used in diagnosis, the challenges of managing not just the patient but their families, and the inevitable race against time as patients begin to worsen and the narrow window of time to diagnose and treat successfully narrows.

The counterbalance to the doctor at work is the doctor trying to doctor his own parents. His father, also a physician, has metastatic bladder cancer which has significantly impacted his quality of life while his mother is suffering from dementia and also needs significant daily care. With their care, Dr. Reilly experiences first hand what many of his own patients' families grapple with including challenging end of life decisions. How much intervention is enough or too much? It is interesting to watch him practice the same deductive approach to medicine without the benefit of distance - he is obviously emotionally invested in his parents and it complicates his care for them.

My Thoughts
I could not get enough of this book - it is fascinating on so many levels. With the health care debate so front and center now with the launch of the Affordable Care Act, it is interesting to explore, on a less superficial level than offered by the media, the many drivers of our issues in healthcare today. It also confirms my belief that there is no silver bullet to our healthcare challenges today and each solution will have some sacrifice with its own downsides.

More than that, however, I loved the front row seat to the practice of medicine and watching the doctor at work. It was like watching an episode of Gray's Anatomy or ER - gripping and emotional. In each case, you see the doctors struggling with their own issues - there is actually quite an exploration of regret in medicine and how it is not well understood or discussed - and juggling multiple patients and a plethora of information as they try to both cure and comfort each patient. At the core of each case is a patient looking to the doctor and the healthcare system for relief and a doctor trying to solve a mystery in order to do just that.

This book is definitely a top read for me in 2013 - highly recommend!