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Proc (Bayl Univ Med Cent). 2007 January; 20(1): 91.
PMCID: PMC1769547
Incidental Findings: Lessons from My Patients in the Art of Medicine by Danielle Ofri
Reviewed by James Marroquin, MD
The reviewer, James Marroquin, MD, is a resident in internal medicine at Baylor University Medical Center.
Boston: Beacon Press, 2006. 192 pp. Hardcover, $23.95; paperback, $14.00.
 
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After 3 years of intense training at New York City's Bellevue Hospital, it was difficult for Danielle Ofri to contemplate life after residency. As she writes near the beginning of her book, “I couldn't quite believe that I would never again spend a night in the hospital. Never again find myself wandering deserted in the hallways at 3:00 in the morning. Never sweat over another IV in a veinless drug user. Never have to sleep in used sheets, shivering for lack of a blanket.” Eager for some freedom and rest, Ofri became a physician-vagabond for a time. She would work locum tenens for a month, use the income to finance her personal travels, and then take on another assignment when her money ran out. Ofri eventually returned to Bellevue, where she has become an attending physician and an accomplished writer. Incidental Findings is a collection of stories chronicling her experiences finding her way as a newly independent doctor.

The book is marked by an earnest reverence for the practice of medicine. Faced with frustrations that push many doctors toward cynicism, Ofri struggles to see her work as a sacred calling. She agonizes over how to convince a lonely old man who has stopped taking his medicines that his life is worth living. She fights to see brokenness and fear in a patient's irritability and rudeness to hospital staff. She spends an hour with a directionless young man persuading him to take the SAT and pursue college.

On first reading, Ofri's idealistic approach to medicine struck me as a bit over the top. She seemed to endow the ordinary events of a doctor's day with a disproportionate amount of drama and meaning. To paraphrase Freud, sometimes a physical exam is just a physical exam. But perhaps my initial response only proves Ofri's point that we physicians too often overlook the deep significance of our work. Quite easily medicine becomes tasks to complete instead of people needing our care. Grinding through our day, we lose sight of what a special role we can play in patients' lives.

For some doctors, it takes becoming a patient to understand the weight of a physician's words and actions. For instance, in one story about getting an amniocentesis, Ofri comes to see that events which seem trivial to doctors can be frightening and overwhelming when they happen to you. As an obstetrician prepares to stick a needle into her belly, Ofri realizes that it is the very same needle that she has so unflinchingly stuck into patients' spinal canals, bone marrows, lung cavities, and abdomens. But, she writes, “This is the first time I've ever faced the business end of the needle. It is metallically menacing, like medieval armor, and far larger than I ever recalled its being.”

Through stories like these, Ofri reveals what a tremendous honor and responsibility it is to be a physician. Indeed, one senses that one reason Ofri wrote these stories was to remind herself of this vital fact. I, for one, would do well to follow her example.