David Newman, M.D., has written an engaging and insightful book about doctors, patients, and the relationships between them. Things seem to have gone wrong somewhere along the line that begins with the revered Greek physician Hippocrates and leads to the present. All is not well in the house of medicine.
The Doctor-Patient Relationship
Hippocrates had no technology available to aid in his diagnoses and treatment recommendations. What he did have was his powers of observation, his empathy for the ill, and the time to spend with them. Contrast that with the modern practitioner, who orders tests, prescribes pills, and often intentionally spends as little time as possible with patients.
Doctor Newman makes a strong case, replete with data and examples, for changing the way things are done in hospitals and doctor's offices. His discussion of the placebo effect and its implications are especially illuminating. Could it be that simply communicating better with patients is the key to improved outcomes?
Doctors Know it Doesn't Work
Sadly, it would seem that doctors know well and good that many of the tests they order, and the medicines they prescribe do little (if any) good in the majority of cases. The sicker a patient is, the more effective a treatment usually is. However, when there is no clear cause of illness, or when a test or regimen is strictly for screening or preventive purposes, science and statistical data analysis are far too often cast aside, to be replaced with the philosophy of "it ought to work." It ought to work, but it doesn't.
High profile and billion-dollar programs such as hormone replacement therapy, and periodic mammography are called into question. The fiascos surrounding the approval of Vioxx and Celebrex are illuminated in a harsh light. Does a low dose aspirin really prevent heart attacks and stroke? Yes and no.
The reader will be exposed (probably for the first time) to the concept of "number needed to treat" (NNT). This is a number calculated from clinical studies, that gives the expected number of people that must be treated with a drug or subjected to a procedure, in order for one person to benefit. It's a real eye opener. Somewhat frightening too, since it would seem that most physicians are aware that in some cases more patients are harmed by a treatment than are actually helped—yet the treatments continue.
Calling for a Better System
Doctor Newman ends with a call for action. Hippoctates' Shadow grips the reader and holds fast, with a mixture of emergency room anecdotes, sober analysis, and thought-provoking elucidation. The author has succeeded to an even greater extent than Gerome Groopman did with his popular book How Doctors Think. Newman might even make you mad, and cause you to wonder why we tolerate the system that we have.
References
Hippocrates' Shadow, Secrets from the House of Medicine, 2008, David H. Newman, Scribner, NY
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