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Wednesday, December 05, 2018

Review: No Apparent Distress

No Apparent Distress is Rachel Pearson's autobiographical account about how she became a doctor and the process of medical training.

Pearson is unusual in that she first wanted to be a writer first, and then changed her mind and decided to be a doctor after graduating with a degree. Much of the story takes place in Galveston after Hurricane Ike, which gave the local medical hospital an excuse to ditch care for people without health insurance.

The book isn't a political screed about the need for universal healthcare, but you see it in Pearson's encounters with patients throughout the book: cancer patients who can't get the surgery or chemotherapy they need, poor children who have no access to antibiotics, teenagers who cannot manage their diabetes properly because their homes are broken and they have no regular physician. (It's not clear that medicare for all would even have worked for some, since many of the patients were also undocumented)

The book was also enlightening to me in that it showed how doctors get trained: in wealthier, teaching situations, the hospital could actually hire "standard patients" who would evaluate doctors in how they approached care and give doctors-to-be feedback about how they were doing. In situations like student-run clinics or hospitals that provide care to folks without insurance, many of those patients would be seen by doctors-in-training, who would occasionally miss important clues. Pearson herself described her misunderstanding of a urine test that caused one man to be diagnosed of cancer too late, and another man who had such high blood sugar that he should have been hospitalized but wasn't. She then contrasts it to the luxury clinics where patient after patient would refuse to be seen by a doctor-in-training even for low risk health issues.

I have nits to pick with the book: frequently, she provides irrelevant details for the English majors who enjoy reading that stuff. It's a depressing book because so many of the cases end tragically not because medical science can't provide a cure, but because the cruel American medical system will not provide resources to help those who aren't insured. At one point she mentioned that the affordable care act had little impact in Texas because the Texas state government refused to expand medicaid to cover its poorest population.  Of course, the poorest part of the population aren't going to vote or can't vote, so there's no penalty for doing so.

Despite the depressing read, I learned more about a doctor's education process than I knew and came away better for it. Recommended.

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