In the Hands of Doctors: Touch and Trust in Medical Care

Book Title: In the Hands of Doctors: Touch and Trust in Medical Care
Book Author: Paul E. Stepansky
Publication Information: Santa Barbara, California, Praeger, 2016, 317 pp., $48, hardcover

I chose to review this book because of its subtitle. Touch and trust, I believe, are essential elements of my work as a family physician, as they are in the work of many of my family medicine colleagues. I looked forward to reading about the historical importance of these two factors on the physician-patient relationship, especially as it was influenced by the introduction of new medical technologies and the use of procedures in primary care practice.

Unfortunately, however, this book was a huge disappointment. Billed as a “comparative historical approach” to topics concerning the nature and goals of medical education and practice, it comes across as more of a hodgepodge of family-of-origin anecdotes and personal judgments than rigorous scholarship. A few chapters do review how then-novel diagnostic equipment changed the complexion of medicine in the 19th and early 20th centuries, and there is a chapter on the introduction of nurse practitioners and physicians’ assistants after 1960. These are interesting, informative, and well referenced.

The rest is an odd mixture: part paean to the author’s general practitioner father (referencing a previously published work)1; part random reflections on encounters with his retinologist and dentist; and part protracted argument in favor of abandoning family medicine in favor of a new specialty, “procedural care medicine”, based for the most part on the tenets of profit, prestige, and procedures.

Throughout the book, the author fails to see our work as more than a compilation of subspecialty-based approaches to patient problems. He condescendingly eschews current models for training students and residents in patient and relationship-centered care. And, according to him, our discipline is at its foundation a

. . . semantically strained, even oxymoronic, vision of a non-specialty specialty, a specialty that rejected specialist values, was an amalgam of 1960s counterculture, the social sciences, and a dash of psychoanalytic object relations theory (per Michael Balint), all abetted by the dearth of “personal physicians” and the emergence in the 1970s of the patient rights movement. (p. 174)

I do not deny there are many challenges to practicing family medicine, and that many barriers limit the establishment of trust and touch as therapeutic modalities in the current medical milieu. In choosing neither to explore beyond the very surface of the family medicine literature nor observe family physicians at work with patients, however, the author (a “Yale-trained historian of ideas specializing in the history of American medicine and psychiatry”) does little to address these concerns. Although other readers may disagree with my assessment—In the Hands of Doctors did win a 2017 Independent Publisher Book Award bronze medal in the Health/Medicine/Nutrition category—this book mostly demonstrates how the study of history can be misused to make claims based primarily on opinion.

For us as family physician educators, the real message of this book is that many people, even highly regarded scholars, are ignorant of what we do and how we practice. We must at every step along our way speak truth to power. We must advocate for quality primary care services for our patients. We must continue to educate the next generation of physicians as to the beneficial effects of person-centered care and family medicine on the health and well-being of people and communities.2-5