Book Titles: A Country Doctor Writes: CONDITIONS: Diseases and Other Life Circumstances; and
A Country Doctor Writes: IN PRACTICE: Starting, Growing, and Staying in the Medical Profession
Author: Hans Duvefelt
Publication Information: Self-published, 2020, 251 pp. (“CONDITIONS”), 265 pp., (“IN PRACTICE”), $17 each, paperback
Originally from Sweden, Hans Duvefelt, MD, trained at Central Maine Medical Center 40 years ago and has practiced in rural Maine ever since. In 2008, he began writing a reflective blog to document his medical experiences, and that writing ultimately became the basis for these collections of brief vignettes. The topics range from his initial impressions of medical school to meaningful personal connections with patients, difficult diagnoses, exciting patient encounters, and even his own experiences as a patient.
These books are collections of Dr Duvefelt’s vignettes ranging from one to five pages long, which makes them easy to pick up or set aside when time is short. The stories are not chronologically arranged and each vignette is separate, so the reader does not need to consume the book sequentially. The common thread through the stories is the humanism of medicine, bringing light to the complex mixture of art and science when caring for patients in a rural medical practice. Dr Duvefelt frequently highlights his use of Sir William Osler’s wisdom and medical reasoning, through which he has incorporated a philosophy of treating patients as individuals, preventing rather than treating disease, and a hands-on approach to patient care. In several vignettes, he underscores the importance of his longitudinal relationship with his patients which allows him to understand their needs quickly and astutely, whether spoken or perceived. He also discusses familiar concerns with modern medicine, including the challenges of providing high-quality and equitable care in resource-limited settings. Furthermore, he illustrates the importance and beauty of being adept at identifying and managing a wide variety of conditions in a world that is becoming increasingly specialized and isolated.
In several vignettes, Duvefelt notes a transition of family physicians from diagnosticians to clinicians who manage chronic conditions, often with evidence-based targets and financial incentives for meeting certain quality metrics. While he does not actively resist this change, he does explore the concept on both an individual and a systemic level throughout these books. There is a contrasting thread woven throughout this collection of stories, in which he astutely identifies rare or missed conditions as a result of spending time and practicing deliberate listening with his patients. Furthermore, he includes several vignettes about his personal experiences as a patient, and what he desires from his own doctor. Ultimately, this reflects the reality of primary care medicine in rural environments: competing interests of patients, communities, physicians, medical groups, and health care systems; expertise in generalized medicine as well as key clinical findings of complex or rare conditions; and limited resources, not the least of which is time. Overall, these books are quick, easy reads that illustrate the complexities of rural family medicine and the importance of personal connection, especially for fostering the doctor-patient relationship and providing individualized care. However, the arrangement and volume of the vignettes leads to some redundancy, and the books may have had more impact if they were further distilled into the key moments in Dr Duvefelt’s career. Students may delight in reading about clever exam techniques or diagnoses of exotic conditions while being reminded of the importance of slowing down and being present in the moment. More seasoned clinicians may relate to the push and pull of the health care industry, evolving clinical guidelines, or the beauty of caring for a multigenerational family over time. For teachers of family medicine, there are several vignettes that can be shared with learners to ground and normalize some of their own experiences caring for patients.
Through his words as a seasoned and experienced generalist, Duvefelt reminds us all to examine why we practice medicine and to reflect on our experiences in a way that encourages not only learning, but also gratitude for the ability to participate in the many moments of our patients’ lives.