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A Doctor's 'Soul' is Tormented By Medical Errors

Failures often result from errors of judgment, says Nuland, a clinical professor of surgery at Yale University. “Judgment is at the heart of medicine. You don’t go to medical school and you don’t have a residency training that’s so long to learn facts.”

No, he says, you go to medical school and become a resident to gain experience, to see how other doctors deal with patients and to learn from your mistakes and your colleagues’ — if you’re paying attention.

As Nuland writes in his new book, “doctors are inordinately fond of saying that their best teachers are their patients, but this is true only when each patient is allowed to teach. A hurried examination and history-taking is not a teaching session.”

He doesn’t regret that he stopped practicing medicine 15 years ago. “The more technological medicine has become, the more overwhelmed physicians seem to be by the non-human aspects,” says Nuland, 79. “The first thing anybody wants to do is an MRI or a CT. Nobody knows how to do a physical examination; nobody does it.”

Technology plays only a minor role in The Soul of Medicine, his 12th book. Nuland wrote each of the specialists’ “tales” in the first person, à la Chaucer’s Canterbury Tales. To protect patients’ privacy, none of the names are real. “Canterbury Hospital” stands in for Yale University Medical Center.

“As the good historian that he is, Dr. Nuland has come to question the ‘march of progress’ version of medical history,” says physician/author Barron Lerner, an associate professor of medicine and public health at Columbia University in New York, also in an e-mail. “Many of his stories thus involve suffering patients and the devoted, but at times imperfect, physicians who try to help them.”

In the book, Nuland dubs Barry Zaret — a Yale cardiologist for more than 35 years and chair of the department for 26 of them — “Louis Kronberg.” At Nuland’s request, Zaret agreed to allow USA TODAY to use his real name.