Physician, Watch Thyself: Witty Lessons on Shitty Ailments of a Dutch GP

Book Title: Physician, Watch Thyself: Witty Lessons on Shitty Ailments of a Dutch GP

Author: Pieter van den Hombergh

Publication Details: Yes!Press, 2022, 160 pp., $15.00, paperback

This book reads like a personal journal of a physician’s lived illness experiences. Van den Hombergh is a Dutch physician, raised in a Catholic community by a physician father who was a role model of a community doctor and a mother who was a devout teacher. He gives us a detailed description of his life’s journey: his childhood experience in a tight-knit religious community, through a traditional medical school, his formative early career experiences as a tropical doctor in Kilgoris, Africa, and long community-oriented practice back in the Netherlands. His formative years in a church community and in Kilgoris solidified his life’s mission and values in global health and his dedication to underserved communities. This background sets the stage for his trajectory as a value-driven community-oriented physician.

The book is structured around van den Hombergh’s career path and the personal ailments and injuries he faced throughout his journey. Each affliction and disease served as his laboratory for investigating the known and unknown of science and aligning with patient experiences and various cultural influences. His perspective provides the nuances and unexpected twists and turns that expose the gaps and unexamined assumptions in his medical education.

He starts with early career global health experiences with the Maasai people in Kenya. Those experiences were seminal and exposed him to different cultures—micro and macro—that widened his knowledge and skills, and highlighted his Western medicine limitations. His descriptions of the limited medical resources, the cultural beliefs and rituals, and the role of innovation and “winging it” are intertwined in each story of individuals afflicted with rabies, injuries from lions, snake bites, or surprising tropical diseases. For example, the Maasai have a coming-of-age ceremony called Eunoto that includes killing a lion. However, the ruling government opposes lion killing. One patient had killed a lion but was bitten in his arm in the process. For fear of arrest, he waited for days before coming to the hospital with his swollen pus-filled arm. He survived but his arm had to be amputated. This situation demonstrated the conflict of values and health care practices of indigent vs dominant cultures.

Through each chapter, he takes the reader through the major organ systems, starting with his own pulmonary struggles with coughing, fatigue, and breathing. He recounts the difficulty diagnosing and treating tuberculosis (TB) years after he had left Africa. “No one in the Western world considered TB in their differential. . . . I—like most physicians—have a blind spot for the disease, which can also be attributed to its near-eradication in the Netherlands” (p. 55). He traces how his symptoms of coughing were assessed, imaged, tested in the labs, and evaluated by several specialists in different ways. He describes how, over the course of many years, the symptoms from a childhood illness came and went, got reassessed and rediagnosed. The treatments were often illusive and blindsided biases that impacted his own diagnosis and treatments.

Van Hombergh covers a range of his other illnesses, such as hernias, ulcers, urinary incontinence, diarrhea, hepatitis, insect bites, and musculoskeletal injuries. In each case, he gives us his personal narrative of how symptoms afflicted him, his attempts to use home remedies or self-treat, and his sequential course of treatment, treatment failures, and some successes. Usually, there is a litany of input from friends, colleagues, and specialists he enlists to investigate his physical anomalies. His writing highlights how academic medical descriptions can be divergent from the actual patient experience of ailments, from the onset through its changing trajectory. He flavors each vignette with a description of his emotions, his family’s reactions, the medical community’s recommended practice, and his internal critique between his personal and professional worlds.

Overall, this book gives us a look at how the worlds of doctor and patient experiences often collide. Van Hombergh gives us detailed sequential descriptions of anatomy and biochemical processes of a disease or injury with his unique insider commentary. Some of these descriptions are too detailed; the reviews of systems are too comprehensive. He has a wonderful, curious approach to analyzing his ailments and a healthy cynicism for our medical biases and gaps in knowledge. This book is an easy read from a self-reported quirky physician who values community and culturally oriented medicine, and who has a keen sense of curiosity and a humorous self-analysis. These reflections of an inquisitive doctor on the lived experiences of his own mental and physical health could give the reader opportunities for further reflection.