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Patients Are a Virtue: Practicing Medicine in the Pennsylvania Amish Country
by Henry S. Wentz, MD, Morgantown, Pa, Masthof Press, 1997.
Arch Fam Med. 1998;7:290.
Taken at face value, this book is a series of vignettes in the life of a country doctor who practiced in the rural United States from 1948 to 1988. Each vignette is short, self-contained, and written in ordinary language. On the surface Dr Wentz and his colleagues, patients, and neighbors are "just simple folks living a simple life." If one scratches below the surface of this book, one is tutored in many medical and life lessons.
The history of medicine is discussed throughout the book. In "Poliomyelitis in the 1950s," the reader hears the history of polio as first an incurable epidemic and then a preventable disease. The reader follows the course of the disease as it riddles the bodies of Dr Wentz's patients; hears of the doctor's frustrations and skills in treating these patients with respiratory failure prior to the use of arterial blood gases and mechanical ventilators; and learns of the salvation of the parenteral Salk vaccine and the later mass immunizations of the public with the oral Sabin vaccine. We are reminded that not long ago physicians treated trauma patients without the aid of ambulances equipped with emergency medical technicians, trauma specialists, plastic surgeons, or intravenous catheters, and that many women gave birth at home.
Many of the personal lessons that physicians face are described. Dr Wentz realizes a diagnosis too late in a case of an infant with seizures in "A Lost Opportunity" and comes to terms with death in "Dying Is a Part of Life." In "An Evening to Remember," the author describes how he and his family put others' needs in front of their own. Inventing medical care when knowledge, skills, or equipment fall short and asking for help from a colleague, family member, or neighbor of the patient are other lessons shared with the reader.
The author's listening skills and intuition are described. His compassion for his patients and their lives and his patients' trust and love for their physician are felt throughout this book. Dr Wentz underscores the importance of keeping accurate medical records, knowing the family history, and understanding the culture of one's patients.
This book is written by a physician who graduated from medical school during World War II and writes, "Medicine will never again be practiced as it was in the mid 20th century. . .." The author probably does not realize just how much light he is shedding on the universality of medicine. The AIDS epidemic today is not unlike the polio epidemic of the 1950s. We have no cure, we are doing the best that we can to help patients and their families, and we see death and suffering every day that we cannot relieve.
Learning about and caring for the Amish is just one lesson in cultural diversity and community-oriented primary care. Medical schools and residencies today are grappling with how to teach both of these concepts. While the wedding of the science and art of medicine and the care of individual patients and their families will never be perfected, Dr Wentz gives us many fine examples of his attempts. This is an understated book well worth an hour of so for reading and reflection.
Judith A. Fisher, MD, Reviewer
University of Pennsylania Health System
Philadelphia
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