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BMJ. 2007 May 19; 334(7602): 1061.
PMCID: PMC1871782
Medical Classic

Healing the Wounds

James Curran, GP locum, Glasgow

David Hilfiker wrote Healing the Wounds in 1982; it is based on his experience of working in rural medicine in the 1970s in Grand Marais, a small town in Minnesota, USA, whose population in the summer months is supplemented by an influx of tourists. The book largely consists of a collection of anecdotal descriptions of semi fictionalised cases of patients he treated.

From the description so far, and a familiarity with the sort of autobiographical books doctors tend to write, one could expect a series of semi humorous vignettes full of eccentricity and whimsy or tales of a doctor modestly saving lives against the odds. However, Healing the Wounds is not that sort of book. The cases Hilfiker describes are not always the ones with happy endings. He writes about difficult childbirths, missed diagnoses, the experience of an unsuccessful resuscitation after a cardiac arrest, and futile attempts at therapy for insoluble emotional problems.

He portrays this side of his work so as to make some points about the job of being a doctor. Each chapter describes a case or two, which Hilfiker then uses to discuss a particular aspect of medical practice—its inherent stress, uncertainty, and error; the difficulty in keeping clinical knowledge up to date; the conflicting duties to the patient and society. For want of a better phrase, these are all the “things they didn't teach you about at medical school,” the things that Hilfiker feel prevent him from giving his patients effective care.

Healing the Wounds sounds like a glum read, but this is not the case. The writing is clear and effective, and what emerges is an honest and refreshing look at medical practice. It is obviously a very personal look because Hilfiker discusses his own thoughts and reactions, but it never becomes self indulgent or solipsistic—he never overanalyses matters, and wherever possible he uses examples from other doctors or published work to illustrate his points.

As he states in a new afterword to the latest edition of this book, David Hilfiker is more affected than most doctors by the issues he describes. Not everyone would draw exactly the same conclusions as he has. However, what he describes are things that affect all of us to varying degrees—priorities to be balanced, trade-offs to be made, lines to be drawn. For that reason—and because this is one of the best complete descriptions of a doctor's work—this is a book that deserves to continue to be read.


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