Patient Encounters

Patient Encounters

James H. Buchanan

New York, NY: Henry Holt and Company Inc., 346 pp., 1991

Medical education has been under heavy attack in recent years for the dehumanizing effect it has on students. The strong emphasis on basic biological sciences, on physical procedures and treatments and the regimented nature of much of the curriculum all combine to make the student forget the person behind the disease. Despite the stress given to social sciences, psychiatrists have not been exempt from these influences. The emphasis on diagnostic labels and the sometimes mechanistic orientation of some teachers can have a similar effect on students and residents.

This book redresses that balance. It provides a series of case histories on patients with various serious diseases. These include amyotrophic lateral sclerosis, multiple sclerosis, lupus, AIDS, cancer, depression (with suicide) and voyeurism. A brief clinical and pathological description of the disease is provided after which the full personal history of one patient is given. These are written from the patient’s perspective and the author uses his imagination, though without overstating his case, to describe what patients are experiencing.

In the main the histories are based on individuals the author himself knew and the stories they recounted to him. A personal note is introduced by the description of the illness and death of his mother from lung cancer, and his own experience of having subacute bacterial endocarditis at the age of 8.

The author is a philosopher who has been involved in medical ethics and decision making. The book reads easily and is highly recommended as an antidote to the scientism of medicine and to the structured organization of medical education.