‘What’s Wrong with Doctors’

To the Editors:

Richard Horton’s interesting review of Jerome Groopman’s book on what’s wrong with doctors [NYR, May 31] suggests that Groopman has built his case on pure anecdotal evidence. I spent five years as a medical resident and research fellow at Memorial Sloan-Kettering Hospital in New York City and I can testify that I never, I mean never, witnessed a single patient needing and seeking care being abandoned by the medical staff, which would have been the antithesis of the hospital’s policy. I also wonder how Groopman’s example of a neglected cancer patient could have escaped the weekly conferences where every patient submitted to chemotherapy is lengthily discussed and where decisions are collegially made about what might be the best therapeutic or palliative option.

The second case is even more surprising. It happens that I had a very dear friend in New York who was in her fifties and had been treated for years in New York Hospital for an interstitial cystitis. Finally a cystoscopy was made and showed an invasive bladder cancer. She called me up in Paris to ask my advice. I told her to go to Memorial Sloan-Kettering, which she did. A surgical removal of the bladder was performed. She had a continent urinary diversion and had to empty the artificial internal pouch with a catheter at regular intervals throughout the day. She spoke highly of the warm, compassionate care she received. Although incurable, she could call up the hospital day and night and consult a physician who was acquainted with her medical record. She was deeply thankful for my suggestion. She died two years later on Christmas Day in Memorial Hospital.

Lucien R. Karhausen, M.D.

Paris, France

To the Editors:

In their long-overdue examination of what is wrong with American physicians [“What’s Wrong with Doctors,” NYR, May 31], neither Dr. Horton nor Dr. Groopman thinks to ask the one group of professionals which could actually help them out—nurses. Go to any hospital and ask who the good doctors are, and who are the ones to run screaming from; no physician will tell you, but nurses will. Having been a nurse for thirty years, I’ve worked in large teaching hospitals and tiny community hospitals, and I’ve dealt with the kind of mistakes in thinking that Dr. Groopman describes. And daily I have to couch my suggestions for fixing problems in a way as to not offend the physician’s ego so much that he or (less frequently) she won’t get annoyed and take the course opposite to the one that I recommend. Medicine is the last business in America where you can throw temper tantrums and be offensive to your clients (patients and nurses) and still get away with it. Physicians still need to heal themselves.

Jane M. Jordan