The Rise and Fall of Modern MedicineBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7219.1276 (Published 06 November 1999) Cite this as: BMJ 1999;319:1276
- John P Bunker, visiting professor
- University College London Medical School
James Le Fanu
Little Brown, £20, pp 490
ISBN 0 316 64836 1
James Le Fanu tells us that medicine today is dull, which, from his perspective in general practice, it may have become. Whether medicine has lost the excitement that accompanied the explosion in treatments in the past 50 years, as he contends, medicine has certainly changed beyond recognition. He leads us instructively through these years of medical change.
In the first of four “paradoxes” with which he introduces and later closes his book, Le Fanu writes: “Medicine is, sadly, no longer as satisfying as in the past. Many of the most interesting diseases that tested the doctor's clinical acumen have simply disappeared, and the family doctor is lucky to see a patient with a serious acute medical problem from one week to the next.” As a result of past success in prevention and treatment, the primary care doctor is left with the symptomatic care of patients suffering from chronic illnesses and of counselling the “worried well.” Serious illness, acute as well as chronic, has increasingly become the province of hospital based physicians and surgeons.
In his second paradox Le Fanu writes: “It is most peculiar that as medicine has become more successful, the proportion of the public who apparently are ‘worried well’ about their health has increased.” As a consequence of epidemiological evidence that an individual's life style can affect his or her health, “an excessive concern about ‘health’ can …