Dissident Doctor

Book Title: Dissident Doctor

Book Author: Michael C. Klein

Publication Information: Madeira Park, BC, Canada, Douglas and McIntyre, 2018, 276 pp., $32.95, hardcover

In Dissident Doctor, Dr Michael Klein tells the story of his uniquely inspiring career. He was a fledgling doctor when family medicine first emerged, and he shifted his course from pediatrics to family medicine to better provide holistic care. From an early age he held unconventional views, ultimately leading him to emigrate from the United States. Dr Klein capitalizes on myriad opportunities in training, research, practice, and leadership, indicating a deep level of engagement with his career. Numerous anecdotes scattered throughout the book illustrate the unique strengths of family medicine as a discipline.

The book first meanders through Dr Klein’s upbringing and early career, including his brushes with McCarthyism and involvement in the civil rights movement. Dr Klein’s professional story begins with an early, formative exposure to international medicine. As a medical student, he cared for Ethiopian patients in a resource-poor and politically unstable setting. He speaks fondly of his experience learning obstetrical care from the unique perspective of midwives before learning traditional obstetric techniques—to the later chagrin of his obstetrical attendings. When Dr Klein became eligible for the military draft, he ultimately emigrated from the United States to Canada, immersing himself in an entirely new health care model to avoid entering a war he opposed. These experiences illustrate his early identification as an outsider, both politically and medically. “I had the idea that as a physician…I would be my own boss, autonomous—free from political interference” (pp 21-22).¹

Dr Klein peppers his overarching “outsider” narrative with stories of doctoring. As a pediatrician fresh out of training, he chronicles his joy in teaching the next generation and passion for making a difference in the public health of his served population. Later, a series of narratives illuminate how he was drawn to the discipline of family medicine. His patients help him realize that comprehensive care ought to include adult patients and obstetrical care through delivery. Though his tone is often matter-of-fact, his anecdotes reveal his calling to find ways to give patients the care they need. These stories will motivate and captivate family medicine clinicians and educators.

Later, Dissident Doctor details Dr Klein’s admirable contributions in scholarship and leadership. His skeptical attitude combined with his outsider perspective led him to shift paradigms as a researcher in maternity care, most famously through cutting-edge research challenging routine episiotomy use in obstetrics.² He later challenged the existing literature regarding anesthesia during labor, finding that early epidurals more than doubled rates of cesarean sections!³ However, when discussing obstetrical care, his attitudes and viewpoints are strongly stated and can be troubling. At one point he challenges the well-established practices of late-term induction and breech cesarean section, yet he fails to provide any supporting evidence (p 222).¹ He argues convincingly in Dissident Doctor about the selective use of epidural, referencing his own meta-analysis.3 Unfortunately, in the book, he unfairly generalizes anesthesiologists’ differing results as dishonest, claiming they “learned how to design the studies that would give them the answers they sought” (p 225).¹

As Dissident Doctor progresses, Dr Klein emphasizes active involvement in decision making as a Canadian health system leader and educator. As a department head during a challenging time of organizational turmoil, he “… considered that removing myself…would affect my ability to make change—so I hung in” (p 218).¹ He shares several accounts of struggling for positive, patient-centered change as a leader. However, in the case of US medicine, he seemingly gave us up as a lost cause. US readers looking to Dissident Docto to find hope that our system can improve may find themselves disappointed. Additionally, when Dr Klein’s memoir finds a touchstone with current events, he’s quite direct and unapologetic in sharing frequent, blunt criticisms of the US administration and health care policy. These are common throughout the text and could alienate some readers. Accordingly, Dissident Doctor may be well-utilized for generating excerpts to share with learners rather than reading in full.

Practicing clinicians and family medicine educators alike can find much to appreciate in Dr Klein’s memoir. Dr Klein details a lifelong practice emphasizing continuity, consideration of the family as a whole, and engagement in the community. He shows us that we should see problems clearly and address them directly, but we shouldn’t give up hope that we can effect change. Dr Klein’s significant contributions to medical research and medical literature make him a galvanizing role model for family physicians. If readers can tolerate a book that’s occasionally abrasive, they will learn lessons demonstrated through experience. Dr Klein’s story is inspirational.