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7 of 8 people found the following review helpful
5.0 out of 5 stars Thought provoking discussion of the evolution of medical ethical issues for practitioners, patients and their families
After hearing Barron Lerner give a lecture on this subject in 2013, I had been eagerly awaiting the publication of his book. It did not disappoint. Anyone looking for easy answers to the complex ethical questions raised in the book will go away unsatisfied. Rather, what the book does is present these questions in a deeply personal light and in a way that is tractable...
Published 3 months ago by Lee B.

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4 of 6 people found the following review helpful
3.0 out of 5 stars Memoir of a family's life in medicine. More about case studies than medical ethics
Pretty quickly I realized that I am not the target audience for this book; I have been an RN and a clinical nurse specialist for 30 years. Medical ethics are the stuff of day to day life for the practitioner. I've also seen the shift from Dr. Phillip Lerner's generation to Dr. Barron Lerner's generation in my practice years. I think this book is far more geared to a lay...
Published 3 months ago by Quickbeam


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7 of 8 people found the following review helpful
5.0 out of 5 stars Thought provoking discussion of the evolution of medical ethical issues for practitioners, patients and their families, May 25, 2014
This review is from: The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics (Hardcover)
After hearing Barron Lerner give a lecture on this subject in 2013, I had been eagerly awaiting the publication of his book. It did not disappoint. Anyone looking for easy answers to the complex ethical questions raised in the book will go away unsatisfied. Rather, what the book does is present these questions in a deeply personal light and in a way that is tractable to the lay person. As such, the reader is left with the context to explore questions which, whether doctor or patient (or both), ultimately impact all of us.

Lerner details his own career in medicine and that of his father, Phil Lerner. The two have much in common: both became accomplished physicians who eschewed the more conventional path of a private practice, both were dedicated to their patients, and both focused on delivering the best medical care possible while engaging in research to advance the medical field. The differences in their careers largely derive from the different historical contexts in which they were trained and in which they practiced medicine. The elder Dr. Lerner practiced in the paternalistic era of medicine in which “doctors knew best”, routinely withheld information from their patients, and made unilateral treatment decisions on behalf of those patients. His son became a doctor in a different era, when the doctor-patient relationship was evolving to one in which patients are now more informed about and involved in decisions related to their care.

The differences in their careers would make for an interesting story by itself. What makes this book so compelling is that studying and understanding those differences within the larger practice of medicine has been a focus of Barron Lerner’s career as a physician, medical historian and bioethicist. Rather than just presenting a series of abstract cases in which ethical questions regarding medical practice are exposed, Barron Lerner draws on several of his father’s actual cases to frame these questions. The cases he describes often involved difficult decisions surrounding end-of-life care, and in some cases the patients were close relatives of the Lerners. As the younger Lerner is forced to confront, question and ultimately reject some of the ways in which medicine was practiced in his father’s era, he is both contributing to the advancement of the field of medical ethics while at the same time engaging in a very personal journey.

What the author shared in this book is just the tip of the iceberg. I know from his lecture that there were other challenging cases that he drew upon for his research, and undoubtedly his father’s journals contained far more than that. I was left wanting to read more, but the decision of what to include and what to leave out, and what makes a good book, was undoubtedly better left to the author and his editor. The bottom line is that I came away learning a lot. This is a well-written, easy-to-read and thought-provoking book that is well worth the read.
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4 of 4 people found the following review helpful
4.0 out of 5 stars Two good doctors; one provocative history, May 29, 2014
By 
Richard F. Silver (Shaker Heights, Ohio USA) - See all my reviews
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This review is from: The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics (Hardcover)
Barron Lerner’s wonderful book is, at heart, a love story. Based on the relationship between a father and son who are both physicians, it also details their shared love for the science of medicine and the personal relationships involved in its practice. Although it is a deeply personal story, it touches a wide range of issues in post-World War II American medicine and culture—the changing philosophies of medical education, the emergence of the concepts of patient rights and autonomy, the concerns raised by the roles of administrators and bureaucracy in the practice of medicine, and even the changing sense of Jewish identity within a largely assimilated family of children and grandchildren of immigrants. The closing chapters challenge the author to consider that there may be exceptions to the ethical certainties of the doctor/patient relationship that he has presented to his students for many years. Indeed, the poignant image of the elder Dr. Lerner as an increasingly debilitated resident of the very nursing home for which he was once Medical Director provides a reminder: that “doctors” and “patients” are not distinct populations, but rather colleagues in their shared humanity. In revealing this family history, the “second” Dr. Lerner provides insight into the evolution of medicine as seen “From Both Sides, Now”. As in the song, he’s learned that “something’s lost, but something’s gained”. In doing so, he provides a provocative message for those who ponder the future of American medicine.
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2 of 2 people found the following review helpful
5.0 out of 5 stars Inspiring History of Medical Bioethics- Narrative Medicine at its Best, August 5, 2014
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This review is from: The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics (Hardcover)
As I start medical school, I feel fortunate to have read this autobiography at this point in my medical career. This novel examines the transition of medicine from a field where physicians were encouraged and expected to form deep relationships with their patients to one where time has become more important than doctor-patient relationships. Having studied medical bioethics in college, I can confidently say that Dr. Lerner’s brief history of medical bioethics is told in an interesting and personal manner that is vastly different from the usual bioethics textbooks. This book will ring true for medical professionals as well as with laypeople with little medical expertise. In fact, the dilemmas of medical futility discussed in the novel may be of particular importance for a lay person in a time when individuals are living longer due to medical interventions. Dr. Lerner’s poignant stories of his grandparents’ deaths made me think about death and old age in a new way, as I began to question when a life ought to end.

The most touching parts of the book focus on the wonderful father-son relationship shared by Dr. Lerner and his father. Through the course of his career, the senior Dr. Lerner deals with various ethical dilemmas, including medically treating his own relatives. The paternalistic tilt of the elder Dr. Lerner’s medical practice causes his son, and the reader, to reevaluate the role of a physician in medical decision-making. The reader may be surprised to find that sometimes, the ethically correct decision may not always seem to be the best one. The journal entries left by his father are used aptly by the younger Dr. Lerner to give the reader insight to the thought pattern behind many of the decisions his father makes. The younger Dr. Lerner’s description of his father’s own experience with old age and illness are profoundly moving. It is unsettling to learn that the older Dr. Lerner eventually becomes a resident at the very nursing home that he was once director of. But this also proves to be a powerful reminder to the reader that even doctors are not exempt from the suffering of old age.

This novel has reminded me that medicine is an art and the older Dr. Lerner provides a beautiful example of what a physician can be at his best. I would strongly recommend this novel to both medical professionals and lay people as a book that is both moving and informative.
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2 of 2 people found the following review helpful
5.0 out of 5 stars Terrific Read, July 22, 2014
By 
J. Ranney (Tucson, AZ United States) - See all my reviews
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Barron Lerner has written a compelling and enjoyable story about the field of medicine while paying homage to his wonderful pioneering father. Both a tale of historical growth and change and the human lifecycle, this book is deeply personal and historically relevant and thoughtful. He does a great job describing the benefits of practicing now with the easy access to substantial empirical data, while lamenting the lack of professional courtesy and intimate knowledge of patients that was common in his father's experience. He describes situations of medical paternalism that are better as artifacts of the past, such as not telling patients about their diagnoses and the more positive situation in medicine that we have now with it emphasis on patient-centered practice. All of this is very interesting, but what makes it more so is how he weaves the ethical dilemmas of practice in both times with his own family history, making it a very real and personal experience for the reader. The book is very poignant in its history telling, with the Sr. Dr. Lerner ending up with a serious illness at the end of his life being cared for in a facility in which he was previously the Medical Director and his own son being embroiled in making his end of life care decisions, much the same (and differently) as his father before him. Though I don't know Barron directly, I did know his father, whom I believe went to Medical School with my father and he was a wonderful man. I was not at all surprised to discover how loved he was by his patients and that he had such a passionate connection to his work. It is clear that in his son, the apple falls not far from the tree. I have been telling everyone in my life about this excellent work. I highly recommend it.
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2 of 2 people found the following review helpful
5.0 out of 5 stars Inspirational, thought-provoking, and exceptionally well-written book, June 25, 2014
By 
Max Moses Feinstein (Los Angeles, CA USA) - See all my reviews
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This review is from: The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics (Hardcover)
I suspected I'd enjoy this book because of my interest in both medicine and medical ethics. With regard to medical ethics, the author lives up to his promise of providing a detailed and engaging account of how the field started and has changed since its conception. Importantly, the author didn't leave medical ethics as a stand-alone subject, but rather elucidates the complex, rich relationship the field has with the practice of medicine. The book's coverage of medical ethics is enhanced by the detailed and interesting anecdotes of the author's experiences as a practicing physician, as well as those of his father.

What I hadn't expected to encounter, however, was the fascinating bigger-picture account of how American medical/physician culture has changed throughout the 20th century. The author provides insight into these changes by way of examining his father's medical practice with his own medical practice, all along using medical ethics as a lens for exploring the similarities and differences between the two. The way in which the author combines said topics is impressive.

It's also worth highlighting the author's incredibly clear writing style, which made the book an absolute joy to read. Although the subject matter of the book is far from simple, the author communicates his ideas in the most lucid way that I've ever encountered in non-fiction.

As an incoming first-year medical student, I found this book to be especially informative and enjoyable. That said, I imagine it would be a similarly enjoyable book for readers with an interest in medicine or medical ethics, regardless of professional interests or background.
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2 of 2 people found the following review helpful
5.0 out of 5 stars Medical ethics and decision making wrought personal. An excellent, thought provoking book. Highest recommendation!, June 2, 2014
By 
Stevierose (Ann Arbor, MI) - See all my reviews
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This review is from: The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics (Hardcover)
I have practiced medicine for 35 years. I have just finished reading "The Good Doctor" and found it to be a very well written, excellent book on an important topic. Reflecting the speciallties of its author (Internal Medicine, History, and Bioethics) it traces the history of the changes that have occured in medicine during my own career from the more paternalistic (but more personally involved) style of the physicians who trained me to the present era which has put a high priority on patient autonomy but perhaps less intense personal involvement on the part of physicians in their patients' lives and medical decisions. The history is told through the career and personal journals of the author's father (an internationally respected infectious disease specialist) in contrast to the experiences and philosophy of the author himself. Issues regarding the medical ethics related to medical decision making, patient autonomy, end of life issues, and physicians caring for their own family members are discussed in the context of the real life cases and family crises presented. In the end, Dr. Lerner's philisophical/ethical viewpoints are challenged by confronting the end of life issues facing his own father.

Dr. Lerner is an excellent writer and I found the writing to be very engaging and the subject matter to be very important for physicians and patients alike (that is to say, all of us). Not surprisingly, as in most human endeavors the book leads us to that most difficult gray middle ground regarding these subjects and therefore is quite thought provoking and will undoubtedly become an excellent teaching tool. HIghly recommended.
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4 of 5 people found the following review helpful
5.0 out of 5 stars What really makes for a good doctor?, April 30, 2014
This review is from: The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics (Hardcover)
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What's the best way to practice medicine? That's the central theme of Dr. Lerner's book. He approaches the question as the son of a doctor who practiced medicine under the "paternalistic" model of an earlier generation and as a doctor and medical ethicist who today views the doctor-patient relationship as more of a partnership.

Dr. Lerner thoroughly explores the good and bad of both approaches, especially as it relates to end-of-life care. His father believed strongly in the concept of medical futility, meaning that heroic measures at the end of life are most often ineffective and needlessly invasive, robbing a patient of dignity in dying. And he believed he had the right to make the decision for the patient, many times not even giving patients the truth about their condition. On the other hand, Dr. Lerner, the son, believes firmly in informed consent and patient involvement -- even patient-led decision-making.

Because Dr. Lerner comes to no firm conclusions, the narrative veers back and forth between the positives and negatives of each approach. I often felt as if we were going around in circles. I think perhaps Dr. Lerner has come to no firm conclusions himself -- he takes great pains to express appreciation for both approaches. At times, I felt the tension in his beliefs, no more strongly than at the end of his father's life, when he is forced to make some decisions for his incapacitated father. I have to say that after reading Dr. Lerner's ardent defense of patient-led decision making, I was shocked when he reveals taking a course of action that seemed contrary to his father's clearly articulated wishes. But I'm sure he would have questioned his decision no matter which path he chose.

For more reading in the general medical nonfiction category, you might like two books edited by Lee Gutkind, I Wasn't Strong Like This When I Started Out: True Stories of Becoming a Nurse and Becoming a Doctor: From Student to Specialist, Doctor-Writers Share Their Experiences. Also, Jerome Groopman's Your Medical Mind: How to Decide What Is Right for You. The Good Nurse: A True Story of Medicine, Madness, and Murder is a hair-raising tale of medical crime, while Second Suns: Two Doctors and Their Amazing Quest to Restore Sight and Save Lives is a heartwarming read. For a personal account of caring for a parent at the end of life, try Will Schwalbe's The End of Your Life Book Club.
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7 of 9 people found the following review helpful
4.0 out of 5 stars "Prior to the era of bioethics, physicians had often overstepped their power....", April 7, 2014
This review is from: The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics (Hardcover)
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Barron H. Lerner's "The Good Doctor" is the author's account of his ambivalent relationship with his father, Phillip, a dedicated medical practitioner, teacher, and infectious disease specialist. In this poignant and candid memoir, Lerner traces his family's roots to Poland. Most of Barron's ancestors came to America before the Holocaust, and once here, they found jobs, established homes, raised families, and worked hard so that their children could succeed in life. Phillip, who was born in Cleveland in 1932, became a brilliant and dedicated physician. He spent countless hours on call, and was usually available whenever a patient or colleague sought his advice.

Dr. Phillip Lerner even provided treatment to his sick relatives. Barron, a highly respected doctor himself, as well as a medical historian and ethicist, insists that it is a conflict of interest for a doctor to treat his loved ones. Nevertheless, Barron's dad thought that he knew best. He was a proponent of "paternalistic" medicine, asserting that it is acceptable for doctors to care for their grandparents, aunts, and cousins. Under certain circumstances, he withheld information from patients about their prognosis and, furthermore, he considered it his duty to help terminally ill patients pass away peacefully.

This is a colorful portrait of an extended family and a close look at the career of a healer who enjoyed what he did until "cookbook medicine," high-tech tests, managed care, and advance medical directives became commonplace. Barron and his father differed on a number of issues. For example, the younger Dr. Lerner is a champion of informed consent and insists that, whenever possible, physicians should confer with their patients and/or next of kin about their medical options.

"The Good Doctor" is a thought-provoking and moving work of non-fiction. Although Dr. Lerner is sometimes critical of his father, he acknowledges his dad's many strong points. Phillip was compassionate and a talented diagnostician. In addition, he showed foresight in recognizing the importance of administering the right antibiotics in carefully managed doses. Another point in the senior doctor's favor was his emotional connection with the men and women who depended on him. Barron knows that Phillip did whatever he could to help his patients, many of whom credit him with saving their lives. For Dr. Phillip Lerner, the practice of medicine was personal. When he and other like-minded physicians passed away, something very precious died with them.
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2 of 2 people found the following review helpful
5.0 out of 5 stars A Wonderful History of Medical Ethics, July 6, 2014
This review is from: The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics (Hardcover)
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Barron Lerner is the 2nd doctor in a generation, his father was a doctor too and when discussing medical ethics and issues with dying, his father told him stories which stunned him, such as lying over a patient who was dying and refusing to allow others to do CPR on him. Barron found this shocking but he learned that the rules which he follows in order to allow a patient to die or be revived were written and created after brave doctors like his father protested how patients were constantly revived and prevented to die and suffer. Lerner began to study how the right to die movement started in medicine or was affected by outside forces. A great history, starting at home.
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2 of 2 people found the following review helpful
4.0 out of 5 stars Solid memoir about "real" life as a physician in the US, today and a generation ago, May 12, 2014
This review is from: The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics (Hardcover)
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Americans within and outside the medical community are all too aware that medicine has changed over the past few generations. Many of these changes have been positive, with increased access to procedures and treatments not even available 50 or 60 years ago. It is, however, the negatives--increasing costs, marketing costs exceeding research expenditures in the pharmaceutical industry, and perceived loss of personalization in care, etc.--that attract most media attention.

Dr. Lerner has used the notebooks of his physician father and his own experiences to create a memoir that gives the reader a picture of what these changes have meant in the lives and practices of two doctors of two different generations. The result is a memoir that touches upon some of the ethical questions that the changes have brought for practitioners. However, the title may be a little over-reaching, in that "the evolution of medical ethics" here really gives us a picture only of two specific physicians, not at all the entire profession.

Lerner makes an important point in demonstrating that life and death decisions have long been a part of a physician's role, way before the "death panels" panicky commentators raised as straw men in the recent Affordable Care Act debates. His ambivalence in whether he might have acted as his father did in the narrative that begins the book is helpful in showing that even for the most experienced physician/medical ethicist, these are decisions that are never easy.

I recommend this book as memoir, a fascinating picture of moving from physicians who still were having to use intuition for a large part of their diagnosis and treatment to a generation with vast amount of test results to interpret in the care of each patient. Nevertheless, the reader should be clear in understanding that the ethics of neither the older or and younger Dr. Lerner are representative of all physicians in their specific generation. Look to some of the excellent, more general, histories of modern medicine and the birth of "medical ethics" for a more accurate presentation.
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The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics
The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics by Barron H. Lerner (Hardcover - May 13, 2014)
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