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  • Reflections on Medicine: Essays by Robert U. Massey, M.D.
  • Jerome Lowenstein
Reflections on Medicine: Essays by Robert U. Massey, M.D. Edited by Martin Duke. New York: Gordian Knot Books, 2011. Pp. 210. $21.95 (paper).

Reflections on Medicine is a rich sampling of 70 essays from a collection of more than 300 essays Robert Massey wrote for Connecticut Medicine: The Journal of the Connecticut State Medical Society, between 1973 and 2005. It is an elegant buffet of the thoughts and observations of a remarkable man. In his foreword to the book, Sherwin Nuland writes: "he applied his massive erudition to so many [other] themes, universal and specific—he accepted the uncertainty of human wisdom and even knowledge, recognizing that it is for each generation to look anew at dilemmas both modern and ancient" (p. ix). In fact, there are countless references to the writings of Albert Schweitzer, T. S. Eliot, Mark Twain, and Lewis Thomas, who was arguably the outstanding medical essayist of the 20th century. Rather than attempt to review the full menu, I will present a "tasting" of some of these essays.

In "The Role of Medical Educators," Massey writes:

Medical education is an initiation into a new culture. Jose Ortega y Gasset, the great Spanish humanist and historian, wrote that "the collective life of a people, a nation, is an intimate—and to a certain extent a secret—matter, very like what those words mean when one says of a personal life that it is an intimacy within [End Page 595] itself, and no one who looks at it from the outside can easily come to understand it." Medicine, the profession, the institution, the culture, is like that. Its ideals, its heroes, its traditions and ceremonies sustain its members in their physical, emotional, ethical and intellectual exertions. The student must be absorbed into this world of medicine; he must come to look at it from the inside and, in a certain sense, at all of life through its windows. As educators we must sense the times when it is good to bring forth the sagas and to celebrate our art and its science.

(pp. 3-4)

At the present time, when medicine is seen as a system, a commodity, a business, and an expensive item on the budget of states and of the nation, and when many physicians breathe a sigh of relief when their offspring chose a career in finance, Massey's voice sounds a clarion call. Medical educators seem to be increasingly preoccupied with fine details of curriculum, balancing specialty training and general medicine, and achieving some balance between time devoted to teaching, patient care, and research. In this setting, I believe that Massey's words carry a very important message. I am sure Massey would characterize medicine as "a calling."

In "Down-Sizing Time: Efficient but Hardly Effective," Massey writes: "Managed care, that is, care managed for profit, will, we pray, be a short footnote in medical history. If we don't bring it down, surely our patients will" (pp. 19-20). In "Virtues, Not Values: Medical Ethics, Not Business Ethos," Massey writes: "The ethos of corporations is hardly the same as the ethics of medicine. Neither is the ethos of big government. . . . But the care of the sick, the disturbed, and the vulnerable should require that the ethics of medicine bind the institutions who profit by their outstanding skill in managing just as they bind the only ones who provide that care" (pp. 37-38). And in "Medicine: Are We on the Threshold of Another Golden Age?" Massey writes:

In another half century, in 2047, medical residents studying today for their boards will be pushing four-score years. With successful aging, many may still be in practice. Society will have moved out its doldrums by then; medical care will be as universal as air and will have broken free from its destructive liaison with the insurance industry; funding for research will once again be in ascendency.

The American College of Physician's 15-year-old Clinical Efficiency Assessment Project (CEAP) has recommitted itself to evidence-based medicine. . . . Nothing new here; Pierre Louis in 1835, by studying the course of...

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