In One Doctor, Brendan Reilly, MD, recounts his 40 year career as a primary care internist turned hospitalist. In many respects, Dr. Reilly’s story closely follows changes in the American medical profession during the last 40 years.
Like many of his predecessors, Dr. Reilly paints a picture of a proud profession of human beings who dare to beat back death itself. Far from the ivory tower of policymakers and payors, a bold few struggle in the trenches against daily chaos, flawed systems, and their own imperfections to care for the sickest of the sick. In a rare showing of vulnerability by a medical professional, Dr. Reilly opens up his war chest of experience so that we all can benefit.
It is genuine pleasure to observe Reilly diagnose complicated conditions from incredibly subtle physical tells. Long before an imaging scan, Reilly quickly diagnoses a patient with cancer on the basis of one eye being slightly more dilated eye than the other. He is correct. An apparent stroke patient is quickly identified to merely have an allergic reaction. Right again. By tickling another patient’s foot with his fingernail, Reilly diagnoses another patient with an extremely rare kind of stroke clot, for which the standard clot-busting drugs cannot be used.
Unlike we lay people commonly believe, Reilly and his peers only use advanced medical imaging and tests to confirm diagnoses they have already made. This lesson is invaluable because Reilly frequently encounters false negative test results throughout the entire book. Can you imaging being so bold and confident as to conclude that an MRI is wrong?
But his troves of experience were earned the hard way.
It is clear that Dr. Reilly’s professional behaviors have been molded by years of excruciating lessons. For instance, when he is about to begin a conversation with a patient’s difficult spouse regarding her husband’s cancer, Dr. Reilly engages in a long, peculiar series of actions to ensure his communication is clear. He pulls a chair into the hospital room, closes the hospital room door, takes the room’s phone off the hook, turns off the intercom to the nursing station, turns off his own cell phone and pager, asks the patient’s spouse to turn off her cell phone, and sits down to deliver his message.
These eccentric behaviors, and others, have practical and elegantly simple back stories. Reilly learned to sit at eye level with patients, rather than towering over them, during an odd psychiatric case involving a patient who self-inflicted injuries on herself. When he confronted this patient with her problem, and towered over her, she refuted his accusation and spitefully upped the intensity of her next self-inflicted injury. This case taught him to sit at eye level with patients when delivering difficult messages. It also forced Dr. Reilly to acknowledge that many patients with psychiatric disorders are far out of his league.
Another recurring observation is that Dr. Reilly and some other physicians appear to struggle constantly with the regret of not doing enough. He and his peers are persistently processing all types of “what if” scenarios after adverse outcomes occur with their patients. In one example from early in his career, we learn how a mere paperwork backlog at the local hospital ultimately killed one Dr. Reilly’s primary care patients. By not knowing one of his patients was admitted to the emergency department, a daisy-chain of unlikely events was set in place that resulted in the patient committing suicide several months later. No mistakes were made by any physicians involved, but they all have to live with the guilt. This incident haunts him the rest of his life.
At 464 pages, One Doctor provides readers with a valuable glimpse into passing generation of medicine that has elapsed since Dr. Reilly entered the profession in 1973.