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The story of two doctors, a father and son, who practiced in very different times and the evolution of the ethics that profoundly influence health care
As a practicing physician and longtime member of his hospital’s ethics committee, Dr. Barron Lerner thought he had heard it all. But in the mid-1990s, his father, an infectious diseases physician, told him a stunning story: he had physically placed his body over an end-stage patient who had stopped breathing, preventing his colleagues from performing cardiopulmonary resuscitation, even though CPR was the ethically and legally accepted thing to do. Over the next few years, the senior Dr. Lerner tried to speed the deaths of his seriously ill mother and mother-in-law to spare them further suffering.
These stories angered and alarmed the younger Dr. Lerner—an internist, historian of medicine, and bioethicist—who had rejected physician-based paternalism in favor of informed consent and patient autonomy. The Good Doctor is a fascinating and moving account of how Dr. Lerner came to terms with two very different images of his father: a revered clinician, teacher, and researcher who always put his patients first, but also a physician willing to “play God,” opposing the very revolution in patients' rights that his son was studying and teaching to his own medical students.
But the elder Dr. Lerner’s journals, which he had kept for decades, showed the son how the father’s outdated paternalism had grown out of a fierce devotion to patient-centered medicine, which was rapidly disappearing. And they raised questions: Are paternalistic doctors just relics, or should their expertise be used to overrule patients and families that make ill-advised choices? Does the growing use of personalized medicine—in which specific interventions may be best for specific patients—change the calculus between autonomy and paternalism? And how can we best use technologies that were invented to save lives but now too often prolong death? In an era of high-technology medicine, spiraling costs, and health-care reform, these questions could not be more relevant.
As his father slowly died of Parkinson’s disease, Barron Lerner faced these questions both personally and professionally. He found himself being pulled into his dad’s medical care, even though he had criticized his father for making medical decisions for his relatives. Did playing God—at least in some situations—actually make sense? Did doctors sometimes “know best”?
A timely and compelling story of one family’s engagement with medicine over the last half century, The Good Doctor is an important book for those who treat illness—and those who struggle to overcome it.
- Sales Rank: #866959 in Books
- Published on: 2015-05-26
- Released on: 2015-05-26
- Original language: English
- Number of items: 1
- Dimensions: 8.98" h x .68" w x 5.99" l, .0 pounds
- Binding: Paperback
- 240 pages
From Booklist
The private and professional lives of two doctors—father and son—are bared in this memoir of a medical family. The younger Dr. Lerner, an internist-historian-ethicist, reminisces and reflects on his father’s extreme devotion to the care of patients. The elder Lerner, an infectious-disease specialist, is portrayed as an old-school, benevolent MD with a take-charge approach. Dad is a practitioner of medical paternalism. Son stands up for patient autonomy. But while reading his father’s personal journals years later, the younger Lerner becomes aware of the congruity between parenting and doctoring: “knowing when to insist on something and knowing when to let go.” He wonders if contemporary medicine has become “too democratized.” Ethical issues—medical futility, informed consent, rationing of medical resources, truth telling, medical errors, and overreliance on testing and technology—are depicted as complex and often controversial. Despite their differing perspectives and generational gap, these two doctors are in complete agreement about the paramount importance of the physician-patient relationship and the necessity of humanism in the medical profession. --Tony Miksanek
Review
“Exquisitely insightful... The Good Doctor poses a fundamental riddle faced by every historian: How can we question the decisions and attitudes of our forebears without having experienced the contexts that shaped them? It makes for a particularly compelling discussion when the players are father and son, sharing as their lives’ work an ethically charged, ever-changing profession.”
—New York Times
“Barron Lerner’s marvelous book—a deeply intimate story about his father and the practice of medicine—touches on some of the most profound issues in medicine today: autonomy, medical wisdom, empathy, paternalism and the evolving roles of the doctor and patient. This is one of the most thoughtful and provocative books that I have read in a long time, and I suspect that generations of doctors and patients will find it just as thought provoking.”
—Siddhartha Mukherjee, author of The Emperor of All Maladies
“The Good Doctor is a lovely book and a loving book; it's a book about medicine and family and ethics and history which embraces complexity and speaks to all those subjects with wide-ranging compassion and great good sense. And it's a father-son doctor saga with much to say about the healing power of story and understanding.”
—Perri Klass, MD, author of A Not Entirely Benign Procedure and The Mercy Rule
“An absolutely compelling treatise on bioethics told thru the lens of a physician's relationship with his physician father. If you want to understand the modern state of ethics in medicine, read this book.”
—Mehmet Oz, MD, Professor and Vice Chair, Surgery NY Presbyterian/Columbia
“A heartwarming story about a father-son doctor duo spanning a century, exquisitely showing the evolution of medical practice from antibiotics through bioethics. A small gem of a book.”
—Samuel Shem, MD, author of The House of God and The Spirit of the Place
“The younger Lerner is occasionally shocked by his father’s belief that his intimate knowledge of his patients and their diseases gave him insight and authority on what was best for them, including the proper time to stop treatment and allow a patient to die. Yet Lerner does more than criticize; he thoughtfully examines the case for both ways of practicing medicine, and in many ways the book is a tribute as much as a critique. Perhaps, Lerner argues, there is an appropriate middle ground behind the father’s art of care and the son’s.”
—Health Affairs
From the Hardcover edition.
About the Author
Barron Lerner is the author of four previous books on medicine and a frequent contributor to the New York Times’ Well column, TheAtlantic.com, Huffington Post, and several blogs. He lives in Westchester County, New York, and is a bioethicist, historian of medicine, and internist at New York University’s Langone School of Medicine.
Most helpful customer reviews
9 of 9 people found the following review helpful.
Two good doctors; one provocative history
By Richard F. Silver
Barron Lerner’s wonderful book is, at heart, a love story. Based on the relationship between a father and son who are both physicians, it also details their shared love for the science of medicine and the personal relationships involved in its practice. Although it is a deeply personal story, it touches a wide range of issues in post-World War II American medicine and culture—the changing philosophies of medical education, the emergence of the concepts of patient rights and autonomy, the concerns raised by the roles of administrators and bureaucracy in the practice of medicine, and even the changing sense of Jewish identity within a largely assimilated family of children and grandchildren of immigrants. The closing chapters challenge the author to consider that there may be exceptions to the ethical certainties of the doctor/patient relationship that he has presented to his students for many years. Indeed, the poignant image of the elder Dr. Lerner as an increasingly debilitated resident of the very nursing home for which he was once Medical Director provides a reminder: that “doctors” and “patients” are not distinct populations, but rather colleagues in their shared humanity. In revealing this family history, the “second” Dr. Lerner provides insight into the evolution of medicine as seen “From Both Sides, Now”. As in the song, he’s learned that “something’s lost, but something’s gained”. In doing so, he provides a provocative message for those who ponder the future of American medicine.
15 of 17 people found the following review helpful.
Memoir of a family's life in medicine. More about case studies than medical ethics
By Quickbeam
Pretty quickly I realized that I am not the target audience for this book; I have been an RN and a clinical nurse specialist for 30 years. Medical ethics are the stuff of day to day life for the practitioner. I've also seen the shift from Dr. Phillip Lerner's generation to Dr. Barron Lerner's generation in my practice years. I think this book is far more geared to a lay audience than me.
The author spends a lot of time painting a portrait of his family and this works for me. His extended family comes through the pages clearly and warmly. Unfortunately, Dr. Lerner is predisposed to a staggering amount of name dropping. I don't think this was necessary to establish his father's credibility or his own. I liked the examples of how the father and some would handle similar situations differently. The withholding of diagnosis from the patient is a concept we are well rid of. Unfortunately, the new age has brought with it a failure to assist; patients are given information and told "it is your decision" when the complexity may be beyond them. I think many of the cases provided do a nice job of highlighting where we've evolved.
For me the historical arrogance of this profession is evident in both the actions of the father and son. It seems hard for the author to accept that the vaunted, near divine position that MDs once held in the community is a memory. Is that a good thing? it probably depends on what side of the fence you are on. In my practice I find that MDs are in general more respectful of the rest of the health care team than they once were. You wouldn't know it from Lerner but today the person holding your hand and standing up for your health care integrity is as likely to be a nurse or other professional. The book mentions that Dr. Phillip Lerner used the nurses at the hospital to watch his children when he did rounds. It gave me a chuckle; try that today.
If you can put aside the aura of privilege that is infused into this book, you may quite like the discussion of patient outcomes and changing times presented. Almost anyone who reads this book can flash back to the care of a loved one or family member and relate to the examples. If you want to know where physician philosophies have evolved over the last 60 years, this might be an interesting read for you.
8 of 9 people found the following review helpful.
Thought provoking discussion of the evolution of medical ethical issues for practitioners, patients and their families
By Lee B.
After hearing Barron Lerner give a lecture on this subject in 2013, I had been eagerly awaiting the publication of his book. It did not disappoint. Anyone looking for easy answers to the complex ethical questions raised in the book will go away unsatisfied. Rather, what the book does is present these questions in a deeply personal light and in a way that is tractable to the lay person. As such, the reader is left with the context to explore questions which, whether doctor or patient (or both), ultimately impact all of us.
Lerner details his own career in medicine and that of his father, Phil Lerner. The two have much in common: both became accomplished physicians who eschewed the more conventional path of a private practice, both were dedicated to their patients, and both focused on delivering the best medical care possible while engaging in research to advance the medical field. The differences in their careers largely derive from the different historical contexts in which they were trained and in which they practiced medicine. The elder Dr. Lerner practiced in the paternalistic era of medicine in which “doctors knew best”, routinely withheld information from their patients, and made unilateral treatment decisions on behalf of those patients. His son became a doctor in a different era, when the doctor-patient relationship was evolving to one in which patients are now more informed about and involved in decisions related to their care.
The differences in their careers would make for an interesting story by itself. What makes this book so compelling is that studying and understanding those differences within the larger practice of medicine has been a focus of Barron Lerner’s career as a physician, medical historian and bioethicist. Rather than just presenting a series of abstract cases in which ethical questions regarding medical practice are exposed, Barron Lerner draws on several of his father’s actual cases to frame these questions. The cases he describes often involved difficult decisions surrounding end-of-life care, and in some cases the patients were close relatives of the Lerners. As the younger Lerner is forced to confront, question and ultimately reject some of the ways in which medicine was practiced in his father’s era, he is both contributing to the advancement of the field of medical ethics while at the same time engaging in a very personal journey.
What the author shared in this book is just the tip of the iceberg. I know from his lecture that there were other challenging cases that he drew upon for his research, and undoubtedly his father’s journals contained far more than that. I was left wanting to read more, but the decision of what to include and what to leave out, and what makes a good book, was undoubtedly better left to the author and his editor. The bottom line is that I came away learning a lot. This is a well-written, easy-to-read and thought-provoking book that is well worth the read.
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