The Human Side of Medicine Book Review

The Human Side of Medicine, authored by Joel Merenstein, MD, Jonathan Han, MD, and Jennifer Middleton, MD, MPH, recently received a review on the STFM website.

This book provides perspectives from three generations of family physicians who worked, taught, and learned together. Dr. Joel Merenstein, Emeritus Director of the University of Pittsburgh Faculty Development Fellowship,  maintained his clinical practice in the same community for over 42 years. Dr. Jonathan Han is Medical Director  of the University of Pittsburgh New Kensington Family Health Center, Associate Residency Program Director, and previously worked in a community health center in Boston. Dr. Jennifer Middleton is Associate Director at Riverside Methodist Hospital Family Medicine Residency in Columbus, Ohio. Their reflections provide close-up views of the rewards and challenges of practicing family medicine, doctor-patient relationships, and the changing nature of medical practice.

Dr. Merenstein reviews messages, recounting patients and stories from decades of practice with fresh perspectives. He and his daughter, a professor of sociology, analyzed themes from patients’ letters and found recurring themes of “being there, caring, medical expertise, personal characteristics, multiple roles, family, and continuity.” He recounts the characteristics of his first practice partner, Dr. Waite, who practiced in rural Pennsylvania, and describes how he tried to emulate this powerful role model through his own practice and teaching. Indeed, the traits embodied by Dr. Waite are the characteristics that were transmitted to Dr. Merenstein, and which enable family physicians to provide and cherish continuity of care for patients across the lifespan, in the context of their families and communities. Dr. Merenstein reflects on how being a family physician provided him with an enduring sense of meaning, importance, and connection throughout and after retirement from patient care.

Dr. Han, a second-generation Korean American who grew up in a small town in Ohio, had been a practicing family physician and teacher for more than 24 years and considered himself at the “middle” of his career at the time of his contributions. He shares poignant stories of forging his own identity as a Korean-American physician. He describes intimate connections with patients from his varied practice in San Francisco at the height of the AIDS epidemic, to working with the Inuit in the Arctic Circle, and then with disadvantaged communities in Boston and Pittsburg. He reflects on the challenges of providing compassionate care for disadvantaged patients who face social stigma, economic hardship, and structural violence. He invites us into a dizzying day in the life of an attending physician starting with 7 am rounds, through patient wards, teaching encounters, administrative meetings, and finally ending with enough time for a satisfying run at the end of the day.

Dr. Han reflects on the tragic loss of life from the 2010 earthquake in Haiti, along with patients in the United States who suffer from an exclusionary, wasteful healthcare system. He urges us to consider what motivates individuals to care for others as well as what might motivate us collectively to develop more proactive health and social policies. He reminds us of the selfish benefit of caring, that caring for others benefits those who care. His satisfaction as a family physician also shines through his poems and essays.

Dr. Middleton, the most junior physician in the group, completed her faculty development fellowship with Drs. Merenstein and Han. These powerful mentors encouraged her to write about her work as a physician. Through writing, blog posts, and use of social media, she was able to process and articulate the emotion and power of patient and teaching encounters, and to transmit these experiences to others. She shares stories of fallibility and forgiveness. One of her essays describes her grief and distress after a friend and physician colleague committed suicide. She applied lessons from this experience to begin to listen more carefully to colleagues and patients. She recounts a poignant moment when she was introduced as “our doctor” by the wife of a dying patient to his family, and how her relationship with the family enriched her life.

In a eulogy to her former self, Dr. Middleton also describes an afternoon when everything stopped. She recounts her shock at the onset of symptoms and her response to her own diagnosis of multiple sclerosis. Many other significant moments of her life and career are captured through “The Singing Pen of Dr. Jen” blog posts at http://singingpendrjen.blogspot.com.

While each of the essays, poems, and reflections of these physicians are compelling and could be used as teaching tools, the entire book provides a powerful intergenerational story. These physicians embody the essence of compassion, fortitude, determination and excellence. Their stories convey the intimate emotions and details of what motivates and inspires family physicians. Their stories remind us that family physicians have the privilege of front-row seats to human drama, suffering, and healing. Additionally, by paying careful attention and maintaining open hearts, family physicians can understand and respond to patient needs, enjoy meaningful relationships with colleagues, and savor a life of bountiful rewards.

Cynthia Haq, MD
University of Wisconsin School of Medicine and Public Health
Madison, WI