James C. Eisenach, M.D., Editor

Sutton's Law. Edited by Janet M. Orient, M.D., and Linda J. Wright. Macon, Hacienda Publishing, 1997. Pages: 299. Price:$21.95.

This was a novel of sufficient intrigue that it was difficult to set down. The mysteries concerning which of the characters were guilty of the mischief described were held significantly long to guarantee total involvement by the reader. The consideration that “managed care” may be heading in the direction portrayed in this book is very disturbing, particularly the ease with which such an “ideal” system seems able to be manipulated for the purpose of greed. Involving primarily interns and residents, young physicians eager to please to make their mark, the story gains great credibility, and the reader is lead to the belief that “this could really happen!” By the same token, making the heroine (Maggie Altman) an idealistic intern with an insatiable curiosity and a deep respect for life is poetic justice.

The array of characters is reminiscent of a Dicken's novel. The hierarchy of a medical center (Texas University Regional Preventive Health Center or TURPH) is aptly shown through the interns (Maggie Altman and Fred Jenkins), the residents ("Pit Boss" Brent Stemmons and Chief Resident Steven Baline), and, finally, the Chief of Medicine, Dr. Phillip Eisig. Milton Silber is a former professor of medicine who retired out of disgust with the changes that the new managed-care system, EQUACARE, has caused, becoming instead a financial wizard. He keeps an interest in things at Texas University Regional Preventive Health Center through his long-time friend Dr. Metzenbaum, the Chief of Pathology. There are drug dealers (Raul) and thugs (at least two, with an argument that can be made to include one of the nurses), assisting financiers (Fitzhugh) available for romantic involvement, and patients, of course. Do the patients really receive the “best” care, or are they victims of the new system? Are patient records really altered, and why are there empty beds in which patients are supposedly assigned? Who is Dr. Miltown, anyway, and what does all of this have to do with Willie Sutton? When did nurses, technicians, clerks, and secretaries start treating physicians with open disrespect? Are there hospitals that really operate by Law IX (the only good admission is a dead admission)?

No one likes to hear about “bad apples.” Although physicians are human, we like to envision ourselves as something more than ordinary. Still, there will always be a percentage of physicians who are swayed as easily as anyone else by greed and vice (e.g., drugs, power). Reading about the decay of one or more “brethren” is very uncomfortable, engendering distaste and dislike. These emotions make finishing this book both difficult and necessary. The sense of justice at the end is incomplete, but very realistic. The message before the first page, medicine is a trust, not a holding company, is proven to be true.

Sutton's Law is worthwhile reading for anyone, but especially the medically oriented. It is the type of book that would be particularly useful to relieve the tedium while traveling during vacation or during trips to and from meetings. The chapters are short; the action is mixed. It is medically accurate, without obvious error in terminology or description. The only down-sides to the book are minor grammatical errors and the occasional repeating of words (e.g., that that, and what what). These are annoying but easily overlooked as the reader becomes involved in the story. It is hoped, however, that these will be corrected before the final printing. The entertainment provided is well worth the cover price.

Terrence D. Bogard, M.D.

Associate Professor of Anesthesiology; Department of Anesthesiology; Wake Forest University School of Medicine; Winston-Salem, North Carolina