I hadn't read a Robin Cook novel since Coma in the 80s - and so was somewhat surprised to discover that not only is he still alive, but he has an ongoing series about a couple of New York Medical Examiners and that the twelth instalment comes out in December. This is number six - but apart from the background story of the relationship between them, it would seem each book stands alone and explores a different aspect of modern American medicine. I got this from Book Club and it's been on my shelf for a year - I only started it because I thought I wouldn't get very far and could get it off the shelf, but unlike many other reviewers, I was rapidly intrigued and keen to know how things turned out. Unfortunately the rest of the book didn't live up to the first chapters and was let down by an ill-judged ending.
Craig Bowman is a Boston physician who has dedicated his life to medicine and his patients, to the detriment of his marriage and family life, health and psyche. After a very typical mid-life crisis - including marital separation, an affair with his nubile young secretary and a red Porsche - he has switched to a lucrative practice offering "concierge medicine" - where wealthy patients who can afford the hefty retainer have constant access to their personal physician for house calls or as many appointments as they wish. Craig is loving being able to practice medicine unrestricted by the limitations of insurance companies, and give each patient the time they need to look after them properly, and has never been happier. The only downside is patients like Patience (!) - hypochondriacs who summon him at all hours, to describe every inconsequential symptom in excruciating detail - but never follow his advice, never improve and never believe him that there is nothing physically wrong.
When Patience's husband calls him for the second time that day to report she is much more unwell than when he saw her at home that morning, he swallows his irritation at the interruption to his planned trip to the symphony to show off his trophy girlfriend, and assumes it will be more of the same - so is horrified on arrival to find her blue and nearing cardiac arrest. He rushes her to hospital, but all attempts at resuscitation are futile, and while he is disappointed to have failed her, he is secretly relieved to be rid of her - until he is served notice that he is being sued by Patience's husband for negligence. Seven months later, the trial begins, and is not going well. Craig's arrogance and narcissism make him a poor witness and the crafty counsel for the plaintiff is using every trick in the book to discredit him in the eyes of the jury. Desperate to help, Craig's wife - with whom he has reunited to try and repair his image - calls her brother, maverick New York ME Jack Stapleton - for help, and on reviewing the case, Jack decides that doing an autopsy may help exonerate Craig - but someone doesn't want their secret exposed and will go to shocking lengths to prevent him revealing the truth.
I don't read a lot of medical thrillers, as unless they are actually written by a qualified doctor the mistakes tend to annoy me too much, but this one is actually more of a legal thriller - and as it happens Robin Cook was an ophthalmologist before he turned to writing, and from the range of issues he has covered in his books obviously keeps up to date with medical developments. I initially felt a lot of sympathy for Craig - possibly more than most readers as I could relate to the burnout from the impossible demands of primary care - in my case there was no Porsche and no change of partner, just a switch to Travel Medicine and Clinical Research, with the pay cut more than offset by the improved quality of life. I also recognised the need for validation from one's peers or seniors and devastating psychological impact of being criticised despite feeling like you gave someone your best efforts - and the frustration that lay people don't understand that medicine is rarely black and white and hindsight is always 20/20... As the book went on, however, he did become progressively harder to sympathise with as his selfish introspection and complete disregard for his family's feelings took over. I thought this was very well done.
Unfortunately, the middle section of this book was pretty slow, and about 100 pages too long, as we follow Jack around Boston from the court to the hospital to the funeral home to the police station and back to the Bowman’s house as he attempts to organise a post mortem and avoid the cartoon gangster bad guys, all the while worrying that he won’t make his wedding back in New York at the end of the week. While I was fascinated by the medical details, I can see they would add nothing for the average reader. Then the ending seemed very abrupt with multiple plot threads left unresolved - but it didn’t seem like these would be resolved in the next book, just that the author reached his word count and left it there. Other reviewers have complained about the dialogue but I can’t say it bothered me. I was impressed by the twist which I did not see coming, but was well set up.
In the afterword the author gives his own perspective on concierge medicine, including the disconnect between disapproving of it in principle but acknowledging the fact that most people who could afford it would want it, and most doctors would like to practice in it - which I did find interesting. This was published in 2006 but I can’t imagine that things have improved any since then. While he acknowledges that the crisis in primary care is occurring around the world, the USA and it’s calamitous medicolegal system lies at the root of most of the problem and I’ve never heard of this concept taking off anywhere else.
Overall this was an average legal thriller which explored some aspects of medicine that are probably only really of interest to people working in the field and an overly drawn out mystery which is incompletely resolved. 3.5 rounded down for the ending.