Bringing Mysteries Into Daylight

In The Scarlet Letter, Nathaniel Hawthorne offers insight into the role of the physician and the outcome of the patient-physician relationship by noting that the physician probes, pries and delves with a “cautious touch.… Few secrets can escape an investigator, who has the opportunity and license to undertake such a quest, and skill to follow it up.” Hawthorne suggests that a wise, intuitive physician who is unobtrusive and empathetic will bring “mysteries into daylight.”

Danielle Ofri’s newest book, Incidental Findings: Lesson from My Patients in the Art of Medicine, underscores the insights Hawthorne uncovers. In a series of essays, Ofri probes, pries and delves into the many conflicts of the physician-patient relationship. In the process we see her develop the ethics, compassion, sagacity and patience to become an excellent physician. Ofri acknowledges an important shift in perspective by stating “I started writing about patients, but now I’m writing about me…. [It’s] stepping into the emotional fray with the patient, that truly awes and humbles me. It is in that unsettling zone in which healing has a chance to take place.”

In Incidental Findings, there are fifteen essays representing various clinical presentations that occupy this “unsettling zone.” Each is an emotionally moving piece that stands alone, but when viewed collectively, Ofri offers us the educational elements, social reality and emotional impact that patients bring to the physician. She demonstrates the clinical synthesis the physician must achieve to approach clinical excellence.

In her deft and effective way, Ofri saliently discusses the clinical and ethical lessons of each essay. For example, she encounters a patient in “Acne” who is involved in an abusive relationship but only wants her skin condition discussed. She meets the non-terminal patient in “Living Will” who is depressed and wishes no treatment. In “Torment” she intervenes on behalf of a daughter whose mother is not very nice either to the family or the physician. In “Vision” she encounters a haughty man who comments negatively on nearly everything: physician style, medical teaching, hospital food, insurance restrictions, dress of students and attendings and quality of relationships. “In Her Own Key” recounts the pain of the well-rehearsed drug-seeker whose goal is not abstinence. Each adds a new dimension to the clinical skill of the physician.

Incidental Findings contributes to a growing body of literature about the clinical aspect of medicine and the importance of physician-patient relationships as evidenced in the works of Verghese, Gawande and Watts. Ofri comments “In the end, medicine will always be about one patient and one physician in one room.”

Incidental Findings is a must read for physicians- in-training. And for those of us who continue to struggle and grow in the practice of medicine, it is a confirmation of our efforts to bring “mysteries into daylight.”