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The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics
The story of two doctors, a father and son, who practiced in very different times and the evolution of the ethical issues that profoundly influence health care
As a practicing physician and longtime member of his hospital’s ethics committee, Dr. Barron Lerner thought he had heard it all. But in the mid-1990s, his father, an infectious diseases physician, told him a stunning story: he had physically placed his body over an end-stage patient who had stopped breathing, preventing his colleagues from performing cardiopulmonary resuscitation, even though CPR was the ethically and legally accepted thing to do. Over the next few years, the senior Dr. Lerner tried to speed the deaths of his seriously ill mother and mother-in-law to spare them further suffering.
These stories angered and alarmed the younger Dr. Lerner—an internist, historian of medicine and bioethicist—who had rejected physician-based paternalism in favor of informed consent and patient autonomy. The Good Doctor is a fascinating and moving account of how Dr. Lerner came to terms with two very different images of his father: a revered clinician, teacher and researcher who always put his patients first, but also a physician willing to “play God,” opposing the very revolution in patients' rights that his son was studying and teaching to his own medical students.
But the elder Dr. Lerner’s journals, which he had kept for decades, showed his son how his outdated paternalism had grown out of a fierce devotion to patient-centered medicine that was rapidly disappearing in a world of managed care, spiraling costs and health care reform. And they raised questions: Are paternalistic doctors just relics or should their expertise be used to overrule patients and families that make ill-advised choices? Does the growing use of personalized medicine—in which specific interventions may be best for specific patients—change the calculus between autonomy and paternalism? And how can we best use technologies that were invented to save lives but now too often prolong death? In an era of high-technology medicine, spiraling costs and healthcare reform, these questions could not be more relevant.
As his father slowly died of Parkinson’s disease, Dr. Lerner faced these questions both personally and professionally. He found himself being pulled into his dad’s medical care, even though he had criticized his father for making medical decisions for his relatives. Did playing God—at least in some situations—actually make sense? Did doctors sometimes “know best?”
A timely and compelling story of one family’s engagement with medicine over the last half century, The Good Doctor is an important book for those who treat illness—and those who struggle to overcome it.
As a practicing physician and longtime member of his hospital’s ethics committee, Dr. Barron Lerner thought he had heard it all. But in the mid-1990s, his father, an infectious diseases physician, told him a stunning story: he had physically placed his body over an end-stage patient who had stopped breathing, preventing his colleagues from performing cardiopulmonary resuscitation, even though CPR was the ethically and legally accepted thing to do. Over the next few years, the senior Dr. Lerner tried to speed the deaths of his seriously ill mother and mother-in-law to spare them further suffering.
These stories angered and alarmed the younger Dr. Lerner—an internist, historian of medicine and bioethicist—who had rejected physician-based paternalism in favor of informed consent and patient autonomy. The Good Doctor is a fascinating and moving account of how Dr. Lerner came to terms with two very different images of his father: a revered clinician, teacher and researcher who always put his patients first, but also a physician willing to “play God,” opposing the very revolution in patients' rights that his son was studying and teaching to his own medical students.
But the elder Dr. Lerner’s journals, which he had kept for decades, showed his son how his outdated paternalism had grown out of a fierce devotion to patient-centered medicine that was rapidly disappearing in a world of managed care, spiraling costs and health care reform. And they raised questions: Are paternalistic doctors just relics or should their expertise be used to overrule patients and families that make ill-advised choices? Does the growing use of personalized medicine—in which specific interventions may be best for specific patients—change the calculus between autonomy and paternalism? And how can we best use technologies that were invented to save lives but now too often prolong death? In an era of high-technology medicine, spiraling costs and healthcare reform, these questions could not be more relevant.
As his father slowly died of Parkinson’s disease, Dr. Lerner faced these questions both personally and professionally. He found himself being pulled into his dad’s medical care, even though he had criticized his father for making medical decisions for his relatives. Did playing God—at least in some situations—actually make sense? Did doctors sometimes “know best?”
A timely and compelling story of one family’s engagement with medicine over the last half century, The Good Doctor is an important book for those who treat illness—and those who struggle to overcome it.
240 pages, Hardcover
First published January 1, 2014
21 people are currently reading
1279 people want to read
About the author
Barron H. Lerner
6 books20 followersBarron H. Lerner is a Professor of Medicine and Population Health at the New York University School of Medicine. Dr. Lerner received his M.D. in 1986 and his Ph.D. in history in 1996. His book, The Breast Cancer Wars: Hope, Fear and the Pursuit of a Cure in Twentieth-Century America, published by Oxford University Press, received the William H. Welch Medal of the American Association for the History of Medicine and was named one of the 26 most notable books of 2001 by the American Library Association. Dr. Lerner has published extensively in scholarly journals and contributes essays to the the Science Times section of The New York Times, the Times' "Well" blog, Slate, Atlantic.com and the Huffington Post. He has also appeared on numerous NPR broadcasts, including “Fresh Air,” “All Things Considered” and “Science Friday.” Dr. Lerner’s latest book, "The Good Doctor: A Father, A Son and the Evolution of Medical Ethics," was published by Beacon Press in May 2014.
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Displaying 1 - 30 of 31 reviews
April 28, 2014
Great Book......had me hooked from the Prologue. A great look at the discussion of death and quality of life from two physicians. The son, Dr. Barron Lerner, goes through his father's journals which he kept for years. He discovers how his father was a patient-center physician, long before it was popular. The book looks at many end of life topics that arise in the medical field. As a person who has a family member currently in Hospice and has gone through this process before, I found this book so revealing from the physician side....Great Read!
July 28, 2014
What's the best way to practice medicine? That's the central theme of Dr. Lerner's book. He approaches the question as the son of a doctor who practiced medicine under the "paternalistic" model of an earlier generation and as a doctor and medical ethicist who today views the doctor-patient relationship as more of a partnership.
Dr. Lerner thoroughly explores the good and bad of both approaches, especially as it relates to end-of-life care. His father believed strongly in the concept of medical futility, meaning that heroic measures at the end of life are most often ineffective and needlessly invasive, robbing a patient of dignity in dying. And he believed he had the right to make the decision for the patient, many times not even giving patients the truth about their condition. On the other hand, Dr. Lerner, the son, believes firmly in informed consent and patient involvement -- even patient-led decision-making.
Because Dr. Lerner comes to no firm conclusions, the narrative veers back and forth between the positives and negatives of each approach. I often felt as if we were going around in circles. I think perhaps Dr. Lerner has come to no firm conclusions himself -- he takes great pains to express appreciation for both approaches. At times, I felt the tension in his beliefs, no more strongly than at the end of his father's life, when he is forced to make some decisions for his incapacitated father.
For more reading in the general medical nonfiction category, you might like two books edited by Lee Gutkind, I Wasn't Strong Like This When I Started Out: True Stories of Becoming a Nurse and Becoming a Doctor: From Student to Specialist, Doctor-Writers Share Their Experiences. Also, Jerome Groopman's Your Medical Mind: How to Decide What Is Right for You. The Good Nurse: A True Story of Medicine, Madness, and Murder is a hair-raising tale of medical crime, while Second Suns: Two Doctors and Their Amazing Quest to Restore Sight and Save Lives is a heartwarming read. For a personal account of caring for a parent at the end of life, try Will Schwalbe's The End of Your Life Book Club.
Dr. Lerner thoroughly explores the good and bad of both approaches, especially as it relates to end-of-life care. His father believed strongly in the concept of medical futility, meaning that heroic measures at the end of life are most often ineffective and needlessly invasive, robbing a patient of dignity in dying. And he believed he had the right to make the decision for the patient, many times not even giving patients the truth about their condition. On the other hand, Dr. Lerner, the son, believes firmly in informed consent and patient involvement -- even patient-led decision-making.
Because Dr. Lerner comes to no firm conclusions, the narrative veers back and forth between the positives and negatives of each approach. I often felt as if we were going around in circles. I think perhaps Dr. Lerner has come to no firm conclusions himself -- he takes great pains to express appreciation for both approaches. At times, I felt the tension in his beliefs, no more strongly than at the end of his father's life, when he is forced to make some decisions for his incapacitated father.
For more reading in the general medical nonfiction category, you might like two books edited by Lee Gutkind, I Wasn't Strong Like This When I Started Out: True Stories of Becoming a Nurse and Becoming a Doctor: From Student to Specialist, Doctor-Writers Share Their Experiences. Also, Jerome Groopman's Your Medical Mind: How to Decide What Is Right for You. The Good Nurse: A True Story of Medicine, Madness, and Murder is a hair-raising tale of medical crime, while Second Suns: Two Doctors and Their Amazing Quest to Restore Sight and Save Lives is a heartwarming read. For a personal account of caring for a parent at the end of life, try Will Schwalbe's The End of Your Life Book Club.
June 6, 2014
I really liked this book. I think it helps explain why so many currently practicing physicians feel unfulfilled in their careers and so many patients feel dissatisfied with the medical care they receive (even though that's not the point of the book). The book raises many important medical ethics questions -- most important, end-of-life decisions. But more than anything, the book tells the stories of father and son as physicians and how their experiences differed (in med school, in residency, and in their profession). The author gives a very balanced view of the issues he considers, finding good and bad (and gray) in the different approaches of the two generations.
Many of the descriptions of the elder Dr. Lerner (Phil) -- how he lived and breathed medicine and devoted himself 24/7 to his patients -- could have been about my dad, who is an internist. I have deep love and admiration for my dad and the way he practiced medicine, so the book felt very personal and immediate to me. Whether someone who doesn't have a physician in the family, or isn't a physician him or herself, would find the book as compelling is unclear to me.
Many of the descriptions of the elder Dr. Lerner (Phil) -- how he lived and breathed medicine and devoted himself 24/7 to his patients -- could have been about my dad, who is an internist. I have deep love and admiration for my dad and the way he practiced medicine, so the book felt very personal and immediate to me. Whether someone who doesn't have a physician in the family, or isn't a physician him or herself, would find the book as compelling is unclear to me.
June 20, 2014
I agree with others that this book is quite "inside baseball" and may not resonate with those lacking close personal ties to the topic. I am a physician, in the generation right between the two Drs. L. I went to med school at Case Western Reserve and then did my residency in internal medicine and a fellowship in cardiology at University Hospital in Cleveland. After training I joined the full time academic faculty there, from 1983 to 2001, thus knowing Phillip Lerner, at least peripherally and by reputation. I am now at the University of Washington in Seattle, another site of training for Barron Lerner.
Having said all that, I must say I enjoyed the book but part of my enjoyment was the fun of spotting familiar colleagues and landmarks. The writing is serviceable but not lyrical and the story, while interesting, is not as unique as the author seems to think.
I suspect that Phillip Lerner was a fairly typical, albeit highly accomplished, doctor of his generation. Things were different then...
Having said all that, I must say I enjoyed the book but part of my enjoyment was the fun of spotting familiar colleagues and landmarks. The writing is serviceable but not lyrical and the story, while interesting, is not as unique as the author seems to think.
I suspect that Phillip Lerner was a fairly typical, albeit highly accomplished, doctor of his generation. Things were different then...
July 22, 2014
What a fantastic read.
April 9, 2015
Probably more detail about the history and changes in medicine than the average reader might be interested in. But I really enjoyed it. And the Jewish slant was also interesting.
December 23, 2018
I found at least the first half of the book very dry, and it didn't hold my attention. That part was largely about how the author's father and the author became doctors, with a lot of the history of medicine and how the Doctor-as-God emerged. The later parts of the book were also about that, but held my interest better, maybe largely because they had more stories about patients, including his own family.
The book is supposedly about medical ethics, but I saw largely three issues, two of them with more examples than strictly needed. The third, the ethics of taking perks from pharmaceutical companies, was addressed sufficiently. The other two issues were: 1. Doctor-as God (my term, not the author's), the paternalistic culture where the doctor decided what, and what not, to do for the patients and what, and what not, to tell them about their illnesses, prognoses, etc., and 2. (in a way a subset of 1) End of life issues; when to keep or stop treating fairly hopeless conditions, and whether to do futile lifesaving measures on actively dying patients. These questions also include how much control over their own care patients and families should have.
His father, in his practice, often thought people should be basically put out of their misery because their quality of life wasn't good enough. I wondered in those instances who should be the judge of quality of life. For example, a doctor thought my father-in-law should die when diabetes and Parkinson's made it impossible for him to move, breathe, eat on his own. But my father-in-law wanted to continue living and indeed got several more years of life from that point, including a lot of enjoyment, and ended up outliving that doctor.
The book also examined how doctor-patient interactions have become less personal over time, because of more reliance on various tests and the pressure for doctors to see more patients more quickly. It didn't include much if any about the idea or practice of limiting patient care for reasons of cost effectiveness. I didn't mind that.
Plenty has been written about all these subjects. The new angle in this book is the examination through the lens of the author's family. The book is organized around that, so the various ethical questions come up a number of times in different chapters, which works out okay.
The book is supposedly about medical ethics, but I saw largely three issues, two of them with more examples than strictly needed. The third, the ethics of taking perks from pharmaceutical companies, was addressed sufficiently. The other two issues were: 1. Doctor-as God (my term, not the author's), the paternalistic culture where the doctor decided what, and what not, to do for the patients and what, and what not, to tell them about their illnesses, prognoses, etc., and 2. (in a way a subset of 1) End of life issues; when to keep or stop treating fairly hopeless conditions, and whether to do futile lifesaving measures on actively dying patients. These questions also include how much control over their own care patients and families should have.
His father, in his practice, often thought people should be basically put out of their misery because their quality of life wasn't good enough. I wondered in those instances who should be the judge of quality of life. For example, a doctor thought my father-in-law should die when diabetes and Parkinson's made it impossible for him to move, breathe, eat on his own. But my father-in-law wanted to continue living and indeed got several more years of life from that point, including a lot of enjoyment, and ended up outliving that doctor.
The book also examined how doctor-patient interactions have become less personal over time, because of more reliance on various tests and the pressure for doctors to see more patients more quickly. It didn't include much if any about the idea or practice of limiting patient care for reasons of cost effectiveness. I didn't mind that.
Plenty has been written about all these subjects. The new angle in this book is the examination through the lens of the author's family. The book is organized around that, so the various ethical questions come up a number of times in different chapters, which works out okay.
February 6, 2017
Since I have two grandsons and a son-in-law in the medical profession I wanted to read this book to better understand the things they face in their daily work. This is a true account of a father and son, one who took on the burden of making decisions for his patients without consulting or telling them what was going on. He had an intense passion for his profession and his patients but his methods of practice would not be tolerated in this day and age. His son in writing the book learned things about his father that he could not imagine anyone doing. Medicine has become too reliant on technology because doctors saw patients not as people but as specific diseases. I myself have experienced this. Dr. Lerner's father felt that the secret of the care of the patient is 'in caring for the patient' and then the disease. If you have any interest at all in the health care system, this is a book to read.
September 18, 2019
This was an interesting book about the evolution of the role of the physician but the book was a bit sidetracked by and excessive amount of biographical information. Lerner hits upon a wonderful way to tell the story of the evolution of the medical profession by following his own career and that of his father, two generations of the Dr. Lerner’s trained and practicing in the US. However, in trying to tie the story to their biographies the balance of the book shifted to just that, a family biography. This results in pages-long sections where the changing expectations of bioethics and medical sub-specializations seemed incidental to the day to day life of the Lerner family. There is nonetheless enough discussion about the movement towards patient autonomy and the like to keep the general reader interested while Lerner’s skill as a biographer is also good enough to interest some readers on its own.
August 21, 2020
This memoir tells the story of two doctors, Phillip Lerner and his son Barron. Phillip became an expert on infectious diseases. He believed the best way to treat a patient was to treat the whole person, not just the disease. His son became an internist and medical historian with a focus on medical ethics. He questioned many of the decisions that his dad made, but realized his dad had the best of intentions no matter the outcome.
July 27, 2021
This book is probably best described as an exploration of the evolution of medical ethics and the changing training environment for doctors through the medium of family biography. A great idea, and a good read.
January 21, 2019
Very eye opening and informative.
April 22, 2020
Interesting look into the ethics of medicine from a personal perspective.
August 5, 2015
A simple read, and yet a wonderfully charming one. In The Good Doctor Barron Lerner compares the training and practice of today's generation of physicians with those of doctors before them. Along the way, he ponders how the discipline has advanced and evolved in its thinking, but is quite thoughtful about what qualities of physicians past might have been lost in this transition. As a physician-in-training, I found The Good Doctor challenged my thinking on topics like paternalism and shared-decision making in the physician-patient relationship, the physician work-life balance, and the ethics of involvement in the medical care of one's relatives. It's a well-written, well-thought book that I found hard to put down, and I'd especially recommend it to other students or young doctors who might benefit from thinking about the changes in habits and values across generations of medical providers.
March 4, 2016
I won this book from Goodreads First-reads.
This book is written by the son of a physician who also went on to become a doctor himself. It compares how ethics in the practice of medicine has changed from the time his father was a practicing physician to the author's own career as a doctor. I enjoyed this book. Although I have no formal background in medicine, the book clearly yet briefly explains medical terms used. It is a great read for anyone in the medical field, or not in the medical field but with an interest in the evolution of medical ethics, and how the practice of medicine has and continues to change.
I found this book to be very informative, without reading like a textbook. It's insightful, and also focuses on a son's relationship with his father and coming to terms with the type of doctor he wants to be.
This book is written by the son of a physician who also went on to become a doctor himself. It compares how ethics in the practice of medicine has changed from the time his father was a practicing physician to the author's own career as a doctor. I enjoyed this book. Although I have no formal background in medicine, the book clearly yet briefly explains medical terms used. It is a great read for anyone in the medical field, or not in the medical field but with an interest in the evolution of medical ethics, and how the practice of medicine has and continues to change.
I found this book to be very informative, without reading like a textbook. It's insightful, and also focuses on a son's relationship with his father and coming to terms with the type of doctor he wants to be.
January 11, 2025
It's obvious that Lerner wrote this as history instead of memoir: he clearly assumes people will read this because they are interested in the topic, and he therefore has no obligation to make his topic more interesting. He is more concerned with accurately identifying places, dates, and people (like random people he hung out with in med school) than with narrative tension or scene or character development or any of the elements crucial to good literature, which is what memoir should be.
I care about accuracy in memoir and read history for pleasure. And one thing I admire about the best works of history is that they manage to surprise me--even though I know how everything turns out.
This book never surprised me. Dramatic outcomes were always telegraphed. The tone and perspective never varied. It is a morally decent but deeply monotonous book.
I care about accuracy in memoir and read history for pleasure. And one thing I admire about the best works of history is that they manage to surprise me--even though I know how everything turns out.
This book never surprised me. Dramatic outcomes were always telegraphed. The tone and perspective never varied. It is a morally decent but deeply monotonous book.
May 3, 2014
I received this book in exchange for a honest review.
I am not usually a non- fiction reader. I prefer a story that I can dive into and leave my day to day stuff behind.
I chose "The Good Doctor" because like many others I am trapped in the Five minute Doctor visit offered thru local HMO to those over 70. Recently I went to my primary Physican complaining of chest pains and her answer was "What do you want me to do about it?"
So somehow I thought that reading this book would give me some amunition and information.
I feel while a personal story about a family and its dedicated Drs., it only holds up a mirror to our ever failing medical care.
It was interesting, and who knows, someday may help.
I am not usually a non- fiction reader. I prefer a story that I can dive into and leave my day to day stuff behind.
I chose "The Good Doctor" because like many others I am trapped in the Five minute Doctor visit offered thru local HMO to those over 70. Recently I went to my primary Physican complaining of chest pains and her answer was "What do you want me to do about it?"
So somehow I thought that reading this book would give me some amunition and information.
I feel while a personal story about a family and its dedicated Drs., it only holds up a mirror to our ever failing medical care.
It was interesting, and who knows, someday may help.
July 19, 2014
This book is primarily a biography of Barron Lerner's father, Phillip Lerner. It is also a Barron Lerner memoir and a history of changes in medical ethics over the professional lives of these two men. Oddly, I felt Barron Lerner does a much better job describing and defending his father's view than his own. Barron Lerner is a historian and bioethicist so it seems he would have opinions on current medical ethics, especially around one of the main themes of the book--dying. Yes, he covers what the standards are now and some about how that came to be but without closely looking at the doctor and patient connection he covers well when describing his father. Is it a requirement that a bioeethicist be emotionally distant from actual sick people so he can make the "right" decision?
October 23, 2015
While Laura had been a trouper, Susan was frustrated and angry with her disease, which she survived for more than nine years. And my father became the receptacle for her vitriol. "She screams and carries on when the going gets tough," he wrote, "knowing that I understand and will never reproach her, never abandon her, whatever!"
Care is a right and providing it is a privilege.
July 17, 2014
A beautifully written tribute from a very talented, loving son to his equally talented, superhuman father/physician. The passion for medicine of both the father and son is conveyed convincingly. I wish that I had a Dr. Lerner as my doctor! The case for patient autonomy vs. paternalism is made clearly. Issues are brought down to the layman's level.
October 19, 2014
I learned of this book when I heard the author interviewed on NPR. I found what he had to say to be really interesting and found his book was no different. I really enjoyed reading this and recommend it!
June 5, 2015
I would give this 3.5 stars but bumped it to 4 here on Goodreads. It's basically a biography of his father with some autobiography on the author. There was much I can relate to being a physician but I'm not sure non-medical readers would be as engrossed.
May 7, 2023
Unfortunately, his family history was not very entertaining to me. However, reading about the dichotomy between the way that the author practices versus the way that his dad practiced prior to medical ethics coming to fruition was genuinely so thought-provoking!
Want to read
October 24, 2014I won this book as part of the Goodreads First-Read program.
Want to read
May 13, 2014Heard the author on Fresh Air 5/13/14.
September 13, 2014
Interesting reading. allowed for a lot of reflection of my own journey in getting an M.D.
Want to read
February 24, 2015As seen in the
New York Times
.
May 7, 2015
A book that examines medical ethics and end of life decisions in a very personal family story.
March 13, 2016
Read this for book club at AAHPM annual meeting. Great discussion about the pitfalls of paternalism, of trying to be physician to your family, and the relative value of autonomy.
January 9, 2018
Hawken graduate- CWRU
Displaying 1 - 30 of 31 reviews