In Things I Didn’t Learn in Medical School: Tough Lessons from a Lifetime of Practice , Dr Gary Fanning speaks directly to readers about the behavior he recommends for physicians to maintain the respect of the public. Although we should have learned some of his moral principles in grade school, high school, or certainly by college, his many illustrative stories depict physicians, other healthcare workers, and/or patients who either did not learn them or chose to ignore them. He says the book pertains mainly to those entering the medical profession or other healthcare professions, but others can learn from his experiences as well. Each of the 14 chapters in the book begins with excellent and relevant quotes from famous people.
The “Introduction” and “Who Am I” chapters offer a description of Gary Fanning’s background, providing insights into where he is coming from when he stresses his philosophies concerning hand washing, alcoholism, drug use, and infidelity, the latter in a chapter entitled “Ignore Your Gonads.” His family, his mentors in school, and especially his Episcopalian minister influenced his ideas. Many readers will recall experiences similar to his and accounts of similar untoward incidents. For example, training hospitals in which operating room pharmacies have not implemented programs to confirm that returned drugs and controlled substances are what they are supposed to be may lose a resident a year to a drug problem.
I am especially glad he wrote a chapter about respect for fellow human beings. He includes respect for patients’ rights to accept or refuse a prescribed treatment. He reminds us that we are not gods and should treat those nonphysicians with whom we work with respect as well as our fellow physicians even when we disagree with them. As an anesthesiologist for more than 50 yr, I too have observed too many incidences of disrespect.
He strongly opposes government telling physicians how to practice medicine or interfering with the doctor–patient relationship, nor does he have any love for insurance companies. Dr Fanning says the practice of medicine is a business, and physicians should be fairly compensated for their work. Therefore, physicians in training should have some courses in economics. In the chapter on “Medical Original Investigations,” he includes valuable stories to illustrate his points.
In the chapter entitled “Medical–Legal Issues,” he tells of his own experiences with lawsuits, offers ideas about how the system can be improved, and concludes with some worthwhile advice. When I was an intern, a philosophical internist told me the way to avoid lawsuits was first to know what you are doing and second to be kind to people. Dr Fanning lists five recommendations, the first two of which are what I was told more than 50 yr ago. The next three are to document, to trust your lawyer, and to remember it is all about money.
Finally, Dr Fanning suggests that there is more to life than medicine and suggests ways to expand one’s horizons and enjoy life. Taking care of oneself is the first step toward having a full and meaningful career and life. Much of the advice is pretty basic in the chapters “There’s More to Life than Medicine” and “Take Care of Yourself,” but repetition never hurts. Dr Fanning’s stories are interesting but often tragic, sad, and/or humorous. As an anesthesiologist in the practice longer than Dr Fanning, I can especially relate to and enjoy his anecdotes, but I am sure any reader can gain insights and pleasure from this book.
Northwestern University Medical School, Chicago, Illinois. firstname.lastname@example.org