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    One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine
    One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine
    One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine
    Audiobook15 hours

    One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

    Written by Brendan Reilly, MD

    Narrated by Rob Shapiro

    4.5/5

    ()

    About this audiobook

    An epic story told by a unique voice in Ameri­can medicine, One Doctor describes life-changing experiences in the career of a distinguished physi­cian. In riveting first-person prose, Dr. Brendan Reilly takes us to the front lines of medicine today. Whipsawed by daily crises and frustra­tions, Reilly must deal with several daunting challenges simultaneously: the extraordinary patients under his care on the teeming wards of a renowned teaching hospital; the life-threatening illnesses of both of his ninety-year-old parents; and the tragic memory of a cold case from long ago that haunts him still. As Reilly's patients and their families survive close calls, struggle with heartrending decisions, and confront the limits of medicine's power to cure, One Doctor lays bare a fragmented, depersonal­ized, business-driven health-care system where real caring is hard to find. Every day, Reilly sees patients who fall through the cracks and suffer harm because they lack one doctor who knows them well and relentlessly advocates for their best interests.

    Filled with fascinating characters in New York City and rural New England-people with dark secrets, mysterious illnesses, impos­sible dreams, and many kinds of courage-One Doctor tells their stories with sensitivity and empathy, reminding us of professional values once held dear by all physicians. But medicine has changed enormously during Reilly's career, for both better and worse, and One Doctor is a cautionary tale about those changes. It is also a hopeful, inspiring account of medicine's poten­tial to improve people's lives, Reilly's quest to understand the "truth" about doctoring, and a moving testament to the difference one doctor can make.
    LanguageEnglish
    PublisherTantor Media, Inc
    Release dateJan 7, 2014
    ISBN9781452688817
    One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

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    Reviews for One Doctor

    4.5/5

    46 ratings14 reviews

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    • 5/5
      Fantastic. Enjoyable for anyone. Such a compassionate and scrupulous doctor.
    • 5/5
      Excellent listen, the stories are captivating and are real eye openers about the struggle and privilege of being a physician. There will always be long days, late nights, moments of regret, high highs and low lows. But nothing amounts to the trust and relationships physicians are bestowed. Well done Dr. Reilly.
    • 5/5
      I really liked ths book. Dr. Reilly is an experienced, thoughful, and intelligent physician. He allows us to see into his occupation and his head. After he discusses his cases he provides his thoughts on policy and present practice. I learned alot about how medical doctors think and about their jobs. This also helped me to see my role as a decision maker regarding the care appropriate for myself and my relatives.
    • 5/5
      Narrator was superb. Story even better. A candid peek at what doctors really struggle with day-to-day in their work and lives. I also really loved the detailed depiction of common and not so common disorders. Well done.
    • 5/5
      Couldn’t stop listening. Rob Shapiro is a brilliant reader. I now want to listen to every book he reads!
    • 5/5
      A very personal account written by an "old-fashioned" doctor who takes us into his world (both personal and professional). Dr. Reilly explains a lot about the state of the healthcare system and what works and what really could be improved.
    • 5/5
      Slice of life story by a doctor involved in taking care of very sick patients at a major NYC hospital. Reilly contrasts this with the historical model in which a doctor followed a patient both in and out of the hospital, in sickness and in health, thus gaining vital information that can affect diagnosis and treatment (and cause really bad results when it’s absent). I enjoyed his stories and reflections on the flaws that the benefits of modern medicine and the profit motive have generated.
    • 4/5
      Brendan Reilly an internist with 40 years of experience practicing medicine divides this memoir into three sections, Now, Then, and Now. In the two Now sections he discusses in real time from his personal view point, his experiences on call in New York City Hospital over a couple of days (the second Now section taking place a few weeks after the first). While dealing with seriously ill patients, and trying to diagnose patients with mystery conditions, he must also deal with his elderly parents who are facing end of life decisions themselves, his father blind and in the terminal phase of bladder cancer, his mother suffering dementia with a heart that is slowing down. In the Then section, Reilly discusses some of his experiences when he first began to practice medicine making house calls in rural Vermont. He focuses on a husband and wife whose diagnoses and treatments he is still second-guessing himself about all these years later. I loved the stories of the process he goes through in arriving at a diagnosis. His pacing is perfect, and many of his experiences read like a medical mystery.Interspersed with his personal stories are discussions of many of the historical, ethical, financial, and other issues facing the practice of medicine. One overriding point I took from the book is that many people today who think they have adequate health care don't have "one doctor" in overall charge of their health care. Despite health care becoming more and more complex, there is frequently no continuity of care, as various specialist handle only their specialty. This can also raise problems since many hospitals today rely on hospitalists, and our primary care doctors do not provide in-hospital care to their patients. There is sometimes a lack of communication such that hospitalists sometimes have to diagnose and treat in a vacuum.Another thing I learned from this book is that there are many, many things I never knew about that can kill you as you get older. Oh Well.Recommended.3 1/2 stars
    • 5/5
      A throwback philosophy to the times when Doctors made house calls, and KNEW their patients. Reilly makes the case that Doctors today could do a much better job of tending to their patients' needs if they could take the time to actually follow their patients' lives.Reilly is on staff at a large metropolitan hospital, and we follow him on his rounds. But, as he visits the various patients, he inserts his thoughts about the larger issues in medicine today.Immensely readable. I recommend this to everyone
    • 4/5
      Each of us needs to have at least one doctor who knows us well.
    • 4/5
      Very interesting, wide ranging, very personal view of medicine. Dr Reilly does not spare anyone, even himself, in this view of how medicine works now. It is both an overview of his history in medical practice and an overview of how medical practice has changed in his lifetime. It makes me wish for a closer relationship with my doctor, one that is not possible in the 5-10 minute slots she has to see each patient.
    • 4/5
      "For centuries, medicine had been considered more than a “helping profession,” it was a vocation, akin in many respects to religious ministry. But, in our increasingly secularized society, even the (non-religious) “Samaritan” role of doctors – empathizing with and helping others, has been devalued, sometimes even ridiculed in the ascendant business culture of medicine. This new culture has even changed our vocabulary. Doctors and nurses have become “providers” of medical care, itself now a “commodity.” Patients have become “customers,” the “consumers” of medical care.” One of my long-term reading goals is to read more books about medicine, specifically more about doctors. NielsenGW had posted an excellent review of this book on his thread of this one and I immediately requested it from my library. This book was just what I wanted: a look inside the mind and heart of a doctor. Dr. Brendan Reilly, the senior attending physician at New York Presbyterian teaching hospital, takes us with him through a few weeks in the not-so-recent past of seeing patients. There is a real-time moment to moment “you are there” feel to the patients and cases presented. In contrast to popular shows like “House,” where it seems the doctors get to focus on one (or maybe two) hard to diagnose and/or treat patients, Dr. Reilly and his team of interns are faced with multiple patients, and multiple decisions to make, in a short period of time. They seem to, quite literally, bounce from one patient – and one decision - to another. It’s not always easy to decide what is best for the patient; one course of action may cause more hurt than harm – every course of action has its drawbacks - but no action at all may have fatal consequences.We bounce this around, too, decide to try this, then that, we’ll see. …. On days like this, doctoring feels like pinball: nonstop random events – intercepted here, altered there, prolonged or postponed by this or that, the bells and boinks sounding all around – and sometimes you can’t be sure whether you’re the guy pushing the buttons, manipulating the levers, and bumping the machine, or whether you’re inside the machine, whether you’re the pinball itself.”Dr. Reilly talks a lot about decision making, a subject he has researched himself, and the “intuitiveness” a doctor develops over time. As advanced as our medical technology is, there are still things CTs, MRIs, and EKGs can miss. Even a simple test can come back “inconclusive,” or with a “false/positive or negative” result. A sharp doctor will rely on his intuition and experience, not solely on lab results. It takes a lot of courage to do so. Missing something can be just as devastating to patient care as testing for something that doesn’t exist. We want our doctors to be perfect – and any doctor, I’m sure, wants to be right 100% of the time. Simply put, doctors are human and make mistakes. That’s another point Reilly brings up: doctors need to learn from their mistakes, certainly most doctors do, but so often, they’re afraid to even confess to themselves that they’ve even made a mistake. When they do have the courage to face an error, there seems to be nowhere to go for support. Reilly quotes Dr. David Hilfiker’s article, “Facing Our Mistakes” in the New England Journal of Medicine:“There is no permission given to talk about errors, no way of venting emotional responses. Indeed … I lapse into neurotic behavior to deal with my anxiety and guilt. Little wonder that physicians are … defensive about our judgments … blame the patient or the previous physician when things go wrong … yell at nurses for our mistakes … have such high rates of alcoholism, drug addiction, and suicide. At some point we … need to find healthy ways to deal with our emotional responses to those errors.”The main focus of Reilly’s is not inevitable medical error, though, but a lack of general practitioners, those old-fashioned doctors who get to know their patients well. There’s an inherent risk, Reilly argues, for patients who lack a primary care physician, the one doctor who has a better view of a patient’s big picture of health. A “perpetual intern” (according to his wife), Reilly practices what he preaches. During rounds at New York Presbyterian, a patient asked Dr. Reilly who her doctor would be over the weekend. “I told her that I cover my own weekends, because, if you’re sick enough to be a patient in the hospital, it’s safer if you’re seen every day by the doctor who knows you best.” He goes on to point out the risks of hospitalized patients being cared for by doctors who don’t know them:“… the early recognition of delirium – by definition an acute change in the patient’s mental status – requires familiarity with the patient’s usual mental status. In acute care hospitals, where so many patients are cared for by doctors and nurses who have never met them before, hospital staff will be far less likely to recognize the telltale changes in affect or behavior that herald the onset of delirium. Worse, when elderly hospitalized patients develop florid delirium – agitated, wandering, disruptive behavior – hospital staff often assume that the patient has dementia (that is, long standing irreversible cognitive impairment). A vicious cycle then ensues. Psychoactive drugs … are given to calm the “demented” patient’s agitation, which drugs often only make the patient’s delirium worse… It happens all the time.”Old fashioned general practitioners seem to be a dying breed; more med students are choosing to specialize because that’s where the money is. There is quite a disparity between the compensation a general practitioner receives for his/her service and the rate of pay a specialist receives. While nobody can argue that specialists aren’t necessary, for they certainly are, a general practitioner is just as necessary, Reilly argues, so why shouldn’t they be paid the same? It’s our business model of medicine that Reilly seems to be bothered by. The reason more med students choose to specialize is pretty apparent – and practical, when you consider the costs of medical school and how indebted a new doctor finds himself upon graduation. But, a human body cannot be divided into bits and pieces; everything needs to work together and without that one doctor who knows a patient well, who has a big picture view of his/her patient, a patient’s healthcare may suffer. I really enjoyed this book and am very glad to have read it but I do have some complaints. The flaws Reilly points out in our present day healthcare system, the human side and the business side, are made very clearly without offering any clear solutions. The writing here bounces around heavily from present, to past, to present, to past, with a discourse on decision making or healthcare insurance, etc. (depending on the chapter) inserted between all this, made it hard to follow at times. For instance, if I was “going” with Dr. Reilly to see Mr. X, a hospitalized patient during his rounds at New York Presbyterian, it may take us quite a few pages to get there! By the time “we” got there, I was thinking “Now, who is this guy again and what’s his problem?” As a trained medical coder, I had no problem with the medical terminology included here, but readers without a background in medical terminology may find themselves a bit stymied at times since Dr. Reilly (usually) doesn’t explain them. One Doctor is not a long book, I was never bored, and finished it in less than week but there seems to be so much information here and so much Dr. Reilly wants to talk about it seemed like it was hard to see the forest for the trees, so to speak. My diagnosis: 4 1/2 stars. Highly recommended.
    • 4/5
      Medicine is simultaneously one of the most rewarding and heart-breaking fields to work in. Every day, millions of physicians are tasked with managing the livelihoods of countless injured or sick patients. They can have an infinite number of backgrounds and come in with a dizzying array of issues. In relatively little time, they have to assess their patient, diagnose them, and pursue a course of treatment that takes many factors into account. I do not envy them one bit, but neither do I bemoan their profession or their pay. Brendan Reilly’s One Doctor gives us a peek into a two-week window of the life of a primary care physician and his team at New York Presbyterian Hospital.Dr. Reilly, normally a hospital administrator, is on a two-week rotation at New York Presbyterian. He readily admits that he is a dinosaur in the field of medicine, a 60ish internist. Nowadays many doctors are pushed to become specialists (because, apparently, that’s where the money is). He tries to get a complete picture of each patient and then use an entire body of symptoms to diagnose and treat. The members of his training team are each on their way to different fields, but still try to learn from each other. In many ways this book is like an episode of House but without all the drug use and incessant snarkiness. While some of the cases presented are easily worked, many involve a complicated mixture of testing, medical history, and personal experience. Reilly’s tales cover the entirety of the human condition. There is sadness, relief, joy, bewilderment, life, and, yes, death. When you treat a person for the first time, everything they’ve ever gone through has brought them to that moment, and the doctor has to comb through all that to properly treat them. The author also goes into details about how modern hospitals and health care regulations have shaped the field of medicine and how that affects patients. Luckily, he a scientist at heart and all this statistics and assertions are supported by bibliographic notes. Like everyone else, he is frustrated at the current condition of medicine, one that values money over mankind, but in the end, he tries his hardest to treat everyone fairly and respectfully. I found this book to be very illuminating and not overly schlocky. It’s a bit thick, but you’ll get absorbed in each case fairly quickly. An enlighening read.
    • 5/5
      This book reads like part House, part Grey’s Anatomy and part diary, yet much, much more informative. By bringing us into his every day life and meeting his various patients at New York Presbyterian Hospital’s emergency department, Dr. Brendan Reilly explains, by example, why US healthcare, or more precise, ER care, has evolved into the complicated, hard-to-navigate maze that we see today; why most young med school graduates decide to to become specialists instead of primary physicians, which our country desperately needs.

      The title, One Doctor, was used. Due to the regulation and involvement of the health insurance industry, most of us do not have a doctor who deeply concerns about us, who knows us well, who rallies for the right care in our behalf. On the other hand, we all have a battery of specialists. We have a cardiologist for our heart, a rheumatogist for our arthritis, an urologist for our prostates...and so on. Specialists make much more money, and where we are referred to once our ailment is out of our primary care’s scope. But, they usually do not know our complete health history since they only focus on a specific part of us. Dr. Reilly claimed that the patient with the one doctor that truly care for him, follows him over time and know him well would win this rat race of so-called American healthcare. It’s the difference between life and death sometimes…or worse, between death and insufferable life.

      Sometimes when a patient or family says, “Do everything for me, doctor,” it unnecessarily that they want to try everything possible to live. Sometimes they do not want to hurt the family members who can’t let go, or they’re scared, or they have no idea hanging on could be worse than death. It’s the doctor, a good doctor’s job to find out what these patients really want, since some scenarios can be really worse than death. We all have a different trade-off limit between how much we are willing to suffer to prolong our life, it’s also a responsible doctor’s job to find out. From the various cases we encounter along with Dr. Reilly, we acquire a better understanding of the end of life, terminal illness, palliative care (which is not used enough), the quality of life, letting go, who to assign as surrogate and all other choices we might face in the future which we most likely never prepared ourselves for. We also will learn about the not perfect, but needed advanced directives as well.

      As Dr. Reilly stated, “Most of the sad stories happen when this process doesn’t start until it’s too late. That’s how all those folks wind up comatose in nursing home and intensive care units, fogged with drugs and flogged by machines, not a prayer of getting better. It’s a living hell—and the only hyperbole in that phrase is the ‘living’ part.”

      Dr. Reilly is a brilliant storyteller and great writer, and also a rare doctor that deeply cares for his patients. I can feel his real concern and love for life and the world. I could also feel the empathy he has for his patients and their families by reading the way he put his thoughts on paper. Several of these stories were deeply moving: Mr. Gunther, who endured a progressive form of cancer earlier in life who now faces another one; Mr. Atkins with a rapidly progressive terminal illness, who does not have time to prepare his family for his death; Ms. Rhodik, who refused to speak, but her family’s decisions are endangering her health. Others were down right disturbing: Fred, who decided that “losing his marbles” was never an option…and many more. We also learn about the cost of a misdiagnosis, as well as the cost of doing too much.

      This is a deeply moving book with many though-provoking stories, and lots of useful information from a good and genuinely caring doctor who has over 40 years of experience. Read this book, for your elders, for yourself, for your children…and for the hope of a better health care system in the near future. This book will make you a better patient, advocate, caretaker, healthcare consumer and....human.

      Thanks to Netgalley and the publisher for providing an advance reading copy.