Customer Reviews

The Uncertain Art: Thoughts on a Life in Medicine

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This book is a collection of recycled pieces written for the magazine of the Phi Beta Kappa society. Nothing is inherently wrong with a compilation, although the pieces didn't flow all that smoothly together. More important is the subject matter addressed; many of the chapters just didn't capture my interest the way his previous books have. And the writing seems a bit pretentious; never use a short word when a longer one can found. Its almost like the articles were written to impress those who are thought to fancy themselves to be of a certain refined intellectual and critical level (eg PBK members), as if to say "sure, I'm a doctor and not a college professor but I have a big vocabulary too!"

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"All of this is prologue [the preceding pages of the book's introduction] to introducing the substance of my book and explaining the title I having chosen for it. By now it is doubtless clear that [the book's title] "The Uncertain Art" refers to medicine and that I have been attempting in the foregoing paragraphs [of this book] to stake out a territory whose boundaries are sufficiently vague that I feel free to roam wherever inclination leads me. Roam, that is, so long as I stay within sight of the assignment I have given myself, which is to write as a doctor, about issues associated with doctoring."

The above is found near the end of the introduction to this book authored by Sherwin Nuland, a clinical professor of surgery at Yale University and the author of numerous books.

Each of the chapters (except for the last one) in this book is a "slight modification" of the "sequence of [stand-alone] essays" the author wrote between 1998 and 2004 for the publication "The American Scholar." Thus, the new writing in this book actually consists of a brief "Author's Note" (found at the beginning), the Introduction, and the last essay or chapter.

It seems to me what Nuland has attempted to do was to take a series of stand-alone essays that he had written previously and tried to connect them so they would have a common theme. The theme being how a doctor has to make decisions and judgements in the face of uncertainty.

However, I had a difficult time extracting this theme from his essays or chapters (except for the two chapters that dealt with Hippocrates). Don't get me wrong. All the essays are well-written and show considerable thought in composition but taken as a whole, they don't seem to have any cohesive theme.

If you reread the quotation that begins this review, you'll see that Nuland tells us in the last sentence that he wrote about "issues associated with doctoring." However, there are several essays (such as the joy of writing and reflections on 9/11) that seem out of place.

The subtitle of this book is "Thoughts on a Life in Medicine." However, there is much research (especially historical research) that actually makes up the bulk of this book, not just the author's thoughts.

There are no references in this book. Most of the essays are well-researched and show considerable attention to detail (such as essays on the hidden meaning of medical words, grave robbing, the medical school & the university, and electroconvulsive therapy). Where did the author get all this information?

Finally, scholarly publications such as "The American Scholar" demand references. It's my guess that the original essays had references but for some reason it was decided not to include them with this book. Why?

In conclusion, the essays that make up this book are well-written but don't clearly accentuate either the book's title or subtitle.

(first published 2008; author's note; introduction; 21 essays or chapters; main narrative 185 pages; acknowledgements; index)

<<Stephen Pletko, London, Ontario, Canada>>

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I enjoyed this book, as I do all of Nuland's offerings, but it wasn't riveting - it was more like meandering through a park. Most of these pieces were previously published in periodicals, and like many compilations, the necessary brevity normally demanded by magazine editors left me, in several cases, wishing for more fleshing out of the various subjects introduced. I especially missed that which Nuland has done so well in his previous books - brought the subject matter literally to life based on specific stories of his patients. This was done only in the final chapter, and not coincidentally, this chapter was by far the most interesting, compassionate, and illustrative of his central thesis. Nevertheless, considering the nonsense that passes for literature today, well worth having and reading more than once.

"The Uncertain Art" is primarily a collection of mostly philosophically-toned essays written for "The American Scholar" between 1998 and 2004. The underlying thesis, sometimes difficult to discern, is that while science has advanced rapidly and improved the practice of medicine, judgment still lies at the heart of diagnosis and therapy. Unfortunately, the book does not provide clear examples of this in practice.

Part of the support of this thesis rests on brief vignettes of prior medical education and the Flexner report; however, again most of this material lacks sufficient detail to impress the reader - one exception involving the difficulties Dr. Lister encountered in getting his germ theory accepted.

In what is the most impressive chapter Dr. Nuland summarized some of his experiences when the call rang out "Is there a doctor in the house?" Unfortunately, for the patient, this did not always turn out well, despite his expert best efforts.

Another potentially very interesting chapter contained predictions on the near future of medicine; again, however, the material was too brief for my taste. On the other hand, Dr. Nuland's interest in accupuncture and its use in some Chinese surgeries was very well done - even though neither he nor the Chinese could explain the phenomena.

Dr. Nuland writes engagingly, perceptively, compassionately, historically, and synthetically about the uncertain art of medicine. No one physician has the capacity or lifespan to learn fully the art of medicine, as Hippocrates and his students recognized two and a half millennia ago (5th & 4th century B.C.E.). Dr. Nuland explores the implications of that first part of the first aphorism of the Hippocratic Corpus of writings. I cannot imagine that any physician, surgeon, biomedical researcher, and medical student would not consider reading this personal-professional-instructional account a memorable and personally influencial experience.

Physician/author Sherwin Nuland writes with uncommon insight and compassion in this, his latest book. The book is actually a compilation of stand-alone essays and musings that apparently originally appeared in The American Scholar magazine.

While the chapters stand alone as jewels in a collection, they reinforce the theme that medicine - for all its apparent scientific exactitude - remains an "uncertain art." We invest doctors and medicine with much more power than they have, perhaps projecting our own hopes and fears.

Nuland is a skilled writer, and his closing chapter on getting to know a heart transplant candidate may bring a tear to your eye. "An Uncertain Art" is a certain gem as a collection of insights on medicine from the vantage point of a seasoned surgeon. .

THE UNCERTAIN ART THOUGHTS ON A LIFE IN MEDICINE
By Sherwood B. Nuland M.D.

("And sign here if you'd like to see his organs become more involved in community theatre." Danny Shanaban, Cartoon Caption in THE NEW YORKER, July 21,2008.)


In his latest collection of medical essays, THE UNCERTAIN ART, Dr. Sherwin B. Nuland, tells us about a new perhaps controversial and decidedly complex medical development: human heart transplantation. This essay is presented towards the book's ending, though to me and possibly to most readers, this is the books most important section.

Heart transplantation presents mammoth emotional, economic, and ethical aspects to patient care. It is an entity never before confronted, which comes with the inevitable condition that someone must die before any patient can benefit.

Dr. Nuland presents the subject with his usual fluidity and clarity. Heart transplantation and its possible ramifications is important to physicians, councelors, and especially to the ones who may need it the most; potential patient candidates.

In a manner, Dr. Nuland's book is "the voice in the wilderness," maybe alerting the world of his new treatment. However, the public in general has to become more conversant and involved in heart transplantation. This is a process of human-to-human bonding and to many it will mean "going too far," while to others it is the only "miraculous ray of hope."
I strongly recommend reading it.