The Hong Kong Practitioner

I first read this book, borrowed from the medical library, some fifteen years ago. I read it by chance again this month, and have mixed feelings. After 15 years, I still cannot be as empathic with my patients as the book suggests. My attitude and concepts about patient care have still not surpassed those discussed by the author. How much I wish that I had read it again ten, eight or even five years ago.

The book starts with the account of how the author treated himself in a hotel room with large doses of intravenous vitamin C, laughter, and a strong will to live, for an alleged collagen disease that had been declared by hospital doctors to be beyond recovery. This treatment was supported, after discussion, by his understanding and sharing family physician. But do not be distracted from this controversial account. The gem of the book is in the later chapters: how a patient perceives an illness. The psychology of the seriously ill puts barriers between the patient and the doctor: the feelings of helplessness, the fear of permanent loss of normal function, the reluctance to be thought a complainer, the desire not to add to the already great burden of the family, the conflict between the terror of loneliness and the desire to be left alone, the lack of self-esteem, the fear of decisions made behind their backs, and the fear of intrusive technology. It discusses and demonstrates the concept of partnership in the doctor-patient relationship, the approach of co-operating with the patient for their informed choice of treatment, the art of giving placebo, and the essence of holistic healing. A placebo may be a drug, a process, or a person (the doctor). "The primary role of the doctor is to help people to prevent illness, and not just to overcome it". Holistic medicine tries to integrate the traditional doctor's father figure and the fast developing but compartmentalising aspects of medical knowledge and technology.

The book was first published in 1979. But many doctors nowadays are still doing what the author strongly advises against, i.e., doing harm by indiscriminate prescribing (procedures, or treatment). On the other hand, many doctors have not yet realised the importance and the healing magic of discussing in full details what therapy their patients are going to have, and of helping the patients to have quality life even when facing terminal illness.

The book is: "Anatomy of an illness: as perceived by the patient" by Norman Cousins, Toronto, Bantam Books, 1981, ISBN 0553343653.

Murmur	*The Hong Kong Practitioner* VOLUME 25 / February 2003