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BMJ. 2007 June 16; 334(7606): 1275.
PMCID: PMC1892509
Review of the Week

Fractured: picking up the pieces

Reviewed by Jessica Watson, academic FY2 doctor, United Bristol Healthcare Trust and University of Bristol

Fracture—Adventures of a Broken Body. Ann Oakley. Policy Press, pp 186, £12.99. ISBN 9781861349378. Rating ***.

An author's fractured arm led to a book on the intrusive surveillance of doctors, finds Jessica Watson

“Medicine can, and does, save lives and contribute to wellbeing, but much of it is a massive cultural deceit.” This is the controversial conclusion Ann Oakley reaches after being treated for the fracture of her right arm. Increasingly the medical profession is becoming aware of the value of patients' narratives, yet Ann Oakley is no ordinary patient. As professor of sociology and social policy at the Institute of Education, University of London, she treats her experiences as a “field trip into the land of bodily damage, disability, and personal injury litigation.” In an attempt to make sense of her experiences she launches a huge research project that touches on a myriad of themes including limitations of Western medicine, medical litigation, the problem of ageing, disability, and the confusion between bodies and identity.

Oakley portrays doctors as self serving and insular. One recurring theme is a lack of communication and in particular an inability or unwillingness to listen: “It quickly becomes clear that what worries me is not what worries the doctors,” she writes. The doctors in her case were interested in the problems they saw—the state of the scar, the movement of the arm, and the degree of pain. No one took the time to find out what Ann Oakley's concerns were, largely that her hand felt like “an alien object”: “I don't feel I have a right hand. It just hangs there at the end of my arm. I hate it.” She is not only right handed but a writer of sociology books and novels, and devotes a whole chapter to exploring the personal, cultural, and psychological significance of the right hand.

The medical model of Western medicine, or “body as machine” approach, “distorts the human experience of living in a body,” Oakley argues. In this model “objective,” quantitative tests are seen as providing the answers, and in the process the patient's subjective experience is ignored and delegitimised. Nerve conduction studies are an example of “the mechanical model of the body par excellence; the patient doesn't have to speak, or even, really, be conscious at all.” On the basis of these “objective” tests, doctors discharged Oakley as “cured”— even though “these tests said nothing about sensibility—about what I felt.”

Oakley portrays her physiotherapist in a much better light than the doctors: “the difference is that Theresa listens when I tell her; she isn't a machine.” Disappointed by mainstream medicine, Oakley also turns to acupuncture, and its more holistic approach makes her hand “feel a little bit more like part of me again.” A fundamental difference between Western medicine and acupuncture, she argues, is the inseparability of mind and body, and this theme of embodiment is central in the book.

Within this theme Oakley explores several other areas, with some controversial conclusions. Screening “isn't to prevent disease, but to change identities—to produce patients.” To back this up she says that evidence to support the benefits of screening is minimal, yet screening subjects large numbers of women to unnecessary investigations and anxiety.

She feels that ageing women are excessively medicalised and medicated, with hormone replacement therapy being “the ultimate case study in pharmaceutical marketing, in how to make millions by inventing new conditions that need treatment, playing on people's susceptibilities, and ignoring the bad news about what drugs do to the body.” Also, one chapter is devoted to a damning criticism of the American system of litigation, blame culture, and lawyers as “ambulance chasers.”

This is a surprisingly readable book, given the complexity of some of the issues discussed. It interweaves the author's own experiences with other patients' stories and evidence from research. Some of Ann Oakley's statements seem to overdramatise the facts to court controversy, but the book has some interesting lessons for doctors.

Although patient centeredness, communication skills, and the holistic approach are increasingly being incorporated into medical teaching, this book finds a gap between the theory and practice of these skills. It would be easy to dismiss the concerns raised as the anecdotal experiences of one patient, but many doctors will recognise an uncomfortable reflection of some aspects of medical practice. Whether the doctors did a technically good job in the medical task of fixing broken bones was, to this patient, secondary. Her book reminds us all of the importance of listening to and learning from our patients and encourages reflection on the universal experience of living in a body.

Notes

Fracture—Adventures of a Broken Body

Ann Oakley

Policy Press, pp 186, £12.99

ISBN 9781861349378

Rating ***


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