Conrad Fischer: Routine Miracles: Personal Journeys of Patients and Doctors Discovering the Power of Modern Medicine

Routine Miracles is a landmark publication in the history of American medicine. It is so because it draws attention to the powerful but not popularly appreciated discontent of American physicians at a time when doing what was impossible a decade ago has now become routine. If the title appears oxymoronic, it is because what was once considered miraculous in medicine is now indeed routine. Patients who were considered incurable but a short time ago, now have their hearing restored, their heart valves replaced, their vision improved, their cancers cured, and their blocked arteries opened. Dramatic advances in diagnostic imaging and technical innovations with newer drugs have resulted not only in cures, but more importantly in transforming once fatal conditions into benign chronic illnesses that can be easily managed for years. Never before in the history of mankind have physicians been able to save so many lives, cure so many people, and restore health and happiness to the once hopeless. Despite all these medical breakthroughs, many American doctors are unhappy. Why? In this volume, Dr. Conrad Fischer, a renowned medical educator and specialist in internal medicine, sets out to explore this professional discontent while simultaneously presenting the perspectives of numerous patients who have triumphed over serious illness thanks to the interventions of their unhappy medical caregivers. The book is divided into seven parts and 29 chapters which primarily focus on individual patients depicting a broad range of morbidities that afflict Americans today. The beneficiaries of modern medicine, these patients portray not only the wonderful advances in medicine, but also their own joy and gratitude in having been treated by dedicated and skilled doctors. Yet, the dark cloud here is not treatment failure or medical errors, of which there are many, but rather the discontents of those who make these modern medical miracles possible. Early on in his volume, Fischer explores the reasons for physician unhappiness in contemporary America despite all the medical advances to which they have access. He begins by citing the false belief of many physicians, residents, and medical students that the profession was better 25 years ago. This belief is a redux of the romantic perspective that things were always better in the good old days. It is important to recognize that what physicians are speaking of here is not patient care, but rather of themselves. Although the workers of medical miracles, they see themselves as worse off then their predecessors. These physician discontents center on loss of autonomy, patient empowerment, the need to work in teams, accountability, tuition burdens incurred in medical school, and finally and most importantly, restrictions on income. There is little new in these findings or in the recent Association of American Colleges’ survey of 3,000 medical students that found that 80% stated that medicine was better to practice 25 years ago, mostly based on the opinions of older physicians. In 1991, this reviewer and a colleague surveyed 314 first year medical students from two conservative classes at the SUNY Downstate Medical Center, College of Medicine [1]. Sixty-eight percent had been discouraged from entering medical school. Most of the discouragement came from physicians (43%) and centered on diminished financial rewards, increased financial costs, and quality of life. Physicians in the US were once highly autonomous with a free rein to do as they pleased. This was neither good for P. J. Imperato (&) Downstate Medical Center, Brooklyn, NY, USA e-mail: pascal.imperato@downstate.edu