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“As is your pathology, so is your practice,” said Sir William Osler, the philosopher-physician over 100 years ago. While today some may not entirely agree with the sweeping generalisation of the statement, it remains a fact that pathology forms the bedrock of medicine. Arthur Hailey, too, recognised this fact when he wrote The Final Diagnosis in 1959. While most novels and movies dealing with medicine revolve around clinicians, particularly surgeons, Hailey decided to make the department of pathology and the pathologist the core of the action. Surgeons and other physicians in the hospital are, of course, important players; they have to be, because, after all, pathology makes its existence felt after the surgeon has made the first move.
When I first read the book just over a quarter of a century ago, I fell in love with the idea of working in a big hospital. Small wonder then that I chose this book as a must read for all doctors (BMJ 2005;331:1482). In retrospect, having read it again recently, the plot is nothing spectacular: it's just another month in the life of a busy general hospital, the Three Counties in Pennsylvania, United States. But, as anyone who's worked in a big hospital knows, every month is interesting and carries its own, different challenges. There is, just as in other Arthur Hailey novels, a multitude of characters, each with their own subplots. The story weaves around the working relationships between the many physicians and others who run the hospital.
Joe Pearson is the chief of pathology; once an excellent pathologist, he is now out of touch with the latest methods in laboratory medicine. Change is under way at the Three Counties Hospital, and Pearson faces the possibility of losing his job. That, however, could lead to loss of a substantial donation to the hospital, from a rich benefactor, who is a friend of Pearson's. Just as the surgeon-administrator Kent O'Donnell weighs the pros and cons of his decisions, Hailey balances O'Donnell's professional life with his love life. Tragedy surfaces in the book, as it does in real life in hospitals, when doctors make errors, or when terrifying diseases strike young, likeable people.
The story is readable nearly 50 years after it was first published. Undoubtedly, some of the scenes are melodramatic, at least from a physician's viewpoint. However, the issues that Hailey deals with are as relevant now as in 1959. Equally striking—and a reflection of the meticulous research that the author was famous for—is the fact that there are no bloomers in Hailey's descriptions of various medical procedures. Perhaps for the first time, non-medical readers were introduced to the concept of frozen sections, clinico-pathologic conferences, and doubt and uncertainty in medicine.
By Arthur Hailey
First published 1959