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Treatment Kind and FairReview - Treatment Kind and Fair
Letters to a Young Doctor
by Perri Klass
Perseus, 2007
Review by Margaret Riley, M.S., R.N.
Jan 1st 2008 (Volume 12, Issue 1)

Treatment Kind and Fair is a collection of "letters to a young doctor" as indicated by its title. But it is more than a simple collection of random letters, written vaguely and impersonally to any "young doctor" that may read the book. Perri Klass writes these essays or letters to her son, who is anticipating attending medical school. While the book's immediate audience is obviously her son Orlando, it is also medical students, young doctors, anywhere. I submit that it is also for those who are not immersed in medicine, but to the layperson who may just read it because of an interest in medicine.

  As a nurse, having worked in an acute care setting for many years, there are several parallel pathways that Klass writes about and that I have myself traveled and experienced. She describes the magic by which medicine invites practitioners into the lives of patients and their families, sharing brief encounters and intimate moments. But this is not a book that is only for doctors and nurses. I think that since she is writing of people in various settings, coping with various situations and diagnoses, there are common threads for those with no medical background, but with curiosity and inquiry, to find and enjoy as well.

  There are three parts to these letters, as times of the author's medical training and medical career are remembered and described, and the future is foretold and embraced for the new generation of medical students and physicians. These parts are presented in a logical, somewhat linear fashion, starting with Medical School, and its first encounters with patients, interactions and examinations. Residency follows, including the novice's search for his or her place in this, the chosen career. Residency also includes the expanded role as the student progresses to the practitioner and has to catalog and make use of a phenomenal amount of information, both scientific and personal. The Resident also establishes him or herself as the decision-maker, having to make choices and feel the combination of certainty and uncertainty of these choices. For most doctors, the weight of choices and decisions is something that they carry throughout their careers.

The final part to this book is that of Medical Practice itself. Klass includes details of patient care, the stories and secrets that come with patients. She also discusses death, that final stage that all our lives will include. Over their lifetimes and their careers, physicians integrate these intimacies, stories, decisions and events into their own lives. They experience so many things with and through their patients, and their lives are touched by these experiences. They grow and change, perhaps visibly, perhaps not, by these encounters.

The subject material of this book definitely includes stories and some terminology that is specific to medicine. Perhaps I enjoyed reading it more because of my own background; perhaps it was easy for me because of the shared history of doctors and nurses. But, I don't believe that Treatment Kind and Fair excludes laypersons. Medical jargon or terms are not left standing independently, but are defined and described as necessary. After all, even assuming the audience made up of young doctors, these are not people for whom the terms and phrases come naturally yet. She also mentions towards the book's end that she writes about medicine for a broader audience. That audience includes non-medical people, because there are many laypeople who find medicine an interesting subject. And so, she tells her stories well, with clarity and even humor when it fits.

Case studies are a proven method of learning for doctors and nurses alike. Situations of real people, real patients can provide some of the best teaching. Cases are used for various learning goals, including understanding tests and coming to diagnostic conclusions; critical thinking is created and nurtured. Treatment Kind and Fair introduces each chapter with a case. Patient cases are from Klass's own life: her own pregnancy, her son's impending interviews with Medical Schools, patients she has known and treated; families she has encountered and learned from. These cases provide a nice introduction to each chapter, ways to introduce different people and their diagnoses and experiences; ways she learned and ways for these future young doctors to learn.

From my own viewpoint as a critical care nurse, I could certainly relate to her "smart intern" remarks: "A smart intern quickly learned that your best bet for successfully getting through the night in the NICU -- and more important, for successfully getting the babies through the night -- was to do what the nurses said." (p. 195) While I am not advocating bossy nurses telling new, future doctors what to do simply because,  I do know that a truly collegial environment, where the physicians listen and consider assessment information from the nurses in their decisions and orders, is the best sort of environment, for patient outcomes and employees alike. My own ICU has never been one including neonates, as Klass writes of, but the same collaborative efforts are required to maintain the lives of critically ill adults. 

The stories that are shared in this book, the ideas and goals that the author considers and hopes for future medical practitioners, are thought-provoking and several are truly touching. She has obviously been included in the lives of her patients, and includes many of them, and their stories, with us as the audience of her book. These people have touched her life, and she is willing to share them with us. As she says, "Medical training is transformative. It will make you over completely -- your emotions, your sense of proportion, your narrative abilities, and your habits of mind." (p. 17) Reading Treatment Kind and Fair will share some of this transformation with its audience, and may enhance their lives in some ways along the way.

© 2007 Margaret Riley

Margaret Riley, M.S., R.N. -- has been a Critical Care nurse in a highly acute ICU in the Denver Metro Area since graduation from nursing school. She continues to work occasionally in that setting, but now works full-time as a faculty member at her Alma Mater.

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