The Role of Medicine: Dream, Mirage, or Nemesis? by Thomas McKeown, and: The Post-Physician Era: Medicine in the Twenty-first Century by Jerrold S. Maxmen (review)
- Perspectives in Biology and Medicine
- Johns Hopkins University Press
- Volume 21, Number 2, Winter 1978
- pp. 314-315
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medullary carcinoma of the thyroid; Baddeley is almost cavalier in his dismissal of renal calculus disease after bypass operations for obesity. These minor flaws or variants in emphasis in no way detract from the overall appeal of this book. It is a provocative and informative volume, will appeal to the surgeon who wishes to "brush up" on what's current, and can be read with genuine pleasure during short periods of leisure. Recent Advances in Surgery #9 should receive ready acceptance from practitioners , house officers, and students of surgery on both sides of the Atlantic. George E. Block, M.D. Department of Surgery University of Chicago The Role ofMedicine: Dream, Mirage, or NemesL·? By Thomas McKeown. London: Nuffield Provincial Hospitals Trust, 1976. Pp. xv+ 180. £3.25 net. The Post-Physician Era: Medicine in the Twenty-first Century. By Jerrold S. Maxmen. New York: John Wiley & Sons, 1976. Pp. 300. $16.50. These books are written by physicians who have surprisingly similar outlooks on the future of medical care. Each author sees change as an ongoing process and wonders whether physicians will keep up with it. Each denigrates to some extent the contributions that physicians have made to health in the past. Each realizes that computers and other devices are in their infancy, and each fears that physicians may not make the best use of them. Both authors state that medical schools must change their teaching, and both emphasize that medical men should be taught to educate patients and the general public to take better care of themselves. McKeown believes that improvements in health in the past few centuries have been due to production of adequate food, protection from hazards (sanitation), and limitation of family size. He is loath to give physicians credit for initiating these changes and says that the doctor has given only limited help through immunization and therapy. Maxmen argues that machines will be able to outperform doctors in the execution of diagnostic and treatment tasks, and that a significant difficulty in designing an effective health system lies in assuming that the doctor is essential in the delivery of health services. He would replace the doctor by "Medic-computers." The "Medic" would have perhaps 18 months of training in some special area. The "Medic" would not have to learn chemistry, biology, or physics because the computer would make diagnostic and treatment decisions. The surgeon would be the last physician to go, and eventually his tasks might be performed by "Medics." The "Medic" will be expected to learn psychology of illness; family dynamics; group processes; medical sociology; medical ethics; patient administration ; and the technology of supportive care, including behavior modification! There would be no medical schools as we know them, but institutes of health sciences, public health, and medical investigation would appear, and the curriculum might be prolonged as needed. Centers of health information would maintain records of all patients, so the information could be universally (or at 314 Book Reviews least nationally) available by telephone or by videotape. Education of the public to these changes is considered and deemed to Ix- plausible. Who will program and maintain the computer and teach the Medics? Both authors challenge the medical professions to be more efficient tcchiiicalh and with regard to informational relations with the public. Rouf.kt W. ViKTiiK, M.I). 727 Birch Sheet Denver, Cobrado 80220 MortalLessons. By Richard Selzer. New York: Simon Sc Schuster, 1076. Pp. L' 19. $8.95. Doctors who scribe are all too uncommon, and uncommoner still is the gifted scribe who makes a living at surgery. These two worlds, literarv and chirurgical, converge in a crafty and winsome volume of essays by Richard Selzer. By probing through layers ofcold, corporeal fact, Selzer manages to reach sublime levels of rhetorical wisdom. Ever the exuberant wordsmith, he writes with a quaintness ofspeech which sometimes threatens to become ponderous Yet such eloquence is what makes Mortal Lessons ultimately so engaging. Wc- observe how the author and his subject have grown attached, knife to heart. Whether describing the onset of rigor mortis or the first throb of puerile infatuation, Selzer employs the same ornate vocabulary with facility and precision. He conjures lively tales from bones, bowels, bladders, blades...