Incidental Findings: Lessons from My Patients in the Art of Medicine (review)

Before I begin, I must confess that reading medical memoirs is a guilty pleasure of mine. Thus, my motives when I agreed to review Danielle Ofri's Incidental Findings: Lessons from My Patients in the Art of Medicine were somewhat selfish. The author is an attending physician at Bellevue Hospital and an assistant professor of medicine at New York University, both located in Manhattan. Like most medical memoirs, her story centers on the highs and lows of practicing medicine. In this sense, there is very little that is novel about the book. Still, Ofri does write rather well, and has arranged the chapters (many of which were published previously as articles in academic journals) so that they tell a continuous story.

The prologue begins with the doctor as patient. A pregnant Ofri is scheduled for an amniocentesis but, unable to find the right room, manages to be "lost in my own hospital" (p. 1). In this opening scene, Ofri clearly conveys the frantic hurry of someone late for an important appointment. The moral of this particular story, one which sets the scene for the remainder of the book, is that to the patient "there is no such thing as incidental" (8). An everyday occurrence for clinicians can mean the world to the patient for whom it is not common and not easily understood.

Next, using a flashback sequence, Ofri takes the reader to her years immediately after medical training. During this time, she worked for a locum tenens agency (an agency setting up physicians in temporary employment) which put her in a variety of locales, from a small town on the Gulf coast of Florida to another in New Mexico and another in New England. All the posts were with private practices and, as Ofri describes it, "practicing medicine had never been so easy" (27). Still, there are intimate accounts, such as Ofri confronting the complex decision of whether or not to refer a pregnant patient to a women's clinic against the policy of the Catholic medical center where she worked, a decision confounded by Ofri's own experience with abortion. Through this experience, which Ofri never discloses during the clinical encounters, she feels connected to her patient. She conveys the idea that the doctor-patient relationship is overshadowed by their common humanity.

Soon, Dr. Ofri is back at Bellevue, where the majority of the book takes place. Work at Bellevue is faster-paced and more challenging than her previous positions in private practice, a point Ofri makes by writing in a stream of consciousness, recording a typical day, journal-style, with some patients receiving entries of several paragraphs while others are reduced to no more than two lines. Ofri recounts facing linguistic and cultural barriers, potential drug seekers, prisoners from Riker's Island, cancer patients, helping a bright but disadvantaged youth prepare for the SAT, end-of-life decisions, and what it is like to be the attending physician, training the residents occupying a position she once held.

The various scenarios are complicated, and provide the reader with insight into precisely how imprecise the art of medicine can prove to be, and how fallible physicians truly are. In one instance, Ofri encounters a troublesome patient of whom she says, "I start to resent her, to hate her, to hate everything about her. I hate to see her name on the roster. I hate to see her in the waiting room. I hate the whine in her voice that is detectable even when she is speaking Bengali. I hate the veil that she wears. Any last bit of cultural sensitivity I possess is washed away. I begin to resent her for her culture. . . . I hate that she routinely keeps her daughter out of school to facilitate her wild overuse of the medical system. And I hate how she makes me feel so utterly useless" (70). It is clear that Ofri is not holding anything back in her...