Heirs of General Practice

by John McPhee

Heirs of General Practice is a frieze of glimpses of young doctors with patients of every age―about a dozen physicians in all, who belong to the new medical specialty called family practice. They are people who have addressed themselves to a need for a unifying generalism in a world that has become greatly subdivided by specialization, physicians who work with the "unquantifiable idea that a doctor who treats your grandmother, your father, your niece, and your daughter will be more adroit in treating you."

These young men and women are seen in their examining rooms in various rural communities in Maine, but Maine is only the example. Their medical objectives, their successes, the professional obstacles they do and do not overcome are representative of any place family practitioners are working. While essential medical background is provided, McPhee's masterful approach to a trend significant to all of us is replete with affecting, and often amusing, stories about both doctors and their charges.

Genres: Nonfiction, Medicine, Medical, Essays, Health, Biography, Science

120 pages, Paperback

First published April 1, 1986

About the author

John Angus McPhee is an American writer. He is considered one of the pioneers of creative nonfiction. He is a four-time finalist for the Pulitzer Prize in the category General Nonfiction, and he won that award on the fourth occasion in 1999 for Annals of the Former World (a collection of five books, including two of his previous Pulitzer finalists). In 2008, he received the George Polk Career Award for his "indelible mark on American journalism during his nearly half-century career". Since 1974, McPhee has been the Ferris Professor of Journalism at Princeton University.

Reviews

[Tony]

This book about family practice in medicine and the doctors who, well, practice it was written in the 1980s but does not feel dated. Ailments haven't changed much, really, and I suspect Maine, where most of the doctoring in this book takes place, hasn't changed much either.

I read McPhee because he has a way with words, like describing the doctor who wears a cross in his lapel and has personally been obstetricated twice.

I also read him because of the cool things I learn. Like about the condition called "Iowa ear". The farmer on his tractor looks over his right shoulder, watching his planter or plow and sighting back down the row. This aims his left ear toward the tractor's engine. Which causes hearing loss, invariably in the left ear.

It's hard to describe how happy knowing that little chestnut makes me.

FYI: This "book" also appears in the McPhee collection: Table of Contents.

[Lobstergirl · Rating 4 out of 5]

Smoky, wiry forty-six-year-old female presents with vague abdominal discomfort that she has mentioned before. The doctor suggests a colonoscopy, and explains that the procedure involves the insertion of a three-and-a-half foot tube. The patient says, "I'm only five feet tall, you know."
(p. 12)

Telephone rings. There is a patient up the road whom the doctor sees only on house calls, for she has long been in a coma and has not opened her eyes in five years. Living with her and caring for her are her son and two other men. They have bought a hospital bed and placed it in the center of the parlor, which they routinely adorn with fresh flowers. They keep the room airy, dustless, and clean. They feed the patient with an eye-dropper. Month in, year out, they give her loving, intensive care. Now her son is on the phone with a question for the doctor. Would it be all right if he and the others took his mother on a camping trip?
(p. 71)

"The United States is thirteenth on the life expectancy list. Why is that? If we are doing things so right, how come we are thirteenth?"
(p. 97)

[The book was published in 1986. By 2022 the U.S. has dropped to 49th.]



"May I look in your ears?" Thanhauser says to Einger West.
And she says, "Yes, if you don't look too far."
(p. 104)

"Residents quickly develop perceptions about who has the smarts in a given sphere. Ten per cent of any medical staff are not competent. They haven't kept up. The residency is at the heart of the continuing education of the medical staff. Ironically, some of the staff are not interested."
(p. 108)

[David · Rating 3 out of 5]

I come from a family of general practitioners - my mother was a G.P. and my sister followed in her footsteps - and I am a fan of John McPhee's writing, in general. So I expected to like this book more than I actually did. The book follows the standard McPhee schema - in-depth reporting on a very specific topic, in this case doctors who choose to work as general practitioners. McPhee provides vignettes of a dozen or so such doctors, almost all of them working in Maine.

McPhee is usually very effective in working from the specific to reach more general insights, and it is clear that he would like to do the same here. That is, by focusing on doctors who have opted out of the mainstream, he would like to illuminate some general truths about the practice of mainstream medicine. However, I think his success in doing so is limited, rarely rising above statement of the obvious. By focusing his microscope only on family practitioners working in Maine, the generalizability of any lessons they might offer is questionable. The needs of communities in Maine cannot be considered particularly representative of the U.S. in general.
So the book never really becomes anything more than a series of isolated vignettes of some individual 'maverick' doctors.

Which is interesting as far as it goes, but I wish McPhee had been able to do more with the material. By the end I felt that an opportunity had been missed.

[Tom · Rating 4 out of 5]

An excerpt of this book appeared in The New Yorker in 1984. That article was very influential for many of us in our early careers in family medicine. The book follows a group of new graduates of a family medicine program in the state of Maine as they engage in rural practice. At the time family medicine had the trappings of a 'movement' in medicine, vestiges of which continue to animate some of us in what is now the 'old guard'.

[Tovah · Rating 5 out of 5]

You guys, my dad is in this book!

[Dave · Rating 4 out of 5]

At a time when reading the news makes me horrified, and then more horrified, it was a great relief to read this book about doctors choosing to go into "family practice"--to choose to work in rural settings, treat the whole patient, and even make house calls. McPhee is careful not to mythologize these real people--they are not SuperDocs, but they are truly admirable human beings. And, of course, since he's a brilliant writer, McPhee has fun describing doctors and patients and adding the occasional clever spin, or twist, or joke. My favorite is this phrase

...the town's other doctor wears a cross in his lapel and has personally been obstetricated twice.

which sent me to Google in vain before I realized it was the medical equivalent of "born again."

[Ben · Rating 4 out of 5]

Delightful quick read!

[Erik Lindstrom · Rating 5 out of 5]

I received this book from a patient and ever so grateful. It offers a beautiful and (almost) timeless lens into the joys, complexities, rewards and struggles of Family Practice. I had to keep glancing at the year it was published. It’s soon to be a staple on my desk to revisit when I need a reminder of why I love what I do in Family Medicine.

[Colby Rondeau · Rating 4 out of 5]

This book was definitely a good read. The writing was a bit gritty at times with back-to-back medical stories surrounding family practice doctors. A good book to gain further perspective into preventative medicine and why we should to care about general practice.

[Sarah Boyle · Rating 4 out of 5]

This was EXCELLENT. Extremely engaging, fascinating, and helped to lessen the stigma surrounding family practice physicians. I am not entering the medical field and I found this to be an enjoyable read. Highly recommend for anyone interested in the doctor-patient relationship.

[Rachel · Rating 3 out of 5]

This book jumps a lot which McPhee employing several different narrative and investigative writing styles. The beginning and throughout are too choppy moving from one patient to next as to imitate the sense the family/general practitioner may experience seeing many diverse patients consecutively. While this may mirror the feeling of witnessing a quick patient turnover, I would have appreciated it if McPhee used his interviewing skills to investigate further and provide more information than just the superficial. Even if decisions are made quickly, they require years of experience to make.

The big question of the book is whether General Practice is justified in modern medicine as a specialty and whether its doctors can keep up with the vastness of knowledge. He makes the case that in rural areas, as in Maine where the book is set, that only GPs have the interest and time to get to know and follow generations of families. It also appears that the GPs knowledge is mostly too superficial to meet the need. In all, I wish McPhee would have gone more in-depth with both the medical diagnoses and the interpersonal interactions. He reveals, to his credit, a lot on inter-doctoring politics and territory grabs. It would be interesting to read essays on other medical specialties.

[Tom · Rating 4 out of 5]

This book was reported and written in the mid-'80s, and while the human elements -- the doctors and patients -- continue to be authentic, it's unlikely family medicine has quite the stigma today that it did then. Still, I gather from talking to medical professionals that it can be difficult to convince medical students and residents to seriously consider a career in family medicine. And that's at the world-famous medical center in the city where I live. In any event, as always with McPhee, "Heirs of General Practice" is well written, with subtle humor and quiet empathy. It is well worth the read, for prospective doctors and writers alike.

[John Benson · Rating 3 out of 5]

John McPhee tells the story of different family practice physicians who chose to practice in rural Maine in the early 1980s, when this was a newer medical sub-specialty resurrected. He brings out the lives of about a dozen doctors, their patients and their conditions as they visit these doctors, and intersperses these stories with explanations of how this medical specialty is different and how it fits into the towns where they serve. The book is good but it doesn't feel like it comes fully together as a book.

[Tyler Kellis · Rating 3 out of 5]

A fun, often humorous, look into the need for family medicine. It follows about 12 doctors and shares why certain patient presentations would best be served by the family doc. I thought all in all it was a little hard to follow, but the topics made for a great book discussion. I think I would actually read it again one day, since it was such a short read and gets your mind thinking, especially if one is considering family Med. Last thought; very impressive how this book was written in the 80’s but the argument fits the current healthcare climate just as well.

[Rowan · Rating 4 out of 5]

An interesting and entertaining glimpse into rural family medicine. Even though this was written in the '80s, it still feels incredibly relevant, and rings true with what I've been seeing firsthand in my work as a medical scribe at a family practice. McPhee is also a great writer. He surrounds vignettes of doctors and the patients they see with context around the development of the field of family medicine and the cultural context of rural Maine, and writes in an engaging and accessible voice.

[Sharon · Rating 3 out of 5]

I didn’t check when this book was published. The edition I bought made me think maybe it was early McPhee, but, no, far from it. I’m not sure how McPhee got access to the patient information that makes up this book—maybe a benefit of writing about doctors at the fringes—but the writing style felt more rote here than other McPhee. He weaves a few threads, but it’s not the rushing waters of the McPhee I love most.

[Adriana Chen · Rating 4 out of 5]

I personally enjoyed the book because of the insights it gave me into family medicine in rural Maine. It did become tedious sometimes, where the author just lists off patient after patient, doctor after doctor without really giving a coherent message or theme. Much like a portrait, it focuses more on atmosphere and function than structure. (Last line paraphrasing a critique of Wong Kar Wai’s Fallen Angels lol.)

Recommend for those who want to know more about family/rural medicine!

[Maya Rebitzer · Rating 5 out of 5]

The structure of this book makes no sense to me but I still loved it, which says a lot. It shared countless interesting little anecdotes about patients and doctors and the history of medicine. It also spent some time discussing different and often critical attitudes toward the field of family medicine, which I appreciated. Overall 5/5 it made me want to marry a carpenter and move to rural Maine and make maple syrup and be a family practice doc.

[Tom · Rating 4 out of 5]

What can I say about John McPhee that I haven't already said in previous reviews. He can take any subject and make it interesting. It matters not if your particular interest lies elsewhere. All of a sudden the book turns into a page turner, you can't wait to get back to it book and you are sorry when it's finished. Just pick up one of McPhee's books and see for yourself.

[Katelyn · Rating 5 out of 5]

An excellent portrait of the heart of family medicine. The fine details of the patients and doctors alike in a case report style are written with such compassion I almost thought the author to be a family physician himself. This book should be required reading for all medical students and for anyone who has ever been a patient. Definitely a book I will be recommending to all my friends!

[Perlie · Rating 3 out of 5]

A slightly dated piece, but one brim full of respect and appreciation for family doctors. McPhee makes a persuasive case for the crucial importance of the family doctor, and its advantage over the specialty approach. Using anecdotes and focusing on the story of a few doctors he brings to live people of care, concern, and great devotion.

[Joel · Rating 4 out of 5]

Quick reading book about what the title says: Family Practice as the heir of the GP. Great, very short, stories and vignettes make the point that there is more to medicine than medicine and that time and listening are often more important to caring relationshps over time.

[Henry · Rating 3 out of 5]

It’s well written like all of his books, however, I just didn’t find it as compelling or deeply researched as others.

[Susan Kasza · Rating 3 out of 5]

This book was interesting to read as a rural family medicine physician who “does it all”, only in a different state. There were only a couple of medical things that were inaccurate.

[Michelle Bechtel · Rating 3 out of 5]

I believe I was assigned to read this book as propaganda to become a Maine general practitioner

[Colin · Rating 4 out of 5]

Solid McPhee. Interesting technique to cover a dozen or so doctors instead of one. A shocking amount of smoking, but then again, it was 1983.

[Collin O'Sullivan · Rating 5 out of 5]

Amazing book, must read for Maine medical students. Interesting reflection on the state of specialization in medicine in the 80s. Written with wit, humor and poise, lovely read and reflection.

[Zach · Rating 5 out of 5]

It's McPhee so it's excellent but it's from the 80s so it's dated. Still brings the world of rural doctors to life.

[Rebecca McPhedran · Rating 5 out of 5]

What an honest and straightforward book about an important form of medicine. I loved this book. It was short, but very meaningful. McPhee gives small glimpses into the lives of doctors who have chosen to practice family medicine. They subscribe to the idea that if a doctor treats your parents, your grandparents and your extended family, they will be more skillful at treating you.
This is the story of the Family Medicine Institute in Augusta, Maine. And how it has revolutionized small town medicine. McPhee follows a group of residents of The Dartmouth Family Practice and shows with honesty and berevity, the types of patients these doctors see on a daily basis. I may also be partial, because my grandfather was a major player in the forming of The Family Medicine Institute. If any form of medicine interests you, definitely read this book!

[Ada Ma · Rating 3 out of 5]

The book is rather fragmented, as the author spends one paragraph to up to a few pages about a patient's visit to a GP. Thus it had a rather fragmented structure, so trying to read more than a dozen of pages at a time can get a bit tiring after a while.

However, because you can read a few paragraphs at a time without losing the plot, I think it is good for being used as an English reader for EFL learners. The stories are straightforward, and there are not too many difficult words except for the medical terms.

I am amazed at how well the GPs know their patients given that they have 2000 to 3000 families to care for. I think my class mistresses while I was at secondary school (like the book in the 80s) with a class size under 40, knew so much less about us.