Talking With Doctors

by Danielle Ofri
New England Journal of Medicine

(review of Talking with Doctors by David Newman)

Imagine falling mysteriously ill in a foreign country, in which the language, culture, and customs have no bearing on your own. Imagine trying to find medical help and evaluating your potential healers without understanding the territory, while the shadow of imminent death lingers over your shoulder.

This is roughly the experience that David Newman underwent when he discovered that he had a rare tumor that was hovering precariously near his brain stem. The foreign capital was a certain well-known medical city on the Hudson River. And even though Manhattan was his hometown and English was his native language, Newman was nonetheless a foreigner in the high-octane world of academic medicine. Despite his education, money, connections, and interpersonal skills (he is a psychotherapist), he found himself floundering in frightening waters.

Talking with Doctors covers the two harrowing months that the author spent in consultation with “the best” doctors in “the best” hospitals in New York (plus a side trip to “the best” doctors in that other well-known medical city, on the Charles River). If the subject under discussion had been how to bake the best spinach soufflé, the disagreements, egotism, childish tantrums, rudeness, inconsistencies, and frank errors might have been comical. Unfortunately, the subjects were palliative care versus curative intent, whether to biopsy or not, what the biopsy actually showed, neurosurgery versus endoscopic surgery versus chemotherapy versus radiation — all of which were up for grabs while the 44-year-old Newman tried to figure out whether his three school-aged children would be fatherless by the end of the year.

In trying to decide whom to trust, Newman sought to understand the thought process of each consulting physician, often pressing the doctor to explain his or her medical logic. This attempt was not met with a kind reception. Most of the doctors expected Newman to accept the pronounced verdict with equanimity because of the stellar reputations of the doctors and of the institution. This reaction seemed to hold true whether the physician was an empathic, communicative person or a peremptory, cold-hearted one.

Lacking medical literature on this rare tumor, the physicians were forced to rely on clinical judgment. It is illustrative — and a bit frightening — to learn how divergent those opinions were. (Two experts, when reading the same computed tomographic scan, could not even agree on whether contrast material had been used.)

It is also humbling to note how much of a role serendipity played. Finding the doctor who eventually became Newman’s physician, for example, depended on the author’s accession to the dubious advice of his own patient to call the patient’s best childhood friend in Israel (at 3 a.m.) and then contact the three surgeons whom this unknown doctor recommended.

Talking with Doctors functions best as a “buyer-beware” manual for patients who are embarking on a consultative tour of prestigious academic medical centers. The choppy structure of the book may have been deliberate, to give readers a sense of the disorienting process, but I found the 45 extremely short chapters frustrating. The overly whimsical chapter titles (heavily loaded with lyrics from songs by the Beatles and Frank Sinatra and with weak puns) did not add any literary heft to the largely telegraphic, but serviceable, writing.

The analytic dimension of this book is disappointingly light. Newman is not the first psychologist to turn his professional eye toward his own corporeal experience, but others have extracted far deeper meaning, as did Bruno Bettelheim in The Informed Heart (London: Penguin, 1991), or have been more literary, like Kay Redfield Jamison in An Unquiet Mind (New York: Vintage, 1997). Newman offers some observations about how he evaluated each physician, but there is little in-depth probing of the complexities of the doctor–patient relationship. The book is not really about “talking with doctors”; it is about David Newman talking with doctors. There is certainly drama and poignancy in this story — we cannot help identifying with the protagonist — but the book would have been far more incisive if Newman had used his professional expertise to broaden the discussion.