When to Act and When to Refrain

My purpose in writing this book is to convey to anyone interested in a medical career the excitement and fascination intrinsic to becoming and serving as a physician. The profession of medicine involves caring, knowledge, skill, accountability, tact, empathy, and lifelong learning. It is challenging and demanding. With all this in mind, I am addressing a broad-based audience that includes young people considering a career in medicine, medical students, physicians who have completed their training (but not their education), and the general reader who has interest in and concern about the status of medical science and health care in the United States. I hope my perspective about medicine will be helpful to readers.

Many decisions that physicians make are dependent upon multiple factors in individual patients. The importance of acting, sometimes aggressively, can be crucial in affecting a patient’s outcome. By contrast, some situations are better managed by refraining to act, temporarily or permanently. These decisions require judgment, which comes from knowledge and experience. Because medicine is an uncertain art and full of complexities, quandaries abound. Thus, when to act and when to refrain are key aspects of doctors’ careers.

Part I, Mentors and Training, relates the story of how I became a physician. This stunning transformation is told in chronological order: medical school (chapter 1), internship and assistant residency (chapter 3), research training (chapter 4), and senior residency and fellowship (chapter 5). A background section is included recounting my early life (chapter 2). Board examinations and specialty societies describe completion of my formal training (chapter 6). An introduction to William Osler, mentor extraordinaire, and the humanities, both important in my life, are found in chapter 7. There is a section on microscopes, instruments that played an important part in Osler’s career and in mine.

Parts II and III deal with my experiences with patients and colleagues, respectively. Patient care is what medicine is all about. Colleagues, young and old, provided me the camaraderie and stimulus to pursue ongoing learning. In writing Parts I, II, and III, I point out instances along the way where when to act and when to refrain were pertinent.

Many of my colleagues long for the “old days” and feel we were lucky to come along when we did. They nostalgically proclaim this was the “Golden Age” of medicine and it will never be the same. Perhaps not. One can make a reasonable case for the last half century being a Golden Age of scientific medicine. Even now, however, advances in molecular genetics, immunology, and other areas of scientific endeavor continue at breakneck speed and pose huge opportunities and complicated challenges for society in the 21st century. Awareness of past successes and mistakes may help identify more of the former and limit repetition of the latter.

I have used real names of people cited in this book, except for patients. Writing for a heterogeneous audience entails some difficulty because of the necessity to employ medical and technical terminology. I’ve tried to explain these terms when feasible. This is particularly conspicuous in chapter 13, “Five Unusual Patients.” I hope the general reader will be able to glean the overall context about these patients and their findings. They, as well as many others, taught me a lot.