by Robert A. Scott
At many colleges and universities, up to one-third of entering students declare their interest in pre-med and from 7-10% of college graduates enroll in medical school. Add in those who apply to dental, nursing, and veterinary schools each year, and a large proportion of baccalaureate candidates are pursuing healthcare careers. For these students, as well as those enrolled in related health professions as undergraduates, the Cardiologist Henry Greenberg’s book should be required reading.
“No Ordinary Doctor, No Ordinary Time” is more than a doctor’s reminiscing about his career in medicine. It is a review of the transformation of the doctor-patient relationship, the growth of specializations, the social determinants of health, the role of science in the art of medicine, advances in the surgery of organs and joints, the growth in chronic diseases, and lifestyle choices of physicians who choose the Emergency Room or Dermatology for their predictable hours. It is about the most dramatic transformation of all: reaching old age.
Dr. Greenberg posits that his career began when medical care was close to the 19th century in its capacity and entered the 21st century within several decades and, he adds, that the coming transformations will continue to be just as exciting and expensive.
The book is organized by time and topic. This includes the evolution of emergency medicine and some medical history. Interesting topics also include the role of mentors; the joy of working on research teams; vignettes from clinical practice and community health centers; the centrality of clinical diagnosis; and the epidemics of Alzheimer’s Disease; HIV/AIDS; and global chronic diseases such as obesity, diabetes, heart and coronary disease, kidney and lung disease, and smoking. Other chapters cover public health, scientific organizations focused on health, clinical research, human rights, serving as a scholar, ethical dilemmas, and both studying and practicing medicine in multiple countries and cultures.
Among the fascinating discussions in the book are those that trace the role of the physician from more passive observer with few options to aggressive interventionist armed with multiple technologies and options, even at neighborhood storefronts. These new roles include obligations to inform patients and their advocates about alternative courses of action. These changes in the physician’s role are in parallel to the change from physician as paternalistic expert to the patient as autonomous actor in shared decision-making. The essential role of nurses is emphasized.
Dr. Greenberg also tracks the arc of clinical care from personal relations to depersonalized and virtual interactions and to new roles as “Hospitalists” and Deliverists,” a new clinical category in OB-GYN. These terms seem to emphasize the separation of the expert from his or her patients and purpose. Furthermore, the growth in specialties begs the question of who will manage a patient’s overall care.
An important subject of discussion is the separation of clinical care, healthcare policy, population health, and the pharmaceutical industry. There seem to be few incentives for these four to be mutually supportive. Our healthcare system focuses on the treatment of individual patients by individual doctors, so the health insurance system focuses on individual medications instead of on population indicators and the social determinants of health. We have the capacity to benefit from experimental empirical learning and clinical reasoning based on observation, but the system lacks incentives that would be available in a universal healthcare system.
One of the social determinants of health that stands out in reading “No Ordinary Doctor, No Ordinary Time” is obesity in the U.S. and around the world. While our nation’s experience with obesity is visible daily, as nearly 50% of people are obese, the consequences are not so apparent.
According to Dr. Greenberg, up to 25% of healthcare costs are related to obesity. These consequences include Type 2 Diabetes, heart disease, cancer, liver failure, hip and knee replacements, and wheelchair dependency, among others. What is even less apparent is the relationship between federal government corn/fructose sugar subsidies and childhood obesity leading to a lifetime of illness and disease. Instead, we could use crop subsidies to foster good nutrition and better health outcomes.
This is a readable book full of interesting facts, stories, histories, and observations. It is a history of medicine as well as the memoir of a practitioner. He accomplishes both with humility and humor.
I am impressed by how Dr. Greenberg was able to manage medical school and medical practice while at the same time taking advantage of opportunities for research and international clinical practice, including service in the Peace Corps. The title, “No Ordinary Doctor,” may seem arrogant, but this is not the conclusion one draws from the book. He is not an “Ordinary Doctor” in the modern sense of the expert facing away from the patient and writing on a computer. He is patient-centered, clinically observant, and scientifically grounded. Dr. Greenberg had the mindset and personality to take advantage of his time, which, because of the advances in diagnosis, clinical knowledge, and technologies, was certainly “no ordinary time.”
This book should be available to every student interested in the health professions, healthcare policy, and health institution leadership. They all will be better professionals and citizens because of it.
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