This book is a collection of papers that report the experiences of physicians and other health care professionals as patients who have had neurologic illnesses. All but four papers were written by the afflicted professionals. The oldest paper, the famous description by Lordat of his own aphasia, was originally published in French in 1843. All the other accounts were originally published in English between 1870 and 1996, the majority in the past two decades.
The papers are grouped in two parts, one dealing with cognitive disorders (sections on memory, language, and visual disorders) and the other with clinical conditions (sections on Parkinson's disease, brain tumor, stroke, head injury, and epilepsy). The editor, Narinder Kapur, a psychologist, provides a brief introduction to each section that is aimed at nonspecialist readers, as well as commentaries after individual papers and sections and an overview at the end of the book. The introductions are generally concise, well-organized, and informative in the sections dealing with cognitive disorders but are much less so in the sections on neurologic illnesses. The commentaries emphasize intellectual and behavioral impairment but largely neglect other neurologic deficits. Neurologists will be disturbed by some statements, such as the classification of seizures as either partial or grand mal and the suggestion that emotional lability in patients with brain injuries, manifested by tearfulness in happy situations, is an epileptic phenomenon. Little or no information is provided about the authors of the individual articles, where they practice, or the dates of the reports. Although some of this information can be obtained from the articles themselves or the references, a brief biographical sketch situating the author in place and time and a summary of the knowledge and care of the illness at that time would have greatly enhanced the value of the papers.
Since many laypeople have described their experiences as patients, one may ask whether clinicians who become patients provide unique insights into their illnesses and medical care. One area in which the clinician turned patient may provide a unique perspective is in judging the physician-patient relationship and the quality of care. Some reports in this book provide specific insight into deficiencies in medical care that have a strong negative effect on patients, such as lack of empathy on the part of the physician, inappropriate comments made in the presence of a patient who is assumed to be unable to understand, poor rehabilitation practices, and lack of adequate speech therapy. A physician turned patient may additionally have a unique perspective on the nature and character of his or her neurologic symptoms, which may shed light on their pathophysiology, depending on the particular knowledge and experience of the patient as well as on the nature of the illness. Extraordinary examples in this area are K.S. Lashley's account of migrainous scotomas and A. Brodal's self-observations and neuroanatomical considerations after a stroke. When one considers the effects of illness on everyday life, however, some compelling accounts written by laypeople remain unsurpassed. An outstanding example is the recent book by Jean-Dominique Bauby, a 45-year-old journalist who had a massive brain-stem stroke that left him completely paralyzed except for his left eyelid, but with intact intellect. His account (The Diving Bell and the Butterfly. Translated from the French by Jeremy Leggatt. New York: Knopf, 1997), "dictated" by signaling with the eyelid, is an extraordinary testimony to human courage and dignity.
Regardless of the particular emphasis given by the editor in his commentaries, the original papers speak for themselves. Physicians, psychologists, nurses, physical therapists, occupational therapists, and others engaged in the care of patients with neurologic disorders are bound to improve their understanding of doctor-patient relations and further their ability to care for such patients by reading the articles compiled in this book. Dr. Kapur has provided a great service by making reports originally published in scattered sources and at various times available in a single book.
Reviewed by Vicente Iragui, M.D., Ph.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Review
`This is an unusual book. ... This eclectic collection is unique and is worth consulting for its more informal insights into the 'Injured Brains of Medical Minds'.' World Neurology, vol.12, no.2
`the work is beautifully presented, and the occasional illustrations pertinent throughout. ... What is impressive is the personal narrative, and the great courage shown by these authors.' British Medical Journal, vol.315, August 1997
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