Let Me Heal: The Opportunity to Preserve Excellence in American Medicine

Abstract

Kenneth M. Ludmerer, MD. 431 pages. New York: Oxford University Press; 2015. Hardcover: US $34.95; ISBN 978-0-19-974454-1. Available from Oxford University Press, Amazon.com, and BarnesandNoble.com. Field of Medicine: Residency training in America Format: Hardcover book. Trim size: 6½ × 9½ inches Recommended Readership: Anyone interested in or involved with medical education and patient care in America Purpose: To provide the first-ever account of the residency system for training doctors in the United States Content: There are 334 pages of text and 13 chapters that trace residency training in America from its 19th-century roots through its present-day struggles with bureaucratic work-hour regulations for house officers. The book focuses on the experience of being a resident, on how that experience has changed over the years, and on the extent to which the current training system meets its obligation to produce competent doctors. Especially well done is Kenneth Ludmerer's discussion of the intensely emotional and divisive controversy regarding resident work-hour limits. He argues convincingly that the evidence linking patient safety to residents' workload and to the quality of supervision they receive is much stronger than the evidence linking patient safety to residents' fatigue from long work hours. In addition, he emphasizes that the current imposition of rigid work rules does not allow house officers enough time to complete their responsibilities. This deprives residents of the opportunity to establish meaningful bonds with their patients, to learn the natural history of disease, and to acquire the knowledge and skills necessary to perform their specialties well. By contrast, Ludmerer cites 2 relatively recent experimental models of residency training in internal medicine that successfully coped with many of the current harmful trends in medical education. One of the programs took place at Faulkner Hospital in Boston, the other at Johns Hopkins Bayview Center in Baltimore. In both models, the number of patients assigned to each resident was cut in half. The reduced census enabled residents to spend more time with their patients, make home visits, participate in teaching sessions, and work with mentors to improve their history-taking, counseling, and ability to create individualized treatment plans. They also had more time to read, reflect, and find new meaning in their work. Ludmerer points out that our country's commercialized system of patient care endangers the education of tomorrow's doctors and gives lip service to patient-centered care. Moreover, residents are acquiring habits and approaches to patient care in which tests and procedures are often obtained simply because they are available, not because they are needed. Residents are also learning in an environment that encourages doctors to see as many patients as possible in the shortest amount of time, which prevents a substantial number of patients from receiving the care, thought, and attention that they deserve and need. The book has a table of contents, a preface, and acknowledgments. Following the text are 74 pages of extensive notes on the preface and 13 chapters, and it all culminates in a 20-page index. Strengths: If ever there was a treasure-trove of information on residency training in America, this book is it. Every page offers something worthwhile and memorable. The writing is clear and captivating. Particularly impressive are the quality of the research and the meticulous manner in which Ludmerer presents his results. For these reasons—together with the unquestionable importance of the subject covered—I consider this book to be a prime candidate for the Pulitzer Prize. Weaknesses: None Overall Grade: