Healing the Wounds: A Physician Looks at His Work by David Hilfiker MD (Pantheon Books: $14.95).
Though his autobiography often reads like a medical Western, we believe David Hilfiker when he says he began practicing medicine not for material gain but "to alleviate humanity's suffering."
We quickly see how the demands of a general family practice in a rural clinic, located five hours from Duluth, Minn., began to erode his idealism. Treating 4,000 souls for both minor and major illnesses turned his life into a "pressure cooker."
In a single day, Hilfiker records losing a man to cardiac arrest, prescribing aspirin for an infant in the hope its 104-degree temperature wasn't a symptom of meningitis and telling a mother that her child, dredged from a lake, was dead despite intensive resuscitation efforts.
He also refused an irate woman's demand for Valium. And, returning home late to a warmed-over supper, he fervently prayed that an obstetrical patient's overdue baby wouldn't arrive that night.
Wrestling with an over-scrupulous conscience, Hilfiker admits not only to his own mistakes, but he also examines what he considers serious flaws in current medical ethics.
The elderly, chronically ill or mentally retarded, he says, get short shrift from our system; often, they "fail to receive the same level of aggressive medical evaluation" as other patients.
Hilfiker is also uneasy with medicine's economic structure. Doctors sometimes perform expensive procedures to earn higher fees, and Hilfiker too found himself being swayed by considerations of money. Though his $40,000 salary was modest when compared to the median $105,000 physicians earned in 1983, it proved an embarrassment when weighed against the amount earned by his indispensable nurse and other clinic workers.
Ultimately, when his practice became dehumanizing in a "drive for efficiency and productivity," Hilfiker took a self-prescribed sabbatical, returning recently to practice among indigents in a religious community in Washington, D.C.
His decision doesn't offer solutions to the crisis in American medicine, but "Healing the Wounds," an engagingly written and unflinchingly honest book, helps us understand Hilfiker's own and other doctors' difficult choices and dilemmas.