Finding Meaning in Work: The Musings of a True Generalist

Book Title: Finding Meaning in Work: The Musings of a True Generalist

Author: W.J. Crump

Publication Details: W.J. Crump, 2023, 277 pp., $9.99, paperback

In times when even places with well-established health care systems like Canada ^{1, 2} face crisis in primary care, reading Finding Meaning in Work is a bit of a sigh of relief. Dr William J. Crump, former editor of the Kentucky Academy of Family Physicians journal, chooses to review his career through a timeline of his published articles intertwined with third-person descriptions about his life situation at that moment. The book opens in a way that could not be more appropriate for a family doctor—with brief personal comments from his family members and a touching poem dedicated to his father.

Dr Crump claims that the “essentials of meaning in work” (p. 7) are found in the last two essays. He briefly argues that “finding meaning in work” is about empathy, a genuine curiosity for the human aspect of each patient. I must disagree with him: These two essays alone are not enough to convey the sense of meaning in work that Dr Crump experienced. One can only grasp the essentials as one follows the author through myriad areas he engaged in while remaining a family physician. He delivered babies, did GI endoscopy, did space medicine, was an academic journal editor, studied the implementation of telemedicine, was a dean, and did inpatient mental health. He used research to provide facts in response to social issues and the public interest (“A Practice-Based Analysis of the Impact of Family Physicians’ Cessation of Obstetric Care” [p. 16]). He advocated for family medicine, working toward longer family medicine clerkships during medical school. In a way, his real-life narrative illustrates what research on general practitioners’ job satisfaction has been pointing out.

What is currently known about job satisfaction for primary care physicians? We know that overbureaucratization, excessive workload, poor IT resources, and lack of time with patients decrease satisfaction, ^{3, 4} whereas autonomy and agency, strong residency training, variety in clinical practice, and educational activities are protective factors.^5-7

Throughout the book, the author highlights how he dealt with these variables in his professional journey. For instance, in “Now Tell Me Again What You Are” (p. 258), he narrates multiple encounters with electronic medical record trainers in his tragicomic quest to gain all the “contexts” he needed for his practice. I believe that Dr Crump’s reflection was intended to demonstrate how versatile family physicians are and how comprehensive their care can be. Although I completely agree, I consider another point to be the most salient in that story: electronic health records (EHR) are terribly low quality, and software developers lack the knowledge of how health care actually occurs. There is no intrinsic reason why Dr Crump could not have easily obtained the electronic templates he needed. The barrier was a consequence of the invisibility of general practice for those who acquire and act as consultants for EHR.

While the timeline narrative approach has its merits, I would have preferred a smaller, more curated number of articles with more commentary and reflection. For example, reading about Dr Crump’s involvement in the NASA program as a family physician is captivating, and he tells picturesque anecdotes; in contrast, the pages about life support in the context of space life sciences are rather dry and technical. His writing stands out most in his first-person narratives.

At some points, the book gets a bit repetitive, and the absence of a book editor is felt, especially in the articles published as editor of the Kentucky Academy of Family Physicians journal. Two articles, from pp. 207-210 and 211-213, are virtually identical. An enumeration of the basic three things all healers do, as described by Howard Brody, is given at least four times and the references on page 230 are sloppily numbered and formatted.

One of the cornerstones of family medicine is continuity of care. ⁸ That sometimes may convey a sense of stillness, of repetition. But Dr Crump shows us that balancing continuity with openness to new experiences and challenges is possible, and that is what keeps the fire lit. Any family physician who reads this book will be inspired by and have a deep sense of respect and admiration for Dr Crump.