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(Chapters)                                                                                                            (Colorful Personal Sidelights)

Introduction to the Expanded Second Edition

Solo: a poem by Noah Pollack

Section I: A Plain Geometry of the Clinical Relationship

1. Superstition in Modern Medicine: The mind-body dichotomy is a two-headed monster. (A real holism is necessary; fragmentation misleads us away from health and wholeness.)

2. Medical Art, Medical Science, Medical Poetry: Current concepts are inverted, but simply can be corrected. (Holism is needed not only in the perception of the patient but in the integrated action of the clinician.)

3. To Be a Patient: Terror and mystery always interfere with a person's ability to care for herself. (Awareness of mortality means acknowledgement of powerlessness, an uncomfortable state which needs a coherent clinical consultant to profess adequate familiarity with death but only limited fear of it.)

Melissa the Prune: a story by Cintra Pollack

4. The Clinician as Student: What is to be accomplished is not mastery over disease and death, but mastery over fear. (It takes much practice to become confident without becoming arrogant, and as clinician adequately to identify with the patient, to tolerate the patient’s disease and one’s own imperfections.)

5. The Clinician as Patient: The health care professional always becomes the most difficult patient. (The accomplishment of confidence in the face of mortality and pain, humility instead of counter-phobic denial, is usually difficult for the clinician to accomplish for herself.)

Let Your Mind Alone!: my own failure as a patient

6. The Accomplished Clinician/The Accomplished Patient: The clinical relationship is the essential tool of diagnosis and treatment. (One’s ego-storms in training can settle into personal and professional identity in true human community, only if tempered with humility, focus and faith in basic human goods.)

The Amygdala of My Cat: Samson’s success as a psychologist

7. Dialogue, Dialectic, Drama: Clinical communication can be understood and taught. (Of course the central requisite skill is listening.)

8. Medical Ethics—There Are No Dilemmas: The clinician is always right to enhance the autonomy of the patient. (Not to be a patient, but merely to live is problematic.)

9. In Defense of “The Oath”: There can be a reliable professional code, although we have none now. (It will always center on understanding and advocating the welfare of the patient.)

10. On Logic and Values: a caution to eschew “right answers” (Are we as smart as a third-grader?)

Miracles and Joy: my own family’s tentative growth in confrontation with mortality

Section II: Entering a Third Dimension

1. The Clinical Team: Each person must stay personal, and all persons must communicate personally. (Formulated or conventional protocols of behavior [fulfilling the minimal requirements of the job description] cannot substitute for dynamic understanding of the patient’s unique problems, responsible sharing of information among the team and responsive communication with the patient by the team as a whole.)

2. The Myth of the Marketplace: There is no competition in the clinical relationship, nor should there be in the health-care system. (Clinical values cannot be translated into fiscal or power terms, nor can economic allocations be considered clinical responses.)

3. Bureaucracy is Ubiquitous: Regulation cannot replace encouragement. (Cop-operation ain’t co-operation, is it, Mister Rogers?)

4. Political Turmoil: Institutional panic programmatically precipitated by federal policies produces health-care chaos. (When we seek to put band-aids on it we make it even more turgid.)

5. The Clinical Relationship in Occupational Medicine: Hippocrates indeed already knew about third parties, regulatory and economic constraints—Why don’t we? (The only true benefit to any party is the promotion of the health of the patient—family, community, insurer, employer, clinician and clinical organization, and even the attorneys will benefit thereby.)

The Good Doctor: my appreciation of the physician-diplomat

Section III: The Integral Calculus of the Clinical Endeavor

1. The Greater Threats of AIDS: Not only the viral disease of body, but the historical and hysterical disease of society will kill us. (Epidemics are indeed frightening, but humility, focus and faith in basic human goods can be enlisted as clinical tools.)

2. The Myth of Abstinence: Our ill-logic dehumanizes the treatment of addictions. (Symptoms have been acquired for good reasons and are not easily abandoned.)

3. Methadone Maintenance, a Freudian Humanist Approach: Each addict is an authority on authority. (Treatment can even make sense to the patient.)

4. Methadone and the Pained Patient: Is there a difference between “primarily pained” versus “primarily addicted”? (Or do we care?)

5. A Little Age Never Hurt Anyone: Reminiscence offers access to the patient's health and strength even when the patient can’t remember. (No one who lives, even the dying, relinquishes her own story, written in her life and body.)

6. The Value of Minor Impairments Like Alzheimer’s Disease: Kevorkian asks. Can America answer? (You don’t get to call these shots, Governor Lamm.)

7. Grown Children: The parent-child relationship is upended in time by natural growth and degeneration, occasioning much confusion in “end-of-life” care.  (Family interactions become problematic when a parent diminishes.)

8. Four Patients Who Had Experienced Some Lack of Success in Previous Care: a meta-clinical dialogue (Even accomplished and dedicated clinical professionals do not have pat answers to complex questions, so they seek broader perspectives and more precise idioms.)

Section IV: Negative and Irrational Values

1. Profit of Doom: The pharmaceutical industry subsumes all research and teaching for the sake of marketing. (The financial battle for academic freedom has already been lost.)

2. The Birth and Death of a Clinic: The impersonal and materialistic predictably corrupt health care and its practitioners. (My own experience and perception may be a crude model for the subversion of the self-centered into joining the human community…or not.)

Society, the Addict and the Physician: I whine about being born before the Renaissance

Section V: A Fancy Topography of the Clinical Universe

1. Buber’s I-Thou Relationship Applied to the Self: I pray for the possibility of true love and true community within my granddaughter’s lifetime. (We need, and can carefully construct, a new and different perspective of what is good, not only clinically but communally.)

2. I have the answer. Now what was the question?: We dismantled the alarm clock, can we put it back together? (Reversion to the two-party model of patient-clinician relation may be the most productive option.)

My curriculum vitae: why I can’t get or keep a regular job.