Tuesday, April 26, 2011

Doctor Confidential: Secrets Behind the Veil

by Richard Sheff, MD

South Kingstown RI, Listen to Your Heart Press, 2011

342 pages Memoir

Everyone has doubts when they begin a new career. Certainly Richard Sheff did as he began medical school. Doctor Confidential is an intimate memoir describing Sheff's years of training, from medical school through residency training. Chapters focus on each aspect of his training, including the good, the bad, and the ugly. Through all of these experiences, Sheff shows the reader both the overwhelming amount of training that is necessary to become a physician, but also the overwhelming amount of humanity it takes to become a good doctor. He says, “The mystique of physicians is not that they are so very different from the rest of us, but rather that they have had the unique privilege of experiences denied to most, especially if they have allowed such experiences to deepen their humanity.” One reviewer called this book “an everyman’s story of quest, discovery, and redemption.”

What I found remarkable about the book is the intensity of Sheff’s memories about his training and the patients he treated during his training. He is a very good storyteller, and the stories resonate for even the casual reader. I especially enjoyed the chapter about obstetrics, most likely because my daughter is about to deliver, and she wants me to be there. This will be the first birth I will be participating in that wasn’t my own. I appreciated the humanity with which Sheff dealt with the young woman as he helped her through labor and delivery.

Sheff has two purposes for this book—to describe the complexity of medical training and to show that medical careers should be chosen based on a desire to show love and compassion to people who are at their most vulnerable. He wants his readers to see that physicians are constantly dancing between making scientific choices and making humane, loving choices. He says, “Students are selected for medical training because of their capacity to achieve in the face of obstacles, to set aside personal needs when a job must be done, to act with clear logic by suppressing emotions.” Because he is such a good storyteller, he is able to describe the dance in such a way that the reader forgets all the times that a doctor appeared to be uncaring and unfeeling, and to look upon the doctor as a partner in the healing process. Sheff chose family medicine because of his desire to become more involved with patients over the long term, rather than as a specialist who is in and out of a patient’s life.

One thing I particularly liked about the book was that he moved most of the technical descriptions into footnotes, which I tended to read over. I was much more interested in the narrative than the technical stuff. But because of the footnotes, a person interested in technical information can find it.

I was a young wife with three small children when my husband died of cancer. Lee had the same oncologist during the entire 5-year process, and the doctor was there with us on the day before Lee died. I never particularly liked our doctor; he seemed to me to be knowledgeable but cold and unfeeling. When the doctor asked for a meeting with me at his office, I remember being so offended by the way in which he told me my husband was going to die, and was going to die sooner, rather than later. He smoked three cigarettes during the time that he was talking to me—in hindsight, I realize that he was experiencing as much anxiety as I was. The last time he came into our hospital room, he stood beside me looking down at my dying husband. He put his arm around me and began to cry; he wept silently for a moment, and then quietly left the room. This is the kind of humanity that Sheff addresses in his book.

Richard Sheff’s personality, warmth, and humanity shine through in Doctor Confidential. The book would be a valuable addition to the library of a medical student or a student contemplating medical school. It would also be a valuable tool for a guidance counselor helping students make career choices.

This book came to me as an advanced reader’s copy. It appears to be self-published.

A good review:

The book’s Facebook page:

Richard Sheff’s website:

After I posted this entry, Dr. Sheff sent me some clarifications. I asked if I could include them in my blog, and I am including them with his permission. He says:
For how I remembered things in so much detail, as mentioned in the Prologue, I started writing this book in the year I finished residency (1984). At that time I outlined the key stories I knew needed to be in the book. But also as noted in the Prologue, I found my initial attempt sophomoric, and could not find my writer’s voice. When I found myself launched into finally writing the book following my chance encounter on the airplane with a dying woman, I was surprised at how vivid the memories were that came back to me. My wife (and toughest critic) has always remarked on the unusual capacity I seem to have for remembering details from the past. (Now that I am 57, I find that easier than remembering yesterday, but this comes with the aging process.)

I note that you took away from the reading experience that my apparent motivations in writing the book were related to two goals: documenting the complexity of medical training and making the point that medical careers should be chosen based upon a desire to show love and compassion. My own experience is that my motivations for writing this book that I felt I had to finish before shuffling off this mortal coil were more varied than that. Some of the motivation came from wanting to share what portion of wisdom I have amassed over the years concerning the best of good doctoring. Much came from a heartfelt desire to drive changes in healthcare as it is provided today, both by individuals and by our healthcare system. Another motivation came from the process of healing my own wounds (which I had not even realized had been there before beginning this project). As noted in the Prologue, I also see this book as potentially invaluable to young students of medicine as they prepare for and undergo medical training, hopefully helping them to preserve and deepen their humanity during that extraordinary socialization process that does so much to destroy that humanity. But one of my greatest motivations was to reach out to the countless individuals who have had experiences with doctors and the healthcare system because of illness for themselves or loved ones. Many of them have come away from those experiences feeling something they needed or wanted went unmet (such as your experience with your husband’s oncologist). Hearing that someone, somewhere “gets” what their experience was and what they so deeply needed has actually been healing to many of the early readers of the book. Finally, I have sought to convey some the deep lessons I’ve learned through the privilege of serving as a physician concerning the journey of our lives, including confronting illness, loss, and death. These are universal experiences, but ones we too often keep behind a veil of secrecy. So one more goal is that reading Doctor Confidential will help prepare readers for these experiences and, for those who have already lived through them, to help them heal. That is, after all, why I went into medicine.

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