Book Review: "Do We Still Need Doctors?” By Dr. John Lantos

Having heard Dr. Lantos speak  University of Chicago, I was curious to read thoughts from his younger self, twenty years prior to his lecture to my medical school class. I found him more fiery than the sedate speaker who led a discussion about Pediatric end of life care but no less relevant. Indeed, each vignette throughout the book could have been written yesterday—the ethical issues he describes  have become more intense than his already far-seeing eyes predicted. Discussions about race, insurance, technological advancements, and the increasing demands on a physician all project forward from when he wrote in 1997 to 25 years later with alacrity and warning. 

Lantos’ title  question, “Do We Still Need Doctors?” is not necessarily the crux of his thesis. His question is not if we still doctors, but what we need doctors to be. Through a series of stories about his early career, he explores the roles doctors play—healer, truth teller, scientist, priest.  In this exploration, he lifts the cover on a swirling mass of contradictions about who a doctor should be: how a doctor is not a person but an ideal— encompassing “both ancient moral virtues and modern scientific knowledge.” Doctors are expected to care for the individual and society, to provide cost effective care but also save lives at any cost, to be rational in the face of death and yet attend to all the emotional needs of the dying. These are just a few of the issues he addressed—the scope of this work is far reaching and at times fragmented. He jumps from medical education to the justice system to insurance companies in the span of a page and in nearly every chapter and he offers no answers—just thoughts and subsequent questions. He even ends the book with a series of questions as he describes a particularly difficult patient case—“I had done my job, I was a good doctor. Nobody could blame me…Nobody could sue me…Did I have some further responsibility? To whom? For what?” 

One of the most prevalent themes in Lantos’ work—the theme of ritual and symbol juxtaposed against truth and science in our practice as physicians. So much of what we do, even with all the technological advancement and miracles science can work, is not done for efficacy’s sake. Medicine at times is mystery, even to the doctor. At times, it can be reduced to a gesture, a vague intervention that does nothing materially but makes the patient and family and even the care team feel as if a divine, or scientific, intervention has taken place.  And sometimes that even works! Intervening, despite the mystery and uncertainty, is what makes a good doctor. And yet despite the at times hand-waving nature of medical treatment, doctors have been recently expected to tell the truth in a way that in the past was not expected. Truth telling, full disclosure, also makes a good doctor. How can we fully disclose what we don’t fully know or can’t explain? How can we fully disclose when we KNOW we are performing a treatment that will not cure anything, just make us feel better? With these ideas in mind, Lantos dedicates two chapters to the truth and fictions of medicine and what it means for something to be true, even if it is not truthful. He ends these two chapters suggesting that in medicine, sometimes the whole truth is too much to bear, for the doctor and the patient, and that the mystery and uncertainty is too difficult a place to live in without some level of white lie. 

I asked myself, as I read this book—what does it mean to be a good doctor? In line with Lantos’ last sentence, Where does the responsibility of my job end? I don’t know. Certainly my training process has not helped me answer this question better—it has taught me that my job should never end until I leave the hospital and even then I must be ready to drop everything, just in case. Residency has taught me I should stop at nothing, that there is no barrier I must not try to knock down. As such, I have countless times felt like a bad doctor—when I fail to discharge a patient exactly when they want to be discharged, when I cannot get a medication covered completely by insurance, even when I cannot find a fridge for my patient’s house. My responsibilities have felt too much, and I think that is Lantos’ point. We do still need doctors—we just need many people to fill the role we have decided they must fill. I cannot be all things to my patients, just one. I am a bad social worker, discharge coordinator, and insurance negotiator, but I can be a good doctor by doing what I can do best—medical care. The problem is that I work in a system that is not designed for me to just do medical care. 

Along those lines, reading this book made me want to lead a discussion series with my interns and medical students about what it means to them to be a good doctor—the roles they think they are meant to inhabit as they go through residency. I think it would help us see that we maybe judge ourselves too harshly as we work in a healthcare system that at times actively prevents us from being what we hoped we’d be when we dreamt and worked ourselves into medical school. I think it might allow us to give grace for the moments when we are angry or sad, or feel like we suddenly have no good choices. It might allow us to tell those white lies more peaceably—knowing that while our system demands clarity from us, sometimes we can only offer mystery and that is good enough.