Customer Reviews

Heirs of General Practice

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A former student sent me this book after her first year in medical studies and said "finally someone who tells it like it is". Definitely NOT about urban Medibusiness or the world of HMOS and doctors too busy to doctor, instead McPhee focuses on the lives and work of young doctors in rural Maine, bringing us their story and that of their patients with compassion and without either the cloying sentimentality or the muck-raking zeal that sometimes clogs this topic. A quick read & well worth it.

I come from a family of general practitioners - my mother was a G.P. and my sister followed in her footsteps - and I am a fan of John McPhee's writing, in general. So I expected to like this book more than I actually did. The book follows the standard McPhee schema - in-depth reporting on a very specific topic, in this case doctors who choose to work as general practitioners. McPhee provides vignettes of a dozen or so such doctors, almost all of them working in Maine.

McPhee is usually very effective in working from the specific to reach more general insights, and it is clear that he would like to do the same here. That is, by focusing on doctors who have opted out of the mainstream, he would like to illuminate some general truths about the practice of mainstream medicine. However, I think his success in doing so is limited, rarely rising above statement of the obvious. By focusing his microscope only on family practitioners working in Maine, the generalizability of any lessons they might offer is questionable. The needs of communities in Maine cannot be considered particularly representative of the U.S. in general.

So the book never really becomes anything more than a series of isolated vignettes of some individual 'maverick' doctors. Which is interesting as far as it goes, but I wish McPhee had been able to do more with the material. By the end I felt that an opportunity had been missed to write a book that would have been of greater general interest.

John McPhee is one of the best non-fiction writers active today. In "Heirs of General Practice" he delves deeply into the General Practice movement in American medicine. In his deft, insightful way he gives us a clear view of what it means to be a general practitioner in a country that rewards specialists more highly, even though what U.S. medicine desperately needs are more doctors in General Practice.

"Heirs of General Practice" is one of my favorite books by John McPhee. Admittedly, being a physician, I have a bias but McPhee humanizes the subject so well, and with such good humor, it brings the stories alive. I wish it were required reading on medical school curricula for pre-clinical students before they have a chance to be lured away by all the bling of subspecialty tertiary care.

I enjoyed this book less than the other books I've read by John McPhee, which is to say I merely "liked it." Another reviewer mentions how McPhee's pieces report on a very specific topic and expands to the general from there. I agree that the title essay was very specific to the general practitioners he met with in Maine. This piece, which is uncommonly long, dragged on for me. I thought the subject matter was interesting-if not too far removed from the mainstream-but for some reason or another I just thought it didn't come together as well as it could have.

The other essays were better in my opinion. This is still a good book overall, just not as good as some of his other work.

This book has its good and bad points. McPhee is an excellent writer, and the piece originally appeared in The New Yorker Magazine. I worked at the hospital in Skowhegan at the time he was in town to do his research, and it is extremely well done in that respect. I appear in it on page 87. As a paeon to family practice physicians in general, this is a sort of a manifesto to describe the lifestyle that an MD can have, and yes, there is an alternative to the insurance-driven practice style that doctors get into if they stay in an urban area.

This book also describes the Maine lifestyle led by many back-to-the-land people as they mixed in with the yankee Mainers of the region. Maine (particularly the part North or east of Augusta) is a place which has maintained a distinctive way of life, unlike so much of the rest of the USA.

I am older now, and there are parts of this book which seem so quaint - it took place during the Reagan era, prior to the introduction of DRGs, prior to the budget cuts of 1984, again in 1878, and yet again the 1990s. The small hospitals in Maine, seventeen out of the forty hospitals, have all been forced to downsize and refocus on outpatient care. And many of the docs described have moved on to other avenues of medicine, away from the youthful idealism.

I decided to write this review when my second daughter called me up to say that she had read the book when a high school freind lent it to her. the high school freind is in med school and had received it as a gift. It's great that we can perpatuate the myth of the old time GP...... maybe the younger generation will be inspired by this yet again.....