Those of us who are acquainted with Mike Nevins’ abundant writings, or may be privileged to know him personally, are well aware of his immense knowledge of and appreciation for medical history and his skills as wordsmith and storyteller.

It has become traditional for the MHSNJ website to publish book reviews written about books authored by its members.  Some might argue that such reviews cannot be objective or unbiased; on the other hand, they perhaps can be regarded as means to recognize outstanding accomplishment by the Society’s own members and our good friends.

Mike Nevins’ latest book, Troubled and Troubling, represents a collection of essays based on his personal experiences and leadership in a nearly half-century-long professional career.  Its core theme concerns what Mike views as progressive deterioration of the fundamental doctor-patient relationship, threatening what he regards as the “soul of medicine” or “the human connection,” which constitutes the art of healing, in a world of increasing technological prowess and crass commercialization.

In 13 succinct but robust chapters, the author traces the evolution of medical practice—from the time he entered, in 1968, to the time of his retirement, in 2008—passing through the phases of paternalism, to increasing patient autonomy, and culminating in today’s bureaucracy, characterized by a burden of electronic documentation, a need for insurance authorizations, and pressure to adhere to compliance tasks and practice guidelines.

Nevins laments the passing of “horse and buggy doctors” and the phasing out of “house calls.”  He illustrates the value these aspects of medical practice provided to patients, with entertaining anecdotes and references to such historical figures as Drs. William Vroom, John Clarence Dingman, and Joseph Moenig.

The author explores the humanistic character of traditional medical practice, referring to writers such as William Carlos Williams and Lewis Thomas, teachers like Rabbi Abraham Joshua Heschel, and innovators like Ignatz Leo Nascher, William Osler, Harvey Cushing, and others.

Dr. Michael Shadid, described as a reformer, is credited with developing the concept of prepaid group medical plans, models for what later became entities like Kaiser Permanente and the Health Insurance Plan of Greater New York, and presaging the growth and development of government-sponsored programs, such as Medicare and Medicaid; private companies, such as Blue Cross/Blue Shield; and Health Maintenance Organizations.  All of these, concerned primarily with financial considerations, are viewed by Nevins as detractions from the “soul of medicine.”   

Other chapters are devoted to ways in which hospitals have changed:  Nevins alludes to the venerable Dr. Bernard Lown, who wrote, “Healing is being replaced by treating, caring is supplanted by managing, and the art of listening is taken over by technological procedures.”

A chapter on “Jew-ish Medicine” recalls Nevins’ earlier examination of the ethical framework of Jewish values that undergird the concept of “medical mensch” and raises concerns about how these values may be threatened.

The concluding chapter considers what Nevins terms “the modern doctor’s dilemma,” namely “artificial intelligence,” raising questions about how this evolving technology will impact physician behavior and perhaps further erode the physician-patient connection.

This book is easily digested (as are all of Nevins’ dozen-odd books), thought-provoking, and worthy of any reader’s attention.