The Midnight Meal and Other Essays About Doctors, Patients, and Medicine (review)

A reprint of Lowenstein's popular 1997 collection of essays, this handy new paperback edition is supplemented by two more recent essays about truth-telling and the problems of training physicians in the 21st century.

Like others of the "older" generations formed before the biomolecular revolution, Lowenstein has reservations about full disclosure of all potential complications of almost any procedure. He worries that truth may depend on where you stand, or where you lie, horizontally or mendaciously. In his essays, he voices concern about how the limitation of residents' work hours has increased the intensity of the training and removed more than a little of the responsibility that trained previous generations.

Lowenstein plumps for team care and hospitalists, but he worries that relying on information from the computer will not be as useful or informative as the old face-to-face system has been, especially in building collegiality and in letting the takeover team know something more of patients than their numbers and stats. In that I suspect he will be proved wrong. I dictate these comments to the computer, to which I talk almost every day as once I did to my Dictaphone. My words are immediately transferred to the screen, albeit with mistakes depending on my diction, but each year there is progress. I can therefore foresee the time when information transfer will be by voice-recognition computers, with the words transmitted immediately to screen, information provided as transfer notes on electronic records. That may limit the number of jokes or witticisms, but not all writing deserves eternity.

These delightful essays cover a world of medicine that is fast disappearing, but they emphasize the importance of narrative, the patient-physician relationships, the virtuosity of medications, and many other wise comments that deserve physicians' attention. The book will provide comfort at the physicians' bedside—at home that is, not in the hospital. There is much in it to ponder and reread.