|
|
|
BOOK REVIEWS
| BIG DOCTORING IN AMERICA: PROFILES IN PRIMARY CARE. By Fitzhugh Mullan. Berkeley: University of California Press in conjunction with the Milbank Memorial Fund (a California/Milbank Book on Health and the Public), 2002. xx, 255 pp. Hardbound $29.95.
|
|
"Big Doctoring" is Fitzhugh Mullan's term for characterizing the practice of primary care medicine in the United States: "Big doctoring is what the generalist does: doctoring that embraces the whole person, that values comprehensiveness and continuity, that welcomes the richness and the complexity of the complete human being" (xi). He is a primary care physician, trained in pediatrics, at George Washington University in the District of Columbia, who says, "I am, by turns, puzzled, fascinated, and troubled by what is happening to health care in this country" (xi). A fervent believer in the central function provided by primary care professionals in the delivery of health services nationally, he set out "traveling the country" with a tape recorder "to understand how primary care practitioners viewed this tradition of doctoring, what these clinicians thought about their lives in medicine and their lives in general" (xv). He recorded 74 interviews—63 with primary care physicians, eight with nurse practitioners, and three with physician assistants. Called the Primary Care Oral History Collection, it has been deposited at the National Library of Medicine in Bethesda, Maryland. |
1
|
|
Fifteen of these 74 "profiles" are accessible in this book, bracketed by an introductory orientation, "Primary Care Roots," and a concluding chapter, "Building a Better Future: The Case for Primary Care." Eleven of these interviewees have M.D. degrees (although one is a non-practicing HMO executive in southern California), one is a Doctor of Osteopathy (and a dean at Ohio University in Athens), two are physician assistants, and one is a nurse practitioner. Nearly all were born before 1960, and most before 1950. Race and ethnicity are broadly represented, and nine of the 15 are women. Mullan readily acknowledges he is an advocate and his book is advocacy history with specific applications: "What do the lives and the experiences of current generalists tell us about recruiting, educating, and supporting future generations of generalists?" (xvii). His informants are lively and engaging colleagues who share his convictions about the satisfactions of their chosen vocations. He encouraged them to express the motivating values that drew them to primary care instead of more remunerative medical specialties. This book helpfully augments Recognitions: Doctors and Their Stories, edited by Carol Donley and Martin Kohn (Kent State University Press, 2002), where very few of the 18 narrators fit Mullan's definition of "Big Doctoring." |
2
|
|
From an oral historian's viewpoint, one wonders how Mullan's decision to remove his questions from his recorded exchanges affected the tenor of the first-person monologues he presents as texts. Likewise, by relying on a "snowball" strategy to locate prospective interviewees, asking one person to recommend another, his cast has many living in snowball country, Northern New England (not that I'm complaining) and only one living in a former Confederate state in the Old South. Moreover, one wonders how Beach Conger, M.D., of Windsor, Vermont, could have geographically placed the Vermont Law School, where his spouse earned her degree, as "about twenty miles south of Burlington" (67) when the actual distance via interstate highway exceeds 70 miles. One surmises Dr. Conger did not review his transcript, although each respondent was sent a copy to edit. Dr. Conger is described as a "Caretaker and Contrarian" (59), and many of the interviewees in this book can also be described as contrarians. (Not all contrarians live in Vermont.) One deduces that Mullan's choice of informants represents an individual mindset. |
3
|
|
Nonetheless, this volume usefully demonstrates how recorded voices of professionals on the front lines of health services during discouraging times, delivered with unyielding passion despite daily frustrations, can contribute to public understanding of the vital work they do. Additionally, as the fifth volume in the "California/Milbank Books on Health and the Public" series, it illustrates how the Milbank Memorial Fund as an endowed foundation can commission and disseminate oral history narratives as a means for fulfilling its stated purpose of contributing to more effective health policy. Here is oral history mobilized to help remedy a national disgrace. |
4
|
| |
|
| Charles T. Morrissey |
| Baylor College of Medicine (Houston) and Vermont College (Montpelier) |
|
Content in the History Cooperative database is intended for personal, noncommercial use only. You may not reproduce, publish, distribute, transmit, participate in the transfer or sale of, modify, create derivative works from, display, or in any way exploit the History Cooperative database in whole or in part without the written permission of the copyright holder.
|