Book of the week

2007-11-21 00:00

As a medical student, I am only too aware of the growing number of disillusioned patients who feel doctors treat them as diseases on legs rather than people. Worryingly, increased specialisation and technological advances in medicine threaten to increase the risk of this.

However, it is important to resist generalising. The medical profession is not simply on a downward slope, sliding from good old-fashioned holistic care towards mass manufacture of robot-like doctors, incapable of seeing the big picture or feeling for their patients. Firstly, not all physicians in the past did care for their patients in the way we would have hoped. Moreover, modern curriculums actually emphasise communication skills and health belief models.

I have sat through countless tutorials urging me to see past the chest X-ray to the person. The truth is that considering a patient's entire psychological and social context, although crucial for effective health care, is a difficult thing to teach. Still, throughout my training I have been encouraged by several doctors who just, well, seem to get it. Still not convinced? Let me introduce you to Dr Cecil Helman.

Helman, a graduate from Cape Town medical school, went on to study anthropology in London before practising as a general practitioner for over 20 years. Despite being an accomplished scientist, it is Helman's sociological perspective and literary tendencies that make his memoirs Suburban Shaman so readable and refreshing. Nothing escapes his anthropological lens as he subjects his patients, his own experience of being an inpatient, hospital routines and the very structure of the medical profession to scrutiny.

Anecdotes from his South African upbringing and training, the lives of his patients and his exploration of alternative health practitioners (from sangomas in the Transkei to Navaho traditional healers in New Mexico and Brazilian priestesses) merge to convey his passion for meeting with patients on their own terms. His message is a clear warning against what he calls “techno-medicine”.

The book has no explicit structure but flows easily, with limited jargon, making it accessible to both medical and non-medical people. Although Helman does on occasion resort to sermonising and reinforcing stereotypes, his example should confound the image of the narrow-minded scientific Western doctor.

Sadly, I suspect Suburban Shaman may preach to the converted because the physicians who do urgently need to read this are unlikely to get as far as picking it up. Nevertheless, it is an enjoyable and gentle read which gives us a glimpse of a man whose diverse career and thoughtful approach should inspire a deeper understanding of the wider determinants of health and healing.

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