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Values in Medical Practice: A Statement of Philosophy for Physicians and a Model for Teaching a Healing Science
326
BOOK REVIEWS
that resulted in the professionalization of biomedical research and the evolution of a consensus that federal support of such research was acceptable. Most physicians will not be interested in the details of the legislation that led to the founding of the NIH. It is reassuring, however, to review the way in which a few persons with vision were able to achieve this goal. To accomplish it, they had to be persistent and to engage in the frustrating business of political compromise. It would be fascinating if a companion volume were written that dealt with the most recent 50 years of NIH history, a period of unprecedented growth and success for biomedical research—growth and success due in large part to the institution that Ransdell and Herty fought so hard to bring into existence. Richard M. Weinshilboum, M.D. Department of Pharmacology
Echocardiographic Diagnosis of Cardiac Malformations, by Roberta G. Williams, Frederick Z. Bierman, and Stephen P. Sanders, 237 pp, with illus, $48.50, Boston, Little, Brown and Company, 1986 This book was designed as a concise and functional reference work for those involved in the practice of pediatric echocardiography. The format is a well-balanced integration of developmental anatomy, techniques for two-dimensional echocardiographic examination, and tomographic image analysis, with an emphasis on practical application. The text is divided into six sections: normal tomographic anatomy, shunt lesions, obstructive lesions, conotruncal abnormalities, complex heart disease, and evaluation of the postoperative patient. Each of the 38 short chapters is devoted to a single topic and is structured as follows: anatomy, diagnostic echocardiographic findings, examination technique, and problems. The illustrations have been carefully selected to depict the points established in the written text. A brief list of the most important references concludes each chapter. The strengths of this book relate to the succinct style with which the authors produce a distillate of
Mayo Clin Proc, April 1987, Vol 62
essential echocardiographic information characterizing each cardiac malformation. From a practical standpoint, one can review the major aspects of anatomy, two-dimensional image analysis, diagnostic pitfalls, and associated malformations for any particular entity in just a few minutes. This integrated approach enables readers with various backgrounds to assimilate the material more easily. If the book has weaknesses, they must relate to the authors' decision to cover a broad and exceedingly complex subject in 237 pages. Some may find the exclusion of Doppler echocardiography—an increasingly used procedure in the pediatric patient—a serious (though perhaps deliberate) omission. Others, already involved in a high-volume practice of complex congenital lesions, will turn to more detailed texts for their reference needs. This book is most suited for the beginning pediatric echocardiographer, the echocardiographer who usually is responsible for adult patients but occasionally examines pediatric patients, the anatomist who wants "real-time" review of subjects, the pediatric cardiologist who has limited experience in echocardiography, and all fellows in pediatric and adult cardiology. Guy S. Reeder, M.D. Division of Cardiovascular Diseases and Internal Medicine
Values in Medical Practice: A Statement of Philosophy for Physicians and a Model for Teaching a Healing Science, by Rudolph J. Napodano, 142 pp, $24.95, New York, Human Sciences Press, 1986 As implied in the title, this brief and relatively expensive volume deals with a subject that would commonly be expounded as an essay. Dr. Napodano, an internist, pleads for the incorporation of humanistic teaching of empathy, compassion, ethics, and egalitarian care with the "hard sciences" to make a "complete physician." His philosophical themes—"always try to do good, avoid more suffering or harm to the patient, be willing to try to help and provide good quality care to all those in need and always try to act in the patient's best overall interests"—sound familiar, as they resemble updated versions of the maxims of the
327
Mayo Clin Proc, April 1987, Vol 62
BOOK REVIEWS
Hippocratic oath and the aphorisms of Osier. The book expands on the application of these truths to the practice of medicine and presents a model for teaching these issues by using six excellent case studies to emphasize the complexity of patient interaction in the right/wrong context. The increased focus on the technical aspects of medicine and the ability to prolong life artificially must be balanced by a greater emphasis on values and ethics in medicine. Increasingly objective viewpoints toward the patient combined with the ritualization of the patient-physician interface, particularly in the inpatient setting, act as professional barriers to altruistic medical practice. Dr. Napodano reminds us that all too commonly "patients perceive something as lacking" in their relationship with their physicians, and he places the responsibility for maintaining values squarely on the shoulders of the physician. The increasing "corporatization" of medicine by private business and financially motivated restrictions on the part of third-party payers and government agencies impair rather than enhance a warm and caring relationship with the patient. Some of the author's proposals, however, such as making the faculty members in the humanities welcome in the clinical setting (making rounds side by side with the clinician) would predictably be met with skepticism if not hostility by the attending physicians. Alternatively, early teaching of values and ethics to medical students and residents and emphasizing that attending clinicians and senior residents should provide good models of total patient care seem fruitful. Educators interested in developing or modifying a course in medical ethics could benefit from Dr. Napodano's suggested approach. The modern physician's bureaucratic and technical seduction from humanitarian values is a reality. In the tradition of previous physician-philosophers, this work again addresses our basic responsibilities to the patient. Gerald C. Peterson, M.D. Department of Psychiatry and Psychology
BOOKS RECEIVED Biostatistics in Clinical Medicine, 2nd ed, by Joseph A. Ingelfinger, Frederick Mosteller, Lawrence A. Thibodeau, and James H. Ware, 339 pp, with illus, $29.95, New York, Macmillan Publishing Company, 1987 Cardiac Glycosides 1785-1985: Biochemistry, Pharmacology, Clinical Relevance, edited by Erland Erdmann, K. Greeff, and J. C. Skou, 552 pp, with illus, $50, New York, Springer-Verlag, 1986 Diagnosing Musculoskeletal Problems: A Prac tical Guide, by Frederick G. Lippert III and Carol C. Teitz, 155 pp, with illus, $16.95, Baltimore, Williams & Wilkins, 1987 Clinical Endocrinology: Theory and Practice, 2nd ed, by Alexis Labhart, 1,092 pp, with illus, $175, New York, Springer-Verlag, 1986 Essentials of Nuclear Medicine Science, edited by William B. Hladik III, Gopal B. Saha, and Kenneth T. Study, 439 pp, with illus, $45.95, Baltimore, Williams & Wilkins, 1987 Harrison's Principles of Internal Medicine, 11th ed, edited by Eugene Braunwald, Kurt J. Isselbacher, Robert G. Petersdorf, Jean D. Wilson, Joseph B. Martin, and Anthony S. Fauci, 2,258 pp, with illus, $85, New York, McGraw-Hill Book Company, 1987 Manual of Nerve Conduction Velocity and Somatosensory Evoked Potentials, 2nd ed, by Joel A. Delisa, Keith Mackenzie, and Ernest M. Baran, 278 pp, with illus, $23, New York, Raven Press, 1987 Radiologie Management of Musculoskeletal Tumors, by Holger Pettersson, Dempsey S. Springfield, and William F. Enneking, 153 pp, with illus, $89, New York, Springer-Verlag, 1987 Infections of the Head and Neck (Clinical Topics in Infectious Disease series), edited by David Schlossberg, 197 pp, with illus, $65, New York, Springer-Verlag, 1987 Clinical Neuroanatomy for Medical Students, 2nd ed, by Richard S. Snell, 613 pp, with illus, $24.50, Boston, Little, Brown and Company, 1987 Offshore Medicine: Medical Care of Employees in the Offshore Oil Industry, 2nd ed, edited by R. A. F. Cox, 258 pp, with illus, $78, New York, SpringerVerlag, 1987 Nicotinic Acetylcholine Receptor: Structure and Function (NATO ASI Series H [Cell Biology], Vol 3), edited by Alfred Maelicke, 489 pp, with illus, $126.50, New York, Springer-Verlag, 1986 Prevention and Control of Nosocomial Infec tions, edited by Richard P. Wenzel, 641 pp, with illus, $65.95, Baltimore, Williams & Wilkins, 1987 Anesthesia and Uncommon Pediatric Diseases, by Jordan Katz and David J. Steward, 549 pp, with illus, $65, Philadelphia, W. B. Saunders Company, 1987
BOOK REVIEWS
that resulted in the professionalization of biomedical research and the evolution of a consensus that federal support of such research was acceptable. Most physicians will not be interested in the details of the legislation that led to the founding of the NIH. It is reassuring, however, to review the way in which a few persons with vision were able to achieve this goal. To accomplish it, they had to be persistent and to engage in the frustrating business of political compromise. It would be fascinating if a companion volume were written that dealt with the most recent 50 years of NIH history, a period of unprecedented growth and success for biomedical research—growth and success due in large part to the institution that Ransdell and Herty fought so hard to bring into existence. Richard M. Weinshilboum, M.D. Department of Pharmacology
Echocardiographic Diagnosis of Cardiac Malformations, by Roberta G. Williams, Frederick Z. Bierman, and Stephen P. Sanders, 237 pp, with illus, $48.50, Boston, Little, Brown and Company, 1986 This book was designed as a concise and functional reference work for those involved in the practice of pediatric echocardiography. The format is a well-balanced integration of developmental anatomy, techniques for two-dimensional echocardiographic examination, and tomographic image analysis, with an emphasis on practical application. The text is divided into six sections: normal tomographic anatomy, shunt lesions, obstructive lesions, conotruncal abnormalities, complex heart disease, and evaluation of the postoperative patient. Each of the 38 short chapters is devoted to a single topic and is structured as follows: anatomy, diagnostic echocardiographic findings, examination technique, and problems. The illustrations have been carefully selected to depict the points established in the written text. A brief list of the most important references concludes each chapter. The strengths of this book relate to the succinct style with which the authors produce a distillate of
Mayo Clin Proc, April 1987, Vol 62
essential echocardiographic information characterizing each cardiac malformation. From a practical standpoint, one can review the major aspects of anatomy, two-dimensional image analysis, diagnostic pitfalls, and associated malformations for any particular entity in just a few minutes. This integrated approach enables readers with various backgrounds to assimilate the material more easily. If the book has weaknesses, they must relate to the authors' decision to cover a broad and exceedingly complex subject in 237 pages. Some may find the exclusion of Doppler echocardiography—an increasingly used procedure in the pediatric patient—a serious (though perhaps deliberate) omission. Others, already involved in a high-volume practice of complex congenital lesions, will turn to more detailed texts for their reference needs. This book is most suited for the beginning pediatric echocardiographer, the echocardiographer who usually is responsible for adult patients but occasionally examines pediatric patients, the anatomist who wants "real-time" review of subjects, the pediatric cardiologist who has limited experience in echocardiography, and all fellows in pediatric and adult cardiology. Guy S. Reeder, M.D. Division of Cardiovascular Diseases and Internal Medicine
Values in Medical Practice: A Statement of Philosophy for Physicians and a Model for Teaching a Healing Science, by Rudolph J. Napodano, 142 pp, $24.95, New York, Human Sciences Press, 1986 As implied in the title, this brief and relatively expensive volume deals with a subject that would commonly be expounded as an essay. Dr. Napodano, an internist, pleads for the incorporation of humanistic teaching of empathy, compassion, ethics, and egalitarian care with the "hard sciences" to make a "complete physician." His philosophical themes—"always try to do good, avoid more suffering or harm to the patient, be willing to try to help and provide good quality care to all those in need and always try to act in the patient's best overall interests"—sound familiar, as they resemble updated versions of the maxims of the
327
Mayo Clin Proc, April 1987, Vol 62
BOOK REVIEWS
Hippocratic oath and the aphorisms of Osier. The book expands on the application of these truths to the practice of medicine and presents a model for teaching these issues by using six excellent case studies to emphasize the complexity of patient interaction in the right/wrong context. The increased focus on the technical aspects of medicine and the ability to prolong life artificially must be balanced by a greater emphasis on values and ethics in medicine. Increasingly objective viewpoints toward the patient combined with the ritualization of the patient-physician interface, particularly in the inpatient setting, act as professional barriers to altruistic medical practice. Dr. Napodano reminds us that all too commonly "patients perceive something as lacking" in their relationship with their physicians, and he places the responsibility for maintaining values squarely on the shoulders of the physician. The increasing "corporatization" of medicine by private business and financially motivated restrictions on the part of third-party payers and government agencies impair rather than enhance a warm and caring relationship with the patient. Some of the author's proposals, however, such as making the faculty members in the humanities welcome in the clinical setting (making rounds side by side with the clinician) would predictably be met with skepticism if not hostility by the attending physicians. Alternatively, early teaching of values and ethics to medical students and residents and emphasizing that attending clinicians and senior residents should provide good models of total patient care seem fruitful. Educators interested in developing or modifying a course in medical ethics could benefit from Dr. Napodano's suggested approach. The modern physician's bureaucratic and technical seduction from humanitarian values is a reality. In the tradition of previous physician-philosophers, this work again addresses our basic responsibilities to the patient. Gerald C. Peterson, M.D. Department of Psychiatry and Psychology
BOOKS RECEIVED Biostatistics in Clinical Medicine, 2nd ed, by Joseph A. Ingelfinger, Frederick Mosteller, Lawrence A. Thibodeau, and James H. Ware, 339 pp, with illus, $29.95, New York, Macmillan Publishing Company, 1987 Cardiac Glycosides 1785-1985: Biochemistry, Pharmacology, Clinical Relevance, edited by Erland Erdmann, K. Greeff, and J. C. Skou, 552 pp, with illus, $50, New York, Springer-Verlag, 1986 Diagnosing Musculoskeletal Problems: A Prac tical Guide, by Frederick G. Lippert III and Carol C. Teitz, 155 pp, with illus, $16.95, Baltimore, Williams & Wilkins, 1987 Clinical Endocrinology: Theory and Practice, 2nd ed, by Alexis Labhart, 1,092 pp, with illus, $175, New York, Springer-Verlag, 1986 Essentials of Nuclear Medicine Science, edited by William B. Hladik III, Gopal B. Saha, and Kenneth T. Study, 439 pp, with illus, $45.95, Baltimore, Williams & Wilkins, 1987 Harrison's Principles of Internal Medicine, 11th ed, edited by Eugene Braunwald, Kurt J. Isselbacher, Robert G. Petersdorf, Jean D. Wilson, Joseph B. Martin, and Anthony S. Fauci, 2,258 pp, with illus, $85, New York, McGraw-Hill Book Company, 1987 Manual of Nerve Conduction Velocity and Somatosensory Evoked Potentials, 2nd ed, by Joel A. Delisa, Keith Mackenzie, and Ernest M. Baran, 278 pp, with illus, $23, New York, Raven Press, 1987 Radiologie Management of Musculoskeletal Tumors, by Holger Pettersson, Dempsey S. Springfield, and William F. Enneking, 153 pp, with illus, $89, New York, Springer-Verlag, 1987 Infections of the Head and Neck (Clinical Topics in Infectious Disease series), edited by David Schlossberg, 197 pp, with illus, $65, New York, Springer-Verlag, 1987 Clinical Neuroanatomy for Medical Students, 2nd ed, by Richard S. Snell, 613 pp, with illus, $24.50, Boston, Little, Brown and Company, 1987 Offshore Medicine: Medical Care of Employees in the Offshore Oil Industry, 2nd ed, edited by R. A. F. Cox, 258 pp, with illus, $78, New York, SpringerVerlag, 1987 Nicotinic Acetylcholine Receptor: Structure and Function (NATO ASI Series H [Cell Biology], Vol 3), edited by Alfred Maelicke, 489 pp, with illus, $126.50, New York, Springer-Verlag, 1986 Prevention and Control of Nosocomial Infec tions, edited by Richard P. Wenzel, 641 pp, with illus, $65.95, Baltimore, Williams & Wilkins, 1987 Anesthesia and Uncommon Pediatric Diseases, by Jordan Katz and David J. Steward, 549 pp, with illus, $65, Philadelphia, W. B. Saunders Company, 1987