Clio in the Clinic: History in Medical Practice (review)

For physicians who seriously engage in researching and writing about the history of medicine, how does their historical scholarship affect how they practice medicine? This question—alluded to in this volume's title, which envisions the historical muse Clio standing at the side of the modern clinician, exerting some influence that requires explication—is the quite purposeful foundation of this collection of twenty-three essays written by clinician-historians. The generation of these essays was spurred by Jacalyn Duffin, who in her introduction recounts the e-mail message that she sent in late 2001 to her colleagues, observing that "as a hematologist I have from time to time run across a case that draws on my experience as a historian of medicine—either in making the diagnosis, or in providing some other insight that might have escaped someone who was not an historian as well as a physician" (p. 7). After inquiring whether others had had similar experiences, she solicited contributions "to a volume of autobiographical essays about such cases" (p. 7).

The resulting compilation offers widely divergent responses to Duffin's query, unified perhaps most of all by the consistently personal—even intimate—tone of the essays. As the authors seek to describe exactly how the pursuit of medical history affects their medical practice, they offer rare (for an academic publication) examinations of their clinical careers, the influence of their families and the illness of loved ones, and the myriad ways in which their doctorly engagement with particular patients related to their thoughts, feelings, and insights as historians.

What are some of the intrapersonal historian-qua-clinician dynamics set forth in the essays? For many of the authors, a more complete and nuanced awareness of the past provides the most informed and functional context for engaging the present. A surgeon recounts being humbled to learn as a chief surgical resident that his "novel" case had in fact been described nearly four hundred years earlier (Sherwin Nuland). One physician engages in a historical archaeology of trust to grapple with the legacy of racism (Joel Howell), while another delves into the institutional history of his former Veterans Administration hospital to supplant frustration with almost empathy (Steven Peitzman), and another mulls over the recent history of encroachment on the patient-physician dyad by managed care in its many guises (Russell Maulitz).

For some of the physicians reporting on these pages, knowledge of the ravages of past plagues seems to have equipped them to cope with modern epidemics as they unfolded—in all their fear and confusion—around them (John Cule, Robert Martenson, Charles Bryan). For other authors, either their historical knowledge provided specific insight regarding how to diagnosis or manage a particular patient (Richard Kahn, Duffin, Max Shein, Jock Murray, Margaret Humphreys), or their historical perspective afforded them deeper understanding of a patient's malady (Carla Keirns, Anne Marie Moulin, Sandra Moss, Jeffrey Baker)—or nonmalady (Howard Markel). With substantially more than just a backward glance, other clinicians struggle with the challenge of wielding the physician's power—or a historically minded physician's knowledge—appropriately in the setting of clinical uncertainty (Paul Berman, Gary Belkin, Joel Braslow, Barron Lerner). Capping off the various relationships of historical scholarship to clinical practice described in these essays, two authors describe an aesthetic experience of feeling a connection across centuries as they engage in some enduring acts of caring (Walton Schalick, Christopher Crenner).

While many of these essays are interesting and enjoyable in themselves, to what end can this rather idiosyncratic collection be put? While no consistent or coherent theory about the personal relationship of historical scholarship and clinical practice emerges across the essays, for a reader who wants to study the history/clinical-practice interface, the book can serve as a primary source document—operating rather like...