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Doctor “Burnout”

The NYTs had a very timely article on Thursday about this issue, which is destined to get worse rather than better as the Affordable Care Act is instituted. See: “The Widespread Problem of Doctor Burnout” by Pauline Chen, August 23,2012, NYT. The only thing that I can add to this comprehensive analysis of the problem is that it isn’t new. As a young doctor 40 years ago I was trying to decide where I should take my career, so I asked many doctors in practice as well as many of my professors how they liked their lives, and whether they were happy with their career choices. I could not find any doctors in practice who were happy. All felt that they were overworked and under-appreciated. Most of these people were in solo private practice, so that they were individual businessmen (there were no women). Now, with the revolution that has occurred in the way medicine is practiced, most doctors are employees of big businesses, it is no better, and as this article points out it is worse, with no change in sight.

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“The Emperor of All Maladies”

I recently read this new book, by Siddhartha Mukherjee, which came out in 2010 amid acclaims from just about everyone that it was the best book of the year, and a winner of the Pulitzer Prize. The book is subtitled as “a biography of cancer”, but I found it to be rather a biography of all of those who have tried to treat and cure cancer, and have failed. Consequently it is an intimate portrait of the major clinicians and scientists, especially of the past century, who attacked this “emperor”. But in addition, it is an intimate portrait of some of the people who suffered from this dreaded disease and their therapies, who happened to be Dr. Mukherjee’s own patients. 

Thus, if you are interested in cancer for any reason, this book is a must read, because it explains how we got to be where we are today in cancer science and medicine. Early on in the book, Vannevar Bush, who was an American scientist and engineer, is quoted as saying that he felt that we simply needed more basic science, as we did not understand what we were dealing with. Essentially that turned out to be prescient, in that only within the past decade have we finally uncovered definitively that cancer is a disease of random genetic mutations in an individual cell that renders it autonomous from the normal controls over it’s capacity to grow and multiply. However, before this new understanding, physicians were confronted with many many people that they knew were destined to die a very painful death usually very rapidly, so that they tried everything they could, hoping to delay or prevent the inevitable. 

This is a gripping story!