The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics Info

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The story of two doctors, a father and son, who practiced in
very different times and the evolution of the ethics that profoundly
influence health care

 
As a practicing
physician and longtime member of his hospital’s ethics
committee, Dr. Barron Lerner thought he had heard it all. But in
the mid-1990s, his father, an infectious diseases physician, told him a
stunning story: he had physically placed his body over an end-stage
patient who had stopped breathing, preventing his colleagues from
performing cardiopulmonary resuscitation, even though CPR was the
ethically and legally accepted thing to do. Over the next few years, the
senior Dr. Lerner tried to speed the deaths of his seriously ill mother
and mother-in-law to spare them further suffering.
  

These stories angered and alarmed the younger Dr. Lerner—an
internist, historian of medicine, and bioethicist—who had rejected
physician-based paternalism in favor of informed consent and patient
autonomy. The Good Doctor is a fascinating and moving account of
how Dr. Lerner came to terms with two very different images of his
father: a revered clinician, teacher, and researcher who always put his
patients first, but also a physician willing to “play God,”
opposing the very revolution in patients' rights that his son was
studying and teaching to his own medical students.
But the elder
Dr. Lerner’s journals, which he had kept for decades, showed the
son how the father’s outdated paternalism had grown out of a
fierce devotion to patient-centered medicine, which was rapidly
disappearing. And they raised questions: Are paternalistic doctors just
relics, or should their expertise be used to overrule patients and
families that make ill-advised choices? Does the growing use
of personalized medicine—in which specific interventions may be
best for specific patients—change the calculus between autonomy
and paternalism? And how can we best use technologies that were invented
to save lives but now too often prolong death? In an era of
high-technology medicine, spiraling costs, and health-care reform, these
questions could not be more relevant.

      
As his father slowly died of
Parkinson’s disease, Barron Lerner faced these questions both
personally and professionally. He found himself being
pulled into his dad’s medical care, even though he had
criticized his father for making medical decisions for his
relatives. Did playing God—at least in some
situations—actually make sense? Did doctors sometimes “know
best”?
 
A timely and compelling story of one
family’s engagement with medicine over the last half century,
The Good Doctor is an important book for those who treat
illness—and those who struggle to overcome it.

Average Ratings and Reviews
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4.13

148 Ratings

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Reviews for The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics:

5

Apr 22, 2014

Great Book......had me hooked from the Prologue. A great look at the discussion of death and quality of life from two physicians. The son, Dr. Barron Lerner, goes through his father's journals which he kept for years. He discovers how his father was a patient-center physician, long before it was popular. The book looks at many end of life topics that arise in the medical field. As a person who has a family member currently in Hospice and has gone through this process before, I found this book so Great Book......had me hooked from the Prologue. A great look at the discussion of death and quality of life from two physicians. The son, Dr. Barron Lerner, goes through his father's journals which he kept for years. He discovers how his father was a patient-center physician, long before it was popular. The book looks at many end of life topics that arise in the medical field. As a person who has a family member currently in Hospice and has gone through this process before, I found this book so revealing from the physician side....Great Read! ...more
5

May 19, 2014

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 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.

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. ...more
4

May 16, 2014

I really liked this book. I think it helps explain why so many currently practicing physicians feel unfulfilled in their careers and so many patients feel dissatisfied with the medical care they receive (even though that's not the point of the book). The book raises many important medical ethics questions -- most important, end-of-life decisions. But more than anything, the book tells the stories of father and son as physicians and how their experiences differed (in med school, in residency, and I really liked this book. I think it helps explain why so many currently practicing physicians feel unfulfilled in their careers and so many patients feel dissatisfied with the medical care they receive (even though that's not the point of the book). The book raises many important medical ethics questions -- most important, end-of-life decisions. But more than anything, the book tells the stories of father and son as physicians and how their experiences differed (in med school, in residency, and in their profession). The author gives a very balanced view of the issues he considers, finding good and bad (and gray) in the different approaches of the two generations.

Many of the descriptions of the elder Dr. Lerner (Phil) -- how he lived and breathed medicine and devoted himself 24/7 to his patients -- could have been about my dad, who is an internist. I have deep love and admiration for my dad and the way he practiced medicine, so the book felt very personal and immediate to me. Whether someone who doesn't have a physician in the family, or isn't a physician him or herself, would find the book as compelling is unclear to me. ...more
3

Jun 17, 2014

I agree with others that this book is quite "inside baseball" and may not resonate with those lacking close personal ties to the topic. I am a physician, in the generation right between the two Drs. L. I went to med school at Case Western Reserve and then did my residency in internal medicine and a fellowship in cardiology at University Hospital in Cleveland. After training I joined the full time academic faculty there, from 1983 to 2001, thus knowing Phillip Lerner, at least peripherally and by I agree with others that this book is quite "inside baseball" and may not resonate with those lacking close personal ties to the topic. I am a physician, in the generation right between the two Drs. L. I went to med school at Case Western Reserve and then did my residency in internal medicine and a fellowship in cardiology at University Hospital in Cleveland. After training I joined the full time academic faculty there, from 1983 to 2001, thus knowing Phillip Lerner, at least peripherally and by reputation. I am now at the University of Washington in Seattle, another site of training for Barron Lerner.
Having said all that, I must say I enjoyed the book but part of my enjoyment was the fun of spotting familiar colleagues and landmarks. The writing is serviceable but not lyrical and the story, while interesting, is not as unique as the author seems to think.
I suspect that Phillip Lerner was a fairly typical, albeit highly accomplished, doctor of his generation. Things were different then... ...more
4

Jan 26, 2015

Probably more detail about the history and changes in medicine than the average reader might be interested in. But I really enjoyed it. And the Jewish slant was also interesting.
3

Mar 20, 2015

A book that examines medical ethics and end of life decisions in a very personal family story.
4

Dec 01, 2015

Read this for book club at AAHPM annual meeting. Great discussion about the pitfalls of paternalism, of trying to be physician to your family, and the relative value of autonomy.
3

Jul 31, 2014

Interesting reading. allowed for a lot of reflection of my own journey in getting an M.D.
4

May 15, 2014

I learned of this book when I heard the author interviewed on NPR. I found what he had to say to be really interesting and found his book was no different. I really enjoyed reading this and recommend it!
4

May 13, 2014

A fascinating narrative for any amateur bioethics nerds. For twice as much fun, read it along with "Intern" by Doctor X (Alan Nourse), which is basically a similar observation made by a doctor in the elder Dr. Lerner's generation about the generation before him.
4

May 18, 2015

I would give this 3.5 stars but bumped it to 4 here on Goodreads. It's basically a biography of his father with some autobiography on the author. There was much I can relate to being a physician but I'm not sure non-medical readers would be as engrossed.
5

Jul 17, 2014

A beautifully written tribute from a very talented, loving son to his equally talented, superhuman father/physician. The passion for medicine of both the father and son is conveyed convincingly. I wish that I had a Dr. Lerner as my doctor! The case for patient autonomy vs. paternalism is made clearly. Issues are brought down to the layman's level.
4

Jul 26, 2015

While Laura had been a trouper, Susan was frustrated and angry with her disease, which she survived for more than nine years. And my father became the receptacle for her vitriol. "She screams and carries on when the going gets tough," he wrote, "knowing that I understand and will never reproach her, never abandon her, whatever!"

Care is a right and providing it is a privilege.
3

Jul 15, 2014

This book is primarily a biography of Barron Lerner's father, Phillip Lerner. It is also a Barron Lerner memoir and a history of changes in medical ethics over the professional lives of these two men. Oddly, I felt Barron Lerner does a much better job describing and defending his father's view than his own. Barron Lerner is a historian and bioethicist so it seems he would have opinions on current medical ethics, especially around one of the main themes of the book--dying. Yes, he covers what the This book is primarily a biography of Barron Lerner's father, Phillip Lerner. It is also a Barron Lerner memoir and a history of changes in medical ethics over the professional lives of these two men. Oddly, I felt Barron Lerner does a much better job describing and defending his father's view than his own. Barron Lerner is a historian and bioethicist so it seems he would have opinions on current medical ethics, especially around one of the main themes of the book--dying. Yes, he covers what the standards are now and some about how that came to be but without closely looking at the doctor and patient connection he covers well when describing his father. Is it a requirement that a bioeethicist be emotionally distant from actual sick people so he can make the "right" decision? ...more
2

May 03, 2014

I received this book in exchange for a honest review.
I am not usually a non- fiction reader. I prefer a story that I can dive into and leave my day to day stuff behind.
I chose "The Good Doctor" because like many others I am trapped in the Five minute Doctor visit offered thru local HMO to those over 70. Recently I went to my primary Physican complaining of chest pains and her answer was "What do you want me to do about it?"
So somehow I thought that reading this book would give me some I received this book in exchange for a honest review.
I am not usually a non- fiction reader. I prefer a story that I can dive into and leave my day to day stuff behind.
I chose "The Good Doctor" because like many others I am trapped in the Five minute Doctor visit offered thru local HMO to those over 70. Recently I went to my primary Physican complaining of chest pains and her answer was "What do you want me to do about it?"
So somehow I thought that reading this book would give me some amunition and information.
I feel while a personal story about a family and its dedicated Drs., it only holds up a mirror to our ever failing medical care.
It was interesting, and who knows, someday may help. ...more
4

Aug 12, 2015

I won this book from Goodreads First-reads.

This book is written by the son of a physician who also went on to become a doctor himself. It compares how ethics in the practice of medicine has changed from the time his father was a practicing physician to the author's own career as a doctor. I enjoyed this book. Although I have no formal background in medicine, the book clearly yet briefly explains medical terms used. It is a great read for anyone in the medical field, or not in the medical field I won this book from Goodreads First-reads.

This book is written by the son of a physician who also went on to become a doctor himself. It compares how ethics in the practice of medicine has changed from the time his father was a practicing physician to the author's own career as a doctor. I enjoyed this book. Although I have no formal background in medicine, the book clearly yet briefly explains medical terms used. It is a great read for anyone in the medical field, or not in the medical field but with an interest in the evolution of medical ethics, and how the practice of medicine has and continues to change.

I found this book to be very informative, without reading like a textbook. It's insightful, and also focuses on a son's relationship with his father and coming to terms with the type of doctor he wants to be. ...more
4

Jul 02, 2015

A simple read, and yet a wonderfully charming one. In The Good Doctor Barron Lerner compares the training and practice of today's generation of physicians with those of doctors before them. Along the way, he ponders how the discipline has advanced and evolved in its thinking, but is quite thoughtful about what qualities of physicians past might have been lost in this transition. As a physician-in-training, I found The Good Doctor challenged my thinking on topics like paternalism and A simple read, and yet a wonderfully charming one. In The Good Doctor Barron Lerner compares the training and practice of today's generation of physicians with those of doctors before them. Along the way, he ponders how the discipline has advanced and evolved in its thinking, but is quite thoughtful about what qualities of physicians past might have been lost in this transition. As a physician-in-training, I found The Good Doctor challenged my thinking on topics like paternalism and shared-decision making in the physician-patient relationship, the physician work-life balance, and the ethics of involvement in the medical care of one's relatives. It's a well-written, well-thought book that I found hard to put down, and I'd especially recommend it to other students or young doctors who might benefit from thinking about the changes in habits and values across generations of medical providers. ...more
4

Apr 22, 2020

Interesting look into the ethics of medicine from a personal perspective.
2

Sep 17, 2019

This was an interesting book about the evolution of the role of the physician but the book was a bit sidetracked by and excessive amount of biographical information. Lerner hits upon a wonderful way to tell the story of the evolution of the medical profession by following his own career and that of his father, two generations of the Dr. Lerners trained and practicing in the US. However, in trying to tie the story to their biographies the balance of the book shifted to just that, a family This was an interesting book about the evolution of the role of the physician but the book was a bit sidetracked by and excessive amount of biographical information. Lerner hits upon a wonderful way to tell the story of the evolution of the medical profession by following his own career and that of his father, two generations of the Dr. Lerner’s trained and practicing in the US. However, in trying to tie the story to their biographies the balance of the book shifted to just that, a family biography. This results in pages-long sections where the changing expectations of bioethics and medical sub-specializations seemed incidental to the day to day life of the Lerner family. There is nonetheless enough discussion about the movement towards patient autonomy and the like to keep the general reader interested while Lerner’s skill as a biographer is also good enough to interest some readers on its own. ...more
5

Feb 02, 2017

Since I have two grandsons and a son-in-law in the medical profession I wanted to read this book to better understand the things they face in their daily work. This is a true account of a father and son, one who took on the burden of making decisions for his patients without consulting or telling them what was going on. He had an intense passion for his profession and his patients but his methods of practice would not be tolerated in this day and age. His son in writing the book learned things Since I have two grandsons and a son-in-law in the medical profession I wanted to read this book to better understand the things they face in their daily work. This is a true account of a father and son, one who took on the burden of making decisions for his patients without consulting or telling them what was going on. He had an intense passion for his profession and his patients but his methods of practice would not be tolerated in this day and age. His son in writing the book learned things about his father that he could not imagine anyone doing. Medicine has become too reliant on technology because doctors saw patients not as people but as specific diseases. I myself have experienced this. Dr. Lerner's father felt that the secret of the care of the patient is 'in caring for the patient' and then the disease. If you have any interest at all in the health care system, this is a book to read. ...more
3

Dec 22, 2018

I found at least the first half of the book very dry, and it didn't hold my attention. That part was largely about how the author's father and the author became doctors, with a lot of the history of medicine and how the Doctor-as-God emerged. The later parts of the book were also about that, but held my interest better, maybe largely because they had more stories about patients, including his own family.

The book is supposedly about medical ethics, but I saw largely three issues, two of them I found at least the first half of the book very dry, and it didn't hold my attention. That part was largely about how the author's father and the author became doctors, with a lot of the history of medicine and how the Doctor-as-God emerged. The later parts of the book were also about that, but held my interest better, maybe largely because they had more stories about patients, including his own family.

The book is supposedly about medical ethics, but I saw largely three issues, two of them with more examples than strictly needed. The third, the ethics of taking perks from pharmaceutical companies, was addressed sufficiently. The other two issues were: 1. Doctor-as God (my term, not the author's), the paternalistic culture where the doctor decided what, and what not, to do for the patients and what, and what not, to tell them about their illnesses, prognoses, etc., and 2. (in a way a subset of 1) End of life issues; when to keep or stop treating fairly hopeless conditions, and whether to do futile lifesaving measures on actively dying patients. These questions also include how much control over their own care patients and families should have.

His father, in his practice, often thought people should be basically put out of their misery because their quality of life wasn't good enough. I wondered in those instances who should be the judge of quality of life. For example, a doctor thought my father-in-law should die when diabetes and Parkinson's made it impossible for him to move, breathe, eat on his own. But my father-in-law wanted to continue living and indeed got several more years of life from that point, including a lot of enjoyment, and ended up outliving that doctor. (view spoiler)[Interestingly, the author's father ended up physically and mentally incapacitated by Parkinson's. He was in a condition that he previously would have judged as not enough quality of life to be worth it, and yet he managed to express that he was happy enough and wanted to keep living. (hide spoiler)]

The book also examined how doctor-patient interactions have become less personal over time, because of more reliance on various tests and the pressure for doctors to see more patients more quickly. It didn't include much if any about the idea or practice of limiting patient care for reasons of cost effectiveness. I didn't mind that.

Plenty has been written about all these subjects. The new angle in this book is the examination through the lens of the author's family. The book is organized around that, so the various ethical questions come up a number of times in different chapters, which works out okay.

...more

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