Physician Doctor Quotes

After you find out all the things that can go wrong, your life becomes less about living and more about waiting.

It’s true that AI can mimic the human brain, but it can also outperform us mere humans by discovering complex patterns that no human being could ever process and identify.

Cognitive robotics can integrate information from pre-operation medical records with real-time operating metrics to guide and enhance the precision of physicians’ instruments. By processing data from genuine surgical experiences, they’re able to provide new and improved insights and techniques. These kinds of improvements can improve patient outcomes and boost trust in AI throughout the surgery. Robotics can lead to a 21% reduction in length of stay.

Pilots used to fly planes manually, but now they operate a dashboard with the help of computers. This has made flying safer and improved the industry. Healthcare can benefit from the same type of approach, with physicians practicing medicine with the help of data, dashboards, and AI. This will improve the quality of care they provide and make their jobs easier and more efficient

In short, physicians are getting more and more data, which requires more sophisticated interpretation and which takes more time. AI is the solution, enhancing every stage of patient care from research and discovery to diagnosis and therapy selection. As a result, clinical practice will become more efficient, convenient, personalized, and effective.

Do not work primarily for money; do your duty to patients first and let the money follow; our life is short, we don't live twice; the whirlwind will pick up the leaves and spin them, but then it will drop them and they will form a pile.

An algorithm that expedites care to a stroke patient in a chaotic emergency room (ER) has a good chance of adoption. An algorithm that reads a routine scan and provides some quantification of what the physicians can already estimate won’t be in as much demand. There are good reasons for algorithms to parse patient records to look for signs of rare diseases, but there are fewer good reasons for using them to evaluate clinical symptoms. It’s cool that AI tools can make diagnoses from scratch, but for most clinical encounters doctors are already pretty good at it.

Much of clinician burnout is due to spending time writing notes, placing orders, generating referrals, writing prior authorization letters, and creating patient communication. In other words, burnout is caused by physicians having to generate output! With the emergence of large language models that are used to train generative AI solutions, these use cases will be at the frontier of AI’s applications in healthcare.

We come unbidden into this life, and if we are lucky we find a purpose beyond starvation, misery, and early death which, lest we forget, is the common lot. I grew up and I found my purpose and it was to become a physician. My intent wasn't to save the world as much as to heal myself. Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness. And it can. but it can also deepen the wound.

The doctor is effective only when he himself is affected. Only the wounded physician heals

THE MAXIMS OF MEDICINE Before you examine the body of a patient, Be patient to learn his story. For once you learn his story, You will also come to know His body. Before you diagnose any sickness, Make sure there is no sickness in the mind or heart. For the emotions in a man’s moon or sun, Can point to the sickness in Any one of his other parts. Before you treat a man with a condition, Know that not all cures can heal all people. For the chemistry that works on one patient, May not work for the next, Because even medicine has its own Conditions. Before asserting a prognosis on any patient, Always be objective and never subjective. For telling a man that he will win the treasure of life, But then later discovering that he will lose, Will harm him more than by telling him That he may lose, But then he wins. THE MAXIMS OF MEDICINE by Suzy Kassem

But the story of leukemia--the story of cancer--isn't the story of doctors who struggle and survive, moving from institution to another. It is the story of patients who struggle and survive, moving from on embankment of illness to another. Resilience, inventiveness, and survivorship--qualities often ascribed to great physicians--are reflected qualities, emanating first from those who struggle with illness and only then mirrored by those who treat them. If the history of medicine is told through the stories of doctors, it is because their contributions stand in place of the more substantive heroism of their patients.

Surgeons know nothing but do everything. Internists know everything but do nothing. Pathologists know everything and do everything but too late.

There was a dragon who had a long-standing obsession with a queen's breasts," she said, growing breathless. "The dragon knew the penalty to touch her would mean death, yet he revealed his secret desire to the king's chief doctor. This man promised he could arrange for the dragon to satisfy his desire, but it would cost him one thousand gold coins." She spread her soapy hands over his nipples, then down his arms. "Though he didn't have the money, the dragon readily agreed to the scheme." Grace," Darius moaned, his erection straining against her stomach. She hid her smile, loving that she had this much power over such a strong man. That she, Grace Carlyle, made him ache with longing. "The next day the physician made a batch of itching powder and poured some into the queen's bra… uh, you might call it a brassiere… while she bathed. After she dressed, she began itching and itching and itching. The physician was summoned to the Royal Chambers, and he informed the king and queen that only a special saliva, if applied for several hours, would cure this type of itch. And only a dragon possessed this special saliva." Out of breath, she paused. Continue," Darius said. His arms wound around her so tightly she could barely breathe. His skin blazed hot against hers, hotter than even the steamy water. Are you sure?" Continue." Taut lines bracketed his mouth. Well, the king summoned the dragon. Meanwhile, the physician slipped him the antidote for the itching powder, which the dragon put into his mouth, and for the next few hours, the dragon worked passionately on the queen's breasts. Anyway," she said, reaching around him and lathering the muscled mounds of his butt, "the queen's itching was eventually relieved, and the dragon left satisfied and touted as a hero." This does not sound like a joke," Darius said. I'm getting to the punch line. Hang on. When the physician demanded his payment, the now satisfied dragon refused. He knew that the physician could never report what really happened to the king. So the next day, the physician slipped a massive dose of the same itching powder into the king's loincloth. And the king immediately summoned the dragon." -Heart of the Dragon

We are wrestling with some form of imposter syndrome, unable to internalize and appreciate our own accomplishments

a real physician almost never seeks another doctor’s help. For they all are painfully aware of just how little anybody understands about curing the sick.

Before you examine the body of a patient, be patient to learn his story. For once you learn his story, you will also come to know his body.

This we prescribe, though no physician; Deep malice makes too deep incision; Forget, forgive; conclude and be agreed; Our doctors say this is no month to bleed.

He thinks I’m having trouble expressing my feelings, which is why he suggested I write in a journal—to get it out, he said, like in the old days when physicians used to bleed their patients in order to drain the mysterious poisons. Which almost always ended up killing them in spite of the doctors’ good intentions, I might point out.

Paul's face grew serious. 'I think whenever a people has enormous resources, it is easy for them to call themselves democratic. I think of myself more as a physician than an American. We belong to the nation of those who care for the sick. Americans are lazy democrats, and it is my belief, as someone who shares the same nationality as [a Russian doctor], I think the rich can always call themselves democratic, but the sick people are not among the rich [...] I'm very proud to be an American. I have many opportunities because I'm American. I can travel freely through the world, I can start projects, but that's called privilege, not democracy.

Before you treat a man with a condition, know that not all cures can heal all people. For the chemistry that works on one patient may not work for the next, because even medicine has its own conditions.

Why did we ever force doctors to learn their profession in this exhausting, sleepless way? The answer originates with the esteemed physician William Stewart Halsted, MD, who was also a helpless drug addict.

Time and time again, throughout the history of medical practice, what was once considered as "scientific" eventually becomes regarded as "bad practice".

The doctors found out that Bunbury could not live, that is what I mean - so Bunbury died. He seems to have had great confidence in the opinion of his physicians. I am glad, however, that he made up his mind at the last to some definite course of action, and acted under proper medical advice.

LADY BRACKNELL. May I ask if it is in this house that your invalid friend Mr. Bunbury resides? ALGERNON. [Stammering.] Oh! No! Bunbury doesn't live here. Bunbury is somewhere else at present. In fact, Bunbury is dead, LADY BRACKNELL. Dead! When did Mr. Bunbury die? His death must have been extremely sudden. ALGERNON. [Airily.] Oh! I killed Bunbury this afternoon. I mean poor Bunbury died this afternoon. LADY BRACKNELL. What did he die of? ALGERNON. Bunbury? Oh, he was quite exploded. LADY BRACKNELL. Exploded! Was he the victim of a revolutionary outrage? I was not aware that Mr. Bunbury was interested in social legislation. If so, he is well punished for his morbidity. ALGERNON. My dear Aunt Augusta, I mean he was found out! The doctors found out that Bunbury could not live, that is what I mean - so Bunbury died. LADY BRACKNELL. He seems to have had great confidence in the opinion of his physicians. I am glad, however, that he made up his mind at the last to some definite course of action, and acted under proper medical advice. And now that we have finally got rid of this Mr. Bunbury, may I ask, Mr. Worthing, who is that young person whose hand my nephew Algernon is now holding in what seems to me a peculiarly unnecessary manner?

I guessed that he was one of those ambitious young physicians who more and more fill the profession, opportunists with a fashionable hoodlum image, openly hostile to their patients. My brief stay at the hospital had already convinced me that the medical profession was an open door to anyone nursing a grudge against the human race.

Before you diagnose any sickness, make sure there is no sickness in the mind or heart. For the emotions in a man's moon or sun, can point to the sickness in any one of his other parts.

Before asserting a prognosis on any patient, always be objective and never subjective. For telling a man that he will win the treasure of life, but then later discovering that he will lose, will harm him more than by telling him that he may lose, but then he wins.

It would be a mistake, though, to consider care by family doctors or midwives inferior to that offered by obstetricians simply on the grounds that obstetricians need not refer care to a family physician or midwife if no complications develop during a course of labor.

Success is judged not by the position you reach in life but by the obstacles you have overcome.

Love is a chemical reaction, But it cannot be fully understood or defined by science. And though a body cannot exist without a soul, It too cannot be fully understood or defined by science. Love is the most powerful form of energy, But science cannot decipher its elements. Yet the best cure for a sick soul is love, But even the most advanced physician Cannot prescribe it as medicine. INCOMPLETE SCIENCE by Suzy Kassem

Going to give you some words of wisdom,” he said, “that were passed down to me when I became a surgeon. Consider them a surgeon’s survival guide.” I closed my eyes briefly, indicating I was ready to absorb. “When you can eat, eat. When you can sleep, sleep. When you can fuck, fuck. But do not fuck with the pancreas.

I don't think you can be a physician and not see yourself reflected in your patient's illness. How would I deal with the kind of news I'd given Mr. Walters?

Many governments employ torture but this was the first time that the element of Saturnalia and pornography in the process had been made so clear to me. If you care to imagine what any inadequate or cruel man might do, given unlimited power over a woman, then anything that you can bring yourself to suspect was what became routine in ESMA, the Navy Mechanics School that became the headquarters of the business. I talked to Dr. Emilio Mignone, a distinguished physician whose daughter Monica had disappeared into the precincts of that hellish place. What do you find to say to a doctor and a humanitarian who has been gutted by the image of a starving rat being introduced to his daughter's genitalia? Like hell itself the school was endorsed and blessed by priests, in case any stray consciences needed to be stilled.

Through all this, patients were getting used to demanding drugs for treatment. They did not, however, have to accept the idea that they might, say, eat better and exercise more, and that this might help them lose weight and feel better. Doctors, of course, couldn’t insist. As the defenestration of the physician’s authority and clinical experience was under way, patients didn’t have to take accountability for their own behavior.

Certainly the primary imperative of a physician is to be skilled in medical science, but if he or she does not probe a patient's soul, then the doctor's care is given without caring, and part of the sacred mission of healing is missing.

I insert the bevel and draw back the plunger. I know that the syringe contains more than sodium chloride-that even as the toxic contents fill my fathers veins, he is sharing with me his final gift: the horror and thrill of saving lives.

Or to think that before Pasteur's discovery of microbes, doctors fought duels over the merits of balsam of Peru vs. tar oil for wound infection. Ignorance was just as dynamic as knowledge, and it grew in the same proportion. Still, each generation of physicians imagined that ignorance was the special provenance of their elders.

... omniscience about life and death is not within a physician's purview. A doctor should never write off a person a priori.

When doctor saves a life, he also saves a family.

Such is the demographic paradox of a junior physician's relationship with his patients: I worry about how to extend their lives. This anxiety inevitably shortens my own.

Far too many doctors-many of them excellent physicians-commit suicide each year; one recent study concluded that, until quite recently, the United States lost annually the equivalent of a medium-sized medical school class from suicide alone. Most physician suicides are due to depression or manic-depressive illness, both of which are eminently treatable. Physicians, unfortunately, not only suffer from a higher rate of mood disorders than the general population, they also have a greater access to very effective means of suicide.

Perhaps the most difficult part about identifying a medical serial killer is that no nurse or physician or medical worker wants to believe a peer would do such a thing—would kill instead of save lives.

As a doctor I constantly have to ask myself what kind of message the patient is bringing me. What does he mean to me? If he means nothing, I have no point of attack. The doctor is effective only when he himself is affected. 'Only the wounded physician heals.' But when the doctor wears his personality like a coat of armor, he has no effect.

An incompetent doctor practices, but a competent doctor performs.

It is not uncommon for doctors to be chronic overachievers; Beck wasn’t the first physician to go overboard with a new hobby. But

In the 10th century, Baghdad instituted a licensing exam that all doctors had to take before practicing as physicians

Families, in some ways, became our second set of patients. They needed time and attention, and if you failed to provide that, things could deteriorate quickly.

The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.

We may indeed be justly proud of our apostolic succesion. THESE ARE OUR METHODS - to carefully observe the phenomena of life in all its stages , to cultivate reasoning faculty so as to be able to know the true from the false. THIS IS OUR WORK - to prevent disease, to relieve suffering and to heal the sick.

We are often given pills or fluids to help remedy illness, yet little has been taught to us about the power of smell to do the exact same thing. It is known that the scent of fresh rosemary increases memory, but this cure for memory loss is not divulged by doctors to help the elderly. I also know that the most effective use of the blue lotus flower is not from its dilution with wine or tea – but from its scent. To really maximize the positive effects of the blue lily (or the pink lotus), it must be sniffed within minutes of plucking. This is why it is frequently shown being sniffed by my ancient ancestors on the walls of temples and on papyrus. Even countries across the Orient share the same imagery. The sacred lotus not only creates a relaxing sensation of euphoria, and increases vibrations of the heart, but also triggers genetic memory - and good memory with an awakened heart ushers wisdom.

The reader, knowing nothing about the ‘dark continent,’ filled in the blanks. Pictured Stone in a tent, kerosene lamp held up by a Hottentot providing the only light, elephants stampeding outside while the good doctor recited Cicero and excised part of himself as blithely as if he were cutting for stone on the body of another.

I was temperamentally better suited to a cognitive discipline, to an introspective field—internal medicine, or perhaps psychiatry. The sight of the operating theater made me sweat. The idea of holding a scalpel caused coils to form in my belly. (It still does.) Surgery was the most difficult thing I could imagine. And so I became a surgeon.

A greater subject fitteth Faustus' wit: Bid Economy10 farewell, and11 Galen come, Seeing, Ubi desinit philosophus, ibi incipit medicus: Be a physician, Faustus; heap up gold, And be eterniz'd for some wondrous cure: Summum bonum medicinae sanitas, The end of physic is our body's health.

Psychology’s service to U.S. national security has produced a variant of what the psychiatrist Robert Lifton has called, in his study of Nazi doctors, a “Faustian bargain.” In this case, the price paid has been the American Psychological Association’s collective silence, ethical “numbing,” and, over time, historical amnesia. 3 Indeed, Lifton emphasizes that “the Nazis were not the only ones to involve doctors in evil”; in defense of this argument, he cites the Cold War “role of …American physicians and psychologists employed by the Central Intelligence Agency…for unethical medical and psychological experiments involving drugs and mind manipulation.” 4

Doctor.’ Piper’s smile was so warm it would’ve melted a Boread. ‘We’d be so grateful for your help. We need the physician’s cure.’ Leo wasn’t even her target, but Piper’s charmspeak washed over him irresistibly. He would’ve done anything to help her get that cure. He would’ve gone to medical school, got twelve doctorate degrees and bought a large green python on a stick.

Government agencies are trying to get doctors to cut back on prescribing opioids. I understand that they need to do something about the epidemic of overdoses. However, labeling everyone as addicts, including those who responsibly take opioids for chronic pain, is not the answer. If the proposed changes take effect, they would force physicians to neglect their patients. Moreover, legitimate pain patients, like myself, would be left in agony on a daily basis.

Love is a chemical reaction, but it cannot be fully understood or defined by science. And though a body cannot exist without a soul, it too cannot be fully understood or defined by science. Love is the most powerful form of energy, but science cannot decipher its elements. Yet the best cure for a sick soul is love, but even the most advanced physician cannot prescribe it as medicine.

I am a physician, and as a consequence I see things most clearly in medical terms. I am arguing that we need an immunization program, one that injects people with respect, dignity, and equality. One that inoculates them against hatred.

The important question isn't how to keep bad physicians from harming patient; it's how to keep good physicians from harming patients. Medical malpractice suits are a remarkably ineffective remedy. (In reference to a Harvard Medical Practice Study)... fewer than 2 percent of the patients who had received substandard care ever filed suit. Conversely, only a small minority among patients who did sue had in fact been victims of negligent care. And a patient's likelihood of winning a suit depended primarily on how poor his or her outcome was, regardless of whether that outcome was caused by disease or unavoidable risks of care. The deeper problem with medical malpractice is that by demonizing errors they prevent doctors from acknowledging & discussing them publicly. The tort system makes adversaries of patient & physician, and pushes each other to offer a heavily slanted version of events.

...to think that before Pasteur's discovery of microbes, doctors fought duels over the merits of balsam of Peru versus tar oil for wound infection. Ignorance was just as dynamic as knowledge, and it grew in the same proportion. Still, each generation of physicians imagined that ignorance was the special provenance of their elders.

Six witnesses affirmed that Jacoba had cured them, even after numerous doctors had given up, and one patient declared that she was wiser in the art of surgery and medicine than any master physician or surgeon in Paris. But these testimonials were used against her, for the charge was not that she was incompetent, but that—as a woman—she dared to cure at all.

It takes the average American four years of doctors' visits to spend as much time with their physician as they spend with their phone in a single day.

Medicines ensures lengthy life but not necessarily healthy life.

As physician Larry Dossey put it, “We are conscious not because of the brain but in spite of it.

When a worker is injured at an IBP plant in Texas, he or she is immediately presented with a waiver. Signing the waiver means forever surrendering the right to sue IBP on any grounds. Workers who sign the waiver may receive medical care under IBP's Workplace Injury Settlement Program. Or they may not. Once workers sign, IBP and its company-approved doctors have control over the job-related medical treatment - for life. Under the program's terms, seeking treatment from an independent physician can be grounds for losing all medical benefits. Workers who refuse to sign the IBP waiver not only risk getting no medical care from the company, but also risk being fired on the spot...Injured workers almost always sign the waiver. The pressure to do so is immense. An IBP medical case manager will literally bring the waiver to a hospital emergency room in order to obtain an injured worker's signature. When Lonita Leal's right hand was mangled by a hamburger grinder at the IBP plant in Amarillo, a case manager talked her into signing the waiver with her left hand as she waited in the hospital for surgery. When Duane Mullin had both hands crushed in a hammer mill at the same plant, an IBP representative persuaded him to sign the waiver with a pen held in his mouth.

Although a male physician could quite easily, and convincingly, assert that ovarian cancer was “silent,” if you were to really listen to women who have had ovarian cancer speak, you’d find that it wasn’t so much that the disease process was silent—but that they were. Conditions that seem to lurk unnoticed in a woman’s body go unnoticed by others because, for one thing, they are an assumed part of womanhood, and, for another, women are taught to keep those pains private. I’ve often found it curious that when a woman is suffering, her competence is questioned, but when a man is suffering, he’s humanized. It’s a gender stereotype that hurts both men and women, though it lends itself to the question of why there is a proclivity in health care, and in society, to deny female pain.

I wanted to say, 'Wait—I am not sure I want to do this—I don’t know if I am ready.' I turned my head and saw him climb onto the wing and hop down onto the pavement. He didn’t give me a chance to tell him I hadn’t decided yet whether or not I was going to solo. Didn’t he know I wasn’t a real aviator? I was only a doctor, after all, and doctors weren’t required to solo. It was too late to tell him anything. I was going flying." (Page 199)

As a physician, I was trained to deal with uncertainty as aggressively as I dealt with disease itself. The unknown was the enemy. Within this worldview, having a question feels like an emergency; it means that something is out of control and needs to be made known as rapidly, efficiently, and cost-effectively as possible. But death has taken me to the edge of certainty, to the place of questions. After years of trading mystery for mastery, it was hard and even frightening to stop offering myself reasonable explanations for some of the things that I observed and that others told me, and simply take them as they are. "I don't know" had long been a statement of shame, of personal and professional failing. In all of my training I do not recall hearing it said aloud even once. But as I listened to more and more people with life-threatening illnesses tell their stories, not knowing simply became a matter of integrity. Things happened. And the explanations I offered myself became increasingly hollow, like a child whistling in the dark. The truth was that very often I didn't know and couldn't explain, and finally, weighed down by the many, many instances of the mysterious which are such an integral part of illness and healing, I surrendered. It was a moment of awakening. For the first time, I became curious about the things I had been unwilling to see before, more sensitive to inconsistencies I had glibly explained or successfully ignored, more willing to ask people questions and draw them out about stories I would have otherwise dismissed. What I have found in the end was that the life I had defended as a doctor as precious was also Holy. I no longer feel that life is ordinary. Everyday life is filled with mystery. The things we know are only a small part of the things we cannot know but can only glimpse. Yet even the smallest of glimpses can sustain us. Mystery seems to have the power to comfort, to offer hope, and to lend meaning in times of loss and pain. In surprising ways it is the mysterious that strengthens us at such times. I used to try to offer people certainty in times that were not at all certain and could not be made certain. I now just offer my companionship and share my sense of mystery, of the possible, of wonder. After twenty years of working with people with cancer, I find it possible to neither doubt nor accept the unprovable but simply to remain open and wait. I accept that I may never know where truth lies in such matters. The most important questions don't seem to have ready answers. But the questions themselves have a healing power when they are shared. An answer is an invitation to stop thinking about something, to stop wondering. Life has no such stopping places, life is a process whose every event is connected to the moment that just went by. An unanswered question is a fine traveling companion. It sharpens your eye for the road.

Love is a chemical reaction, but it cannot be fully understood or defined by science. And though a body cannot exist without a soul, it too cannot be fully understood or defined by science. Love is the most powerful form of energy, but science cannot decipher its elements. Yet the best cure for a sick soul is love, but even the most advanced physician cannot prescribe it as medicine.

The freedom of patient speech is necessary if the doctor is to get clues about the medical enigma before him. If the patient is inhibited, or cut off prematurely, or constrained into one path of discussion, then the doctor may not be told something vital. Observers have noted that, on average, physicians interrupt patients within eighteen seconds of when they begin telling their story.

Where there were once several competing approaches to medicine, there is now only one that matters to most hospitals, insurers, and the vast majority of the public. One that has been shaped to a great degree by the successful development of potent cures that followed the discovery of sulfa drugs. Aspiring caregivers today are chosen as much (or more) for their scientific abilities, their talent for mastering these manifold technological and pharmaceutical advances as for their interpersonal skills. A century ago most physicians were careful, conservative observers who provided comfort to patients and their families. Today they act: They prescribe, they treat, they cure. They routinely perform what were once considered miracles. The result, in the view of some, has been a shift in the profession from caregiver to technician. The powerful new drugs changed how care was given as well as who gave it.

As for the prayers, I suppose they can’t hurt. I’ve never found much good in them, I’ll confess that here, though I keep such thoughts private when in public company. Who would confide in a physician who claimed no affiliation with God? I still must feed myself, and keep my house. I still need my patients. But too many people believe with too much conviction in what amounts to, at best, a superstition. I’ve seen science change a patient’s diagnosis, but I’ve never heard a prayer that changed God’s mind about a damn thing..

A Boy was bathing in a river and got out of his depth, and was in great danger of being drowned. A man who was passing along a road heard his cries for help, and went to the riverside and began to scold him for being so careless as to get into deep water, but made no attempt to help him. “Oh, sir,” cried the Boy, “please help me first and scold me afterwards.” Give assistance, not advice, in a crisis. THE QUACK FROG Once upon a time a Frog came forth from his home in the marshes and proclaimed to all the world that he was a learned physician, skilled in drugs and able to cure all diseases. Among the crowd was a Fox, who called out, “You a doctor! Why, how can you set up to heal others when you cannot even cure your own lame legs and blotched and wrinkled skin?” Physician, heal thyself.

A Medical Affair is more than compelling fiction. It also is a powerful narrative about how relationships between physicians and patients can evolve in unethical, even unlawful ways. And as a medical ethicist and educator, I was delighted to see Strauss deftly weave important information about sexual misconduct by physicians into her story line.” David Orentlicher Professor of law, medicine and ethics at Indiana University. Oversaw drafting of American Medical Association's ethical guidelines on intimate relationships between physicians and their patients

With the managed care movement of the 1980s and 1990s, insurance companies cut costs and reduced what services they’d pay for. They required that patients give up their longtime physicians for those on a list of approved providers. They negotiated lower fees with doctors. To make up the difference, primary care docs had to fit more patients into a day. (A Newsweek story claimed that to do a good job a primary care doctor ought to have a roster of eighteen hundred patients. The average load today is twenty-three hundred, with some seeing up to three thousand.)

The United States spends more than twice as much per capita on health care as other rich capitalist countries —around $9,400 compared to around $3,600—and for that money its citizens can expect lives that are three years shorter. The United States spends more per capita on health care than any other country in the world, but 39 countries have longer life expectancies. [...] Under the current US system, rich, insured patients visit doctors more than they need, running up costs, while poor patients cannot afford even simple, inexpensive treatments and die younger than they should. Doctors spend time that could be used to save lives or treat illness by providing unnecessary, meaningless care. What a tragic waste of physician care.

Several years ago, researchers at the University of Minnesota identified 568 men and women over the age of seventy who were living independently but were at high risk of becoming disabled because of chronic health problems, recent illness, or cognitive changes. With their permission, the researchers randomly assigned half of them to see a team of geriatric nurses and doctors—a team dedicated to the art and science of managing old age. The others were asked to see their usual physician, who was notified of their high-risk status. Within eighteen months, 10 percent of the patients in both groups had died. But the patients who had seen a geriatrics team were a quarter less likely to become disabled and half as likely to develop depression. They were 40 percent less likely to require home health services. These were stunning results. If scientists came up with a device—call it an automatic defrailer—that wouldn’t extend your life but would slash the likelihood you’d end up in a nursing home or miserable with depression, we’d be clamoring for it. We wouldn’t care if doctors had to open up your chest and plug the thing into your heart. We’d have pink-ribbon campaigns to get one for every person over seventy-five. Congress would be holding hearings demanding to know why forty-year-olds couldn’t get them installed. Medical students would be jockeying to become defrailulation specialists, and Wall Street would be bidding up company stock prices. Instead, it was just geriatrics. The geriatric teams weren’t doing lung biopsies or back surgery or insertion of automatic defrailers. What they did was to simplify medications. They saw that arthritis was controlled. They made sure toenails were trimmed and meals were square. They looked for worrisome signs of isolation and had a social worker check that the patient’s home was safe. How do we reward this kind of work? Chad Boult, the geriatrician who was the lead investigator of the University of Minnesota study, can tell you. A few months after he published the results, demonstrating how much better people’s lives were with specialized geriatric care, the university closed the division of geriatrics.

Tolstoy recognized this. As Ivan Ilyich’s health fades and he realizes that his time is limited, his ambition and vanity disappear. He simply wants comfort and companionship. But almost no one understands—not his family, his friends, or the stream of eminent physicians whom his wife pays to examine him. Tolstoy saw the chasm of perspective between those who have to contend with life’s fragility and those who don’t. He grasped the particular anguish of having to bear such knowledge alone. But he saw something else, as well: even when a sense of mortality reorders our desires, these desires are not impossible to satisfy. Although none of Ivan Ilyich’s family or friends or doctors grasp his needs, his servant Gerasim does. Gerasim sees that Ivan Ilyich is a suffering, frightened, and lonely man and takes pity on him, aware that someday he himself would share his master’s fate.

Today, the lay midwife is a response to a growing home-birth movement. In my own community most physicians have decided to withhold prenatal care from the home-birther. This is judgmental and vindictive. These doctors have decided that home birth is not safe, and by withholding prenatal care they are doing their best to make sure it is unsafe. Often it is lay midwives who step forward to fill the void and help eliminate the unnecessary dangers of home birth. They are essential for screening out women who really should not have a home birth. For considerably less money than a physician charges, they spend many more hours with a pregnant woman before, during, and after the birth. and in most places they courageously face the opposition of the established medical community.

His heart is weak, but his will is strong-more so now than ever,” he continued, shrugging into the light cape Ormsley was putting over his shoulders. “What do you mean, ‘more now than ever’?” The physician smiled in surprise. “Why, I meant that your coming here has meant a great deal to him, my lord. It’s had an amazing effect on him-well, not amazing, really. I should say a miraculous effect. Normally he rails at me when he’s ill. Today he almost hugged me in his eagerness to tell me you were here, and why. Actually, I was ordered to “have a look at you,” he continued in the confiding tone of an old family friend, “although I wasn’t supposed to tell you I was doing so, of course.” Grinning, he added, “He thinks you are a ‘handsome devil.’” Ian refused to react to that admonishing information with any emotion whatsoever. “Good day, my lord,” the doctor said. Turning to the duke’s sisters, who’d been hovering worriedly in the hall, he tipped his hat. “Ladies,” he said, and he departed. “I’ll just go up and look in on him,” Hortense announced. Turning to Charity, she said sternly, “Do not bore Ian with too much chatter,” she admonished, already climbing the stairs. In an odd, dire voice, she added, “And do not meddle.” For the next hour Ian paced the floor, with Charity watching him with great interest. The one thing he did not have was time, and time was what he was losing. At this rate Elizabeth would be giving birth to her first child before he got back to London.

A little later, when breakfast was over and I had not yet gone up-stairs to my room, I had my first interview with Doctor Brandon, the famous alienist who was in charge of the case. I had never seen him before, but from the first moment that I looked at him I took his measure, almost by intuition. He was, I suppose, honest enough -- I have always granted him that, bitterly as I have felt toward him. It wasn't his fault that he lacked red blood in his brain, or that he had formed the habit, from long association with abnormal phenomena, of regarding all life as a disease. He was the sort of physician -- every nurse will understand what I mean -- who deals instinctively with groups instead of with individuals. He was long and solemn and very round in the face; and I hadn't talked to him ten minutes before I knew he had been educated in Germany, and that he had learned over there to treat every emotion as a pathological manifestation. I used to wonder what he got out of life -- what any one got out of life who had analyzed away everything except the bare structure.

I don't think this is a good idea. We all live on one planet so we cannot segregate the genders. If the Holy Mosque in Makkah, which is the holiest place on earth, does not segregate women, then why would the Ministry of Health want to segregate them?” She also went on to object to the selection of a physician based only on gender and not competence, expressing her disdain as follows: “I prefer doctors who are professional in studying my situation and solving my problem, regardless of whether they are male or female. I cannot imagine a men's hospital without female nurses and doctors, and I also cannot imagine women's hospitals without men playing a role in them.

Discounting mental behavior as a factor of sickness definitely sounds irrational, much less so than myths. Every practitioner knows that the will of the patient to recover plays a vital part in his treatment. Wedded to "strong" treatment, most physicians can nevertheless accept the idea that mentality, conviction and feelings do not play their part. At the dawn of Western medicine, Hippocrates claimed that "a patient who is mortally ill may yet recover from his doctor's confidence in the goodness." This has been corroborated by several modern studies, showing that people who trust their doctor and yield to his care are more likely to recover than those who treat treatment with distrust, anxiety and antagonism.

the Times says there's a heroin epidemic, Malone thinks, which is only an epidemic of course because now white people are dying. Whites started to get opium-based pills from their physicians: oxycodone, vicodin... But, it was expensive and doctors were reluctant to prescribe too much for exactly the fear of addiction. So the white folks went to the open market and the pills became a street drug. It was all very nice and civilized until the Sinoloa cartel down in Mexico made a corporate decision that it could undersell the big American pharmaceutical companies by raising production of its heroin thereby reducing price. As an incentive, they also increased its potency. The addicted white Americans found that Mexican ... heroin was cheaper and stronger than the pills, and started shooting it into their veins and overdosing. Malone literally saw it happening. He and his team busted more bridge-and-tunnel junkies, suburban housewives and upper Eastside madonnas than they could count....

WE COME UNBIDDEN into this life, and if we are lucky we find a purpose beyond starvation, misery, and early death which, lest we forget, is the common lot. I grew up and I found my purpose and it was to become a physician. My intent wasn’t to save the world as much as to heal myself. Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness. And it can. But it can also deepen the wound.

Whatever else you may think about me," he said gruffly, "I would never play that kind of game with you. The devil knows how you could doubt my attraction to you after our lesson at Baujart's. Or didn't you notice that being near you made me as randy as a prize bull?" "I noticed," Garrett whispered sharply. "However, the male erection isn't always caused by sexual desire." His face went blank. "What are you talking about?" "Spontaneous priapism can be caused by scrotal chafing, traumatic injury to the perineum, a flare-up of gout, an inflamed prostatic duct-" Her list was interrupted as Ransom hauled her against him, front to front. She was alarmed to feel his entire body shaking. It wasn't until she heard a ragged chuckle near her ear that she realized he was struggling not to laugh. "Why is that funny?" she asked, her voice muffled against his chest. He didn't reply, couldn't, only shook his head vehemently and continued to wheeze. Nettled, she said, "As a physician, I can assure you there's nothing humorous about involuntary erections." That nearly sent him into hysterics. "Holy God," he begged, "no more doctor-talk. Please." "It wasn't from scrotal chafing," Ransom eventually said, a last tremor of laughter running through his voice. Letting out an unsteady sigh, he nuzzled against the side of her head. "Since we don't seem to be mincing words, I'll tell you what caused it: holding a woman I'd already dreamed about more than I should. Being near you is all it takes to put me in high blood.

Once I had been diagnosed with a terminal illness, I began to view the world through two perspectives; I was starting to see death as both doctor and patient. As a doctor, I knew not to declare “Cancer is a battle I’m going to win!” or ask “Why me?” (Answer: Why not me?) I knew a lot about medical care, complications, and treatment algorithms. I quickly learned from my oncologist and my own study that stage IV lung cancer today was a disease whose story might be changing, like AIDS in the late 1980s: still a rapidly fatal illness but with emerging therapies that were, for the first time, providing years of life. While being trained as a physician and scientist had helped me process the data and accept the limits of what that data could reveal about my prognosis, it didn’t help me as a patient. It didn’t tell Lucy and me whether we should go ahead and have a child, or what it meant to nurture a new life while mine faded. Nor did it tell me whether to fight for my career, to reclaim the ambitions I had single-mindedly pursued for so long, but without the surety of the time to complete them. Like my own patients, I had to face my mortality and try to understand what made my life worth living—and I needed Emma’s help to do so. Torn between being a doctor and being a patient, delving into medical science and turning back to literature for answers, I struggled, while facing my own death, to rebuild my old life—or perhaps find a new one. —

The laws of physics apply to everything equally, to stars as well as flowers. Botany and astronomy are separate sciences, but if they are somehow fundamentally inconsistent then there is something wrong with our theories. The need for such an all-encompassing vision was not really felt in the Classical past. Aristotle wrote very widely and was happy enough to draw analogies between disparate phenomena, but he was conspicuously silent on some topics (such as what we would now call chemistry) and gives little impression of the need for congruence and continuity. For encyclopedists such as Pliny, "local" explanations for things were often enough: phenomena are explained largely in terms of themselves, not in terms of other things. Where do the four humors, the bodily fluids that were thought to govern health, come from? Neither Galen nor Hippocrates, the two preeminent physicians of antiquity, tell us; they assume that it is just how things are.

Experts in diagnostic errors provided an answer to the puzzle that had been nagging me: How was it possible for missed diagnoses to be so common and yet not perceived by doctors as a major problem? The problem is that physicians, while generally aware that mistakes happen, greatly underestimate how often they make them. In his talks to doctors on the topic, Graber often asks how many have made a diagnostic error in the past year; typically, only about 1 percent of the hands go up. 'The concept that they, personally, could err at a significant rate is inconceivable to most physicians,' he writes. In short, they think it's the other guy. This overconfidence is not necessarily their fault: doctors simply do not get the feedback needed to gain an accurate sense of their batting average. They assume their diagnoses are correct until they hear otherwise. Since there are few, if any, health care organizations that systematically measure diagnostic error rates, they typically learn of their mistakes only from the patients themselves.

When I interviewed with the Chief of Family Medicine at a large medical corporation on the West Coast, he explained that, since he was part of a team of people who arranged for pharmaceutical companies to issue cash grants, he was in a position to offer me a particularly enticing salary. “What are the grants for?” I asked. “We have a quality improvement program that tracks physician prescribing patterns. We call it ‘quality’ but it’s really about money.” And that’s all it’s about. It works like this. In his organization, any patient with LDL cholesterol over 100 is put on a cholesterol-lowering medication. Any person with a blood pressure higher than 140/90 is put on a blood pressure medication. Any person with “low bone density” is put on a bone-remodeling inhibitor. And so on. The doctors who prescribe the most get big bonuses. Those who prescribe the least get fired. With a hint of incredulousness in his voice, he explained, “So far, every time we’ve asked for funding for our program, the drug companies give it to us.” If this is where healthcare is headed, then these hybrid physicians-executives will instinctively turn their gaze to our children and invent more creative methods to bulldoze an entire generation into the bottomless pit of chronic disease.

Before you examine the body of a patient, Be patient to learn his story. For once you learn his story, You will also come to know His body. Before you diagnose any sickness, Make sure there is no sickness in the mind or heart. For the emotions in a man's moon or sun, Can point to the sickness in Any one of his other parts. Before you treat a man with a condition, Know that not all cures can heal all people. For the chemistry that works on one patient, May not work for the next, Because even medicine has its own Conditions. Before asserting a prognosis on any patient, Always be objective and never subjective. For telling a man that he will win the treasure of life, But then later discovering that he will lose, Will harm him more than by telling him That he may lose, But then he wins. THE MAXIMS OF MEDICINE by Suzy Kassem Copyright 1993-1994 - THE SPRING FOR WISDOM

In 1994, Friedman wrote a memo marked “Very Confidential” to Raymond, Mortimer, and Richard Sackler. The market for cancer pain was significant, Friedman pointed out: four million prescriptions a year. In fact, there were three-quarters of a million prescriptions just for MS Contin. “We believe that the FDA will restrict our initial launch of OxyContin to the Cancer pain market,” Friedman wrote. But what if, over time, the drug extended beyond that? There was a much greater market for other types of pain: back pain, neck pain, arthritis, fibromyalgia. According to the wrestler turned pain doctor John Bonica, one in three Americans was suffering from untreated chronic pain. If that was even somewhat true, it represented an enormous untapped market. What if you could figure out a way to market this new drug, OxyContin, to all those patients? The plan would have to remain secret for the time being, but in his memo to the Sacklers, Friedman confirmed that the intention was “to expand the use of OxyContin beyond Cancer patients to chronic non-malignant pain.” This was a hugely audacious scheme. In the 1940s, Arthur Sackler had watched the introduction of Thorazine. It was a “major” tranquilizer that worked wonders on patients who were psychotic. But the way the Sackler family made its first great fortune was with Arthur’s involvement in marketing the “minor” tranquilizers Librium and Valium. Thorazine was perceived as a heavy-duty solution for a heavy-duty problem, but the market for the drug was naturally limited to people suffering from severe enough conditions to warrant a major tranquilizer. The beauty of the minor tranquilizers was that they were for everyone. The reason those drugs were such a success was that they were pills that you could pop to relieve an extraordinary range of common psychological and emotional ailments. Now Arthur’s brothers and his nephew Richard would make the same pivot with a painkiller: they had enjoyed great success with MS Contin, but it was perceived as a heavy-duty drug for cancer. And cancer was a limited market. If you could figure out a way to market OxyContin not just for cancer but for any sort of pain, the profits would be astronomical. It was “imperative,” Friedman told the Sacklers, “that we establish a literature” to support this kind of positioning. They would suggest OxyContin for “the broadest range of use.” Still, they faced one significant hurdle. Oxycodone is roughly twice as potent as morphine, and as a consequence OxyContin would be a much stronger drug than MS Contin. American doctors still tended to take great care in administering strong opioids because of long-established concerns about the addictiveness of these drugs. For years, proponents of MS Contin had argued that in an end-of-life situation, when someone is in a mortal fight with cancer, it was a bit silly to worry about the patient’s getting hooked on morphine. But if Purdue wanted to market a powerful opioid like OxyContin for less acute, more persistent types of pain, one challenge would be the perception, among physicians, that opioids could be very addictive. If OxyContin was going to achieve its full commercial potential, the Sacklers and Purdue would have to undo that perception.

It seems obvious that throughout history, as one of the few professions open to women, midwifery must have attracted women of unusual intelligence, competence, and self-respect§. While acknowledging that many remedies used by the witches were “purely magical” and worked, if at all, by suggestion, Ehrenreich and English point out an important distinction between the witch-healer and the medical man of the late Middle Ages: . . . the witch was an empiricist; She relied on her senses rather than on faith or doctrine, she believed in trial and error, cause and effect. Her attitude was not religiously passive, but actively inquiring. She trusted her ability to find ways to deal with disease, pregnancy and childbirth—whether through medication or charms. In short, her magic was the science of her time. By contrast: There was nothing in late mediaeval medical training that conflicted with church doctrine, and little that we would recognize as “science”. Medical students . . . spent years studying Plato, Aristotle and Christian theology. . . . While a student, a doctor rarely saw any patients at all, and no experimentation of any kind was taught. . . . Confronted with a sick person, the university-trained physician had little to go on but superstition. . . . Such was the state of medical “science” at the time when witch-healers were persecuted for being practitioners of “magic”.15 Since asepsis and the transmission of disease through bacteria and unwashed hands was utterly unknown until the latter part of the nineteenth century, dirt was a presence in any medical situation—real dirt, not the misogynistic dirt associated by males with the female body. The midwife, who attended only women in labor, carried fewer disease bacteria with her than the physician.

But I can cite ten other reasons for not being a father." "First of all, I don't like motherhood," said Jakub, and he broke off pensively. "Our century has already unmasked all myths. Childhood has long ceased to be an age of innocence. Freud discovered infant sexuality and told us all about Oedipus. Only Jocasta remains untouchable; no one dares tear off her veil. Motherhood is the last and greatest taboo, the one that harbors the most grievous curse. There is no stronger bond than the one that shackles mother to child. This bond cripples the child's soul forever and prepares for the mother, when her son has grown up, the most cruel of all the griefs of love. I say that motherhood is a curse, and I refuse to contribute to it." "Another reason I don't want to add to the number of mothers," said Jakub with some embarrassment, "is that I love the female body, and I am disgusted by the thought of my beloved's breast becoming a milk-bag." "The doctor here will certainly confirm that physicians and nurses treat women hospitalized after an aborted pregnancy more harshly than those who have given birth, and show some contempt toward them even though they themselves will, at least once in their lives, need a similar operation. But for them it's a reflex stronger than any kind of thought, because the cult of procreation is an imperative of nature. That's why it's useless to look for the slightest rational argument in natalist propaganda. Do you perhaps think it's the voice of Jesus you're hearing in the natalist morality of the church? Do you think it's the voice of Marx you're hearing in the natalist propaganda of the Communist state? Impelled merely by the desire to perpetuate the species, mankind will end up smothering itself on its small planet. But the natalist propaganda mill grinds on, and the public is moved to tears by pictures of nursing mothers and infants making faces. It disgusts me. It chills me to think that, along with millions of other enthusiasts, I could be bending over a cradle with a silly smile." "And of course I also have to ask myself what sort of world I'd be sending my child into. School soon takes him away to stuff his head with the falsehoods I've fought in vain against all my life. Should I see my son become a conformist fool? Or should I instill my own ideas into him and see him suffer because he'll be dragged into the same conflicts I was?" "And of course I also have to think of myself. In this country children pay for their parents' disobedience, and parents for their children's disobedience. How many young people have been denied education because their parents fell into disgrace? And how many parents have chosen permanent cowardice for the sole purpose of preventing harm to their children? Anyone who wants to preserve at least some freedom here shouldn't have children," Jakub said, and fell into silence. "The last reason carries so much weight that it counts for five," said Jakub. "Having a child is to show an absolute accord with mankind. If I have a child, it's as though I'm saying: I was born and have tasted life and declare it so good that it merits being duplicated." "And you have not found life to be good?" asked Bertlef. Jakub tried to be precise, and said cautiously: "All I know is that I could never say with complete conviction: Man is a wonderful being and I want to reproduce him.

Given the central place that technology holds in our lives, it is astonishing that technology companies have not put more resources into fixing this global problem. Advanced computer systems and artificial intelligence (AI) could play a much bigger role in shaping diagnosis and prescription. While the up-front costs of using such technology may be sizeable, the long-term benefits to the health-care system need to be factored into value assessments. We believe that AI platforms could improve on the empirical prescription approach. Physicians work long hours under stressful conditions and have to keep up to date on the latest medical research. To make this work more manageable, the health-care system encourages doctors to specialize. However, the vast majority of antibiotics are prescribed either by generalists (e.g., general practitioners or emergency physicians) or by specialists in fields other than infectious disease, largely because of the need to treat infections quickly. An AI system can process far more information than a single human, and, even more important, it can remember everything with perfect accuracy. Such a system could theoretically enable a generalist doctor to be as effective as, or even superior to, a specialist at prescribing. The system would guide doctors and patients to different treatment options, assigning each a probability of success based on real-world data. The physician could then consider which treatment was most appropriate.

While all of us dread being blamed, we all would wish to be more responsible—that is, to have the ability to respond with awareness to the circumstances of our lives rather than just reacting. We want to be the authoritative person in our own lives: in charge, able to make the authentic decisions that affect us. There is no true responsibility without awareness. One of the weaknesses of the Western medical approach is that we have made the physician the only authority, with the patient too often a mere recipient of the treatment or cure. People are deprived of the opportunity to become truly responsible. None of us are to be blamed if we succumb to illness and death. Any one of us might succumb at any time, but the more we can learn about ourselves, the less prone we are to become passive victims. Mind and body links have to be seen not only for our understanding of illness but also for our understanding of health. Dr. Robert Maunder, on the psychiatric faculty of the University of Toronto, has written about the mindbody interface in disease. “Trying to identify and to answer the question of stress,” he said to me in an interview, “is more likely to lead to health than ignoring the question.” In healing, every bit of information, every piece of the truth, may be crucial. If a link exists between emotions and physiology, not to inform people of it will deprive them of a powerful tool. And here we confront the inadequacy of language. Even to speak about links between mind and body is to imply that two discrete entities are somehow connected to each other. Yet in life there is no such separation; there is no body that is not mind, no mind that is not body. The word mindbody has been suggested to convey the real state of things. Not even in the West is mind-body thinking completely new. In one of Plato’s dialogues, Socrates quotes a Thracian doctor’s criticism of his Greek colleagues: “This is the reason why the cure of so many diseases is unknown to the physicians of Hellas; they are ignorant of the whole. For this is the great error of our day in the treatment of the human body, that physicians separate the mind from the body.” You cannot split mind from body, said Socrates—nearly two and a half millennia before the advent of psychoneuroimmunoendocrinology!

The story is told about three men who were sentenced to death by guillotine. One was a doctor, another a lawyer, and the third an engineer. The day of execution arrived, and the three prisoners were lined up on the gallows. “Do you wish to face the blade, or look away?” the henchman asked the doctor. “I’ll face the blade!” the physician courageously replied. The doctor placed his neck onto the guillotine, and the executioner pulled the rope to release the blade. Then an amazing thing happened – the blade fell to a point just inches above the doctor’s neck, and stopped! The crowd of gathered townspeople was astonished, and tittered with speculation. After a bevy of excited discussions, the executioner told the doctor, “This is obviously a sign from God that you do not deserve to die. Go forth – you are pardoned.” Joyfully the doctor arose and went on his way. The second man to confront death was the lawyer, who also chose to face the blade. The cord was pulled, down fell the blade, and once again it stopped but a few inches from the man’s naked throat! Again the crowd buzzed – two miracles in one day! Just as he did minutes earlier, the executioner informed the prisoner that divine intervention had obviously been issued, and he, too, was free. Happily he departed. The final prisoner was the engineer who, like his predecessors, chose to face the blade. He fitted his neck into the crook of the guillotine and looked up at the apparatus above him. The executioner was about to pull the cord when the engineer pointed to the pulley system and called out, “Wait a minute! – I think I can see the problem!” Within each of us there resides an overworking engineer who is more concerned with analyzing the problem than accepting the solution. Many of us have become so resigned to receiving the short end of the stick in life, that if we were offered the long end, we would doubt its authenticity and refuse it. We must be willing to drop the heavy load of guilt, unworthiness, and self-denial we have carried for so long, perhaps lifetimes. We must openly affirm that we are ready to receive all the good that life has to offer us, without argument or wariness. Then we must accept our good – not just in word, but in action. In so doing we claim our right to live in a new world – one which attests that we are deserving not of punishment, but of release, freedom, and celebration.

Elizabeth snapped awake in a terrified instant as the door to her bed chamber was flung open near dawn, and Ian stalked into the darkened room. “Do you want to go first, or shall I?” he said tightly, coming to stand at the side of her bed. “What do you mean?” she asked in a trembling voice. “I mean,” he said, “that either you go first and tell me why in hell you suddenly find my company repugnant, or I’ll go first and tell you how I feel when I don’t know where you are or why you want to be there!” “I’ve sent word to you both nights.” “You sent a damned note that arrived long after nightfall both times, informing me that you intended to sleep somewhere else. I want to know why!” He has men beaten like animals, she reminded herself. “Stop shouting at me,” Elizabeth said shakily, getting out of bed and dragging the covers with her to hide herself from him. His brows snapped together in an ominous frown. “Elizabeth?” he asked, reaching for her. “Don’t touch me!” she cried. Bentner’s voice came from the doorway. “Is aught amiss, my lady?” he asked, glaring bravely at Ian. “Get out of here and close that damned door behind you!” Ian snapped furiously. “Leave it open,” Elizabeth said nervously, and the brave butler did exactly as she said. In six long strides Ian was at the door, shoving it closed with a force that sent it crashing into its frame, and Elizabeth began to vibrate with terror. When he turned around and started toward her Elizabeth tried to back away, but she tripped on the coverlet and had to stay where she was. Ian saw the fear in her eyes and stopped short only inches in front of her. His hand lifted, and she winced, but it came to rest on her cheek. “Darling, what is it?” he asked. It was his voice that made her want to weep at his feet, that beautiful baritone voice; and his face-that harsh, handsome face she’d adored. She wanted to beg him to tell her what Robert and Wordsworth had said were lies-all lies. “My life depends on this, Elizabeth. So does yours. Don’t fail us,” Robert had pleaded. Yet, in that moment of weakness she actually considered telling Ian everything she knew and letting him kill her if he wanted to; she would have preferred death to the torment of living with the memory of the lie that had been their lives-to the torment of living without him. “Are you ill?” he asked, frowning and minutely studying her face. Snatching at the excuse he’d offered, she nodded hastily. “Yes. I haven’t been feeling well.” “Is that why you went to London? To see a physician?” She nodded a little wildly, and to her bewildered horror he started to smile-that lazy, tender smile that always made her senses leap. “Are you with child, darling? Is that why you’re acting so strangely?” Elizabeth was silent, trying to debate the wisdom of saying yes or no-she should say no, she realized. He’d hunt her to the ends of the earth if he believed she was carrying his babe. “No! He-the doctor said it is just-just-nerves.” “You’ve been working and playing too hard,” Ian said, looking like the picture of a worried, devoted husband. “You need more rest.” Elizabeth couldn’t bear any more of this-not his feigned tenderness or his concern or the memory of Robert’s battered back. “I’m going to sleep now,” she said in a strangled voice. “Alone,” she added, and his face whitened as if she had slapped him. During his entire adult life Ian had relied almost as much on his intuition as on his intellect, and at that moment he didn’t want to believe in the explanation they were both offering. His wife did not want him in her bed; she recoiled from his touch; she had been away for two consecutive nights; and-more alarming than any of that-guilt and fear were written all over her pale face. “Do you know what a man thinks,” he said in a calm voice that belied the pain streaking through him, “when his wife stays away at night and doesn’t want him in her bed when she does return?

Yet the homogeneity of contemporary humanity is most apparent when it comes to our view of the natural world and of the human body. If you fell sick a thousand years ago, it mattered a great deal where you lived. In Europe, the resident priest would probably tell you that you had made God angry and that in order to regain your health you should donate something to the church, make a pilgrimage to a sacred site, and pray fervently for God’s forgiveness. Alternatively, the village witch might explain that a demon had possessed you and that she could cast it out using song, dance, and the blood of a black cockerel. In the Middle East, doctors brought up on classical traditions might explain that your four bodily humors were out of balance and that you should harmonize them with a proper diet and foul-smelling potions. In India, Ayurvedic experts would offer their own theories concerning the balance between the three bodily elements known as doshas and recommend a treatment of herbs, massages, and yoga postures. Chinese physicians, Siberian shamans, African witch doctors, Amerindian medicine men—every empire, kingdom, and tribe had its own traditions and experts, each espousing different views about the human body and the nature of sickness, and each offering their own cornucopia of rituals, concoctions, and cures. Some of them worked surprisingly well, whereas others were little short of a death sentence. The only thing that united European, Chinese, African, and American medical practices was that everywhere at least a third of all children died before reaching adulthood, and average life expectancy was far below fifty.14 Today, if you happen to be sick, it makes much less difference where you live. In Toronto, Tokyo, Tehran, or Tel Aviv, you will be taken to similar-looking hospitals, where you will meet doctors in white coats who learned the same scientific theories in the same medical colleges. They will follow identical protocols and use identical tests to reach very similar diagnoses. They will then dispense the same medicines produced by the same international drug companies. There are still some minor cultural differences, but Canadian, Japanese, Iranian, and Israeli physicians hold much the same views about the human body and human diseases. After the Islamic State captured Raqqa and Mosul, it did not tear down the local hospitals. Rather, it launched an appeal to Muslim doctors and nurses throughout the world to volunteer their services there.15 Presumably even Islamist doctors and nurses believe that the body is made of cells, that diseases are caused by pathogens, and that antibiotics kill bacteria.