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Edited by R Crawshaw. Medi-Ed Press, 2002, US$38.50, pp 648. ISBN0936741155
This book is a set of anecdotes, stories, travelogues, film and book reviews, essays and even fairy tales. All of these are representative of Ralph Crawshaw’s work, which has been published over a period of about 35 years, and they have been skilfully edited into eleven sections covering a broad range of topics. They make compelling reading. The book reflects the extensive experience of the author as a physician, psychiatrist, international medical diplomat, leader and opinion maker, ethicist, writer, and last but not least, as a compassionate fellow human being.
The editor/author advises the reader to pick and choose the chapters which may be of particular interest, treating the collection more like a smorgasbord than a full meal to be consumed from beginning to end at one sitting. A short summary at the beginning of each section facilitates this. Despite being over 600 pages in length, the layout of the book makes for easy reading. The eighty one individual chapters are short (about two to twenty pages), so it is easy to fit in a chapter between activities or at bedtime. As a reviewer, I felt compelled to read the entire book and my motivation to keep reading was maintained by the content. It was certainly not soporific.
As an introduction to the book, the author gives a brief outline of his relatively humble origins. His family, educational, and military experiences give the reader a reasonable understanding of his roots and what may have shaped his professional life and thoughts along the lines reflected in this work.
The main message of the book concerns the close relationship that exists between doctor and patient. Compassion is expressed as far more than a concept, being an experience which involves the deeper aesthetic values of both doctor and patient; the doctor has to contribute faith, hope, and charity, all presented with the essential ingredient of humility, while the patient has to reciprocate with trust. He relates very clearly the many factors which can intrude to break up this relationship. These include technology (which should be a tool and not the dictator it has often come to represent), and management and third party payer structures (which should be incorporated as an integral part of the team and not be self serving), as well as economic factors, age, social status, and many others. Actions should be weighed up as to who benefits most, the patient, or third parties.
Although acknowledging that the sanctity of personal interactions should always be respected, the author relates many stories illustrating the important need for social responsibility. These are collected from his experiences across many cultures (including communist Russia, China, India, South Africa, the United Kingdom, and Mexico, as well as his native USA). Many of these experiences are very moving and thought provoking. The frustration resulting from inequity of standards and access to health care for these communities is represented very clearly. Although people living in developing nations are experiencing a particularly tough time, the developed world is certainly no medical or social utopia.
Members of the medical profession shoulder a heavy burden of responsibility toward the public. This carries personal risks and stresses which result in significant fallout among our colleagues. Impaired and inept health professionals bear a particularly heavy burden, with the suicide risk among this group being particularly alarming. The author dissects a number of situations where we could all help to promote better understanding and to develop supportive and preventive policies to curb this trend. On the other hand, some doctors are described as “too ept,” in that they are unable to resist the drive toward more technological developments, which might have very questionable (if any) benefits for the patient. Without compassion from the doctor, patient trust (and that of their families) is easily eroded. All of us are exhorted to remain focused on our relationship with individuals, and to understand them as people with families and a wider personal history. Once personal attitudes are relegated to concepts, theories, budgets, and sometimes experiments, it is so much easier to drop our guard and slide into areas of questionable ethics. Care is taken to avoid a Luddite approach. All our actions need, however, to be balanced with respect to scientific, civic, economic, and ethical components. Each of these needs to be part of the learning process for medical students; medical oaths are often helpful to focus the mind on these areas, and should not be left as an emotional addendum to graduating ceremonies.
If there are any criticisms: the book could have been a little shorter and some minor repetitions could have been avoided. If, however, the book is read as a smorgasbord (as advised by the author), this criticism is negated. Some of the film reviews are perhaps a little esoteric and tangential, but whenever I thought this, the next review turned out to be a real gem, rich in thought and insight into the human condition. The references are useful. Although many of the chapters were published as articles 30 years ago, the topics are evergreen and are still applicable today.
Who would find this book most interesting: everyone who deals with people as individuals, and indeed, also those who deal with population groups because they too need to appreciate what is required when dealing with individuals. The first group would include doctors, medical students, nurses, other ancillary medical staff, and pastors and chaplains; the second group would include managers (especially those in the health field) and politicians and personnel who help to shape health policy. Many of the chapters would provide wonderful material for discussion groups (at either undergraduate or postgraduate level) to do with medical ethics, professional development or even civic or social policy. The real life experiences add credibility to their validity. While not all readers would necessarily agree with Ralph Crawshaw’s views, there seems to be little doubt that they promote a better understanding of our human condition. The world would be a much happier and safer place if the way of compassion was followed.