Sustaining the Dignity and Nobility of Medical Care:
A Collection of Essays
By Joseph V. Simone, MD

Foreword by Dr. Young

It’s a sad fact that most of a physician’s precious reading time is necessarily spent focused on the continued advances in science and medicine. To be sure, those subjects should play a central role in ensuring that doctors stay on the forefront of medicine so that their patients benefit from the latest medical advances. But the vast majority of the thousands of medical and scientific journals and the tens of thousands of books devoted to medicine rarely touch on many of the personal aspects of medicine that play such a pivotal role in what makes a good physician. Nor are these humane aspects of the practice of medicine a centerpiece of medical school or house staff training. Such topics as ethics in medicine, principled medical economics, and the characteristics of medical leadership are rarely the subject of articles in traditional medical journals. When they are, the articles tend to be summations of the collective behavior of many physicians rather than the personal beliefs and motivation behind individual physician behavior.

That’s what’s so refreshing and satisfying about the collection of essays in this remarkable and insightful text by Dr. Joseph Simone. Joe’s rich tapestry of experience comes through in every section of the book. A son of immigrant parents and blessed with a remarkably warm family environment, Joe has been a consummate pediatrician; a clinical investigator and visionary who has transformed the care of pediatric cancer patients; an administrative leader of two of the country’s finest cancer centers and an advisor to many others (Fox Chase included); and, more recently, a volunteer hospice physician.

This collection of essays originally appeared in Oncology Times but here has been reconfigured around important themes. Having personally read most, but not all, of these essays in their original form, they are more powerful and enriching when arranged in the present format. Particularly the two chapters on “Caring for Patients” and “Living with Dying” address some of the most important aspects of becoming a fine and principled physician. Most of these insights would never be found in the conventional medical literature or in a medical school classroom. However, reading them here, and, more importantly, thinking deeply about the messages will likely enrich the quality of one’s own medical practice.

Joe doesn’t pull any punches in many of these essays and one will doubtless not agree with everything said. Nevertheless, his criticisms of “econo-docs,” medical commercialism, and self-referrals are blunt, well reasoned, and applicable to a broad range of medical specialties far beyond oncology. Running through these essays is the premise that the practice of medicine is a noble profession and that there should be dignity and nobility in medical care. But Joe is experienced, wise, and self-confident enough to point out that medicine is a human pursuit accompanied by all of the usual flaws and weaknesses inherent in human behavior. Doctors after all are just people like everyone else. His thesis is that we must honestly recognize and address our weaknesses or we will never achieve the level of quality medicine to which all of us aspire.

Many of the chapters contain important references that direct the readers to other literature which expands and enhances the subject of the essay. Access to references on health care expenditures, consumer-directed health care, and ensuring quality cancer care are valuable sources of hard-to-find information. The chapter on influential books highlights Sinclair Lewis, Paul DeKruif, and Sir William Osler; I would personally add the wonderful works of Lewis Thomas including “The Youngest Science and Lives of a Cell.”

Another important example of the significant niche filled by these essays is the chapter “Leadership in Medicine.” Although many physicians end up in leadership positions, almost nothing has been written about the characteristics of good medical leaders. Joe has utilized insights from business management writers such as Peter Drucker, Jim Collins, and Bill George to craft a series of essays on effective medical leadership. His ideas on criteria for enhancing medical leadership as well as tools for benchmarking the quality of leaders are illuminating and applicable to a wide range of medical settings.

But in my view, his essays are most powerful and most deeply affecting when they use his own personal experiences to illustrate important facets of the dignity and nobility of medicine. His volunteer role at Our Lady of Perpetual Help Home, an Atlanta hospice, as well as the people who work there provide one of the most endearing stories of the power and goodness of the human spirit. One cannot read those essays without concluding that even with all our human frailties, there is an inherent good that can be cultivated and maximized in all of us.

My favorite of all of these many wonderful essays are the two in the Chapter “Living with Dying,” which he devoted to his mother’s death. In the marvelous book by Sherwin Nuland “How We Die,” Nuland addresses the myth of the “good death.” He points out that the physical act of death is rarely dignified and more commonly is difficult, wrenching, and solitary. It is the “spiritual” death with dignity that should be attainable and a skilled and sensitive physician can play an important role in the successful outcome. The warm interplay between Joe’s mother and the family members, his willingness to freely admit when he didn’t have the answers, and the careful suspension of medical interventions no longer relevant is a masterpiece of how a physician should interact with a patient at the end of life. Reading these two essays in Oncology Times in my office, I wept. Not for the death of someone I did not know, but for the spiritual death with dignity possible through the support of a loving family, a caring son, and a consummate physician. I have learned a lot about myself as a physician and as a person from reading Joe Simone’s essays. I believe they have helped make me a better physician and a better person.

There is much in these pages that will enrich your life as a physician and make you recognize the dignity and nobility of medical care.

Please find the time in the press of your medical responsibilities to make room for this insightful volume.

Robert C. Young, M.D.
Chancellor, Fox Chase Cancer Center

Book Excerpt