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CMAJ. 2010 January 12; 182(1): 67–68.
PMCID: PMC2802624

A commentary on the truth

Reviewed by Lara Hazelton, MD, Psychiatrist

The orange wire problem and other tales from the doctor’s office, David Watts, University of Iowa Press; 2009. 186 pp $25.00 

Writing reflective essays about clinical experiences is a complex endeavour that can appear deceptively simple.

It is not always easy to balance fidelity to the facts with the imperative to maintain patient confidentiality. There are the ethical questions of what benefits are accrued, and to whom, and what the risks might be. There is the matter of choosing your audience and deciding how best to speak to them.

The number of physicians who write despite these difficulties is quite striking and while not everyone possesses the same degree of skill, there is generally an earnest quality to the writing that suggests an effort to understand, and to share, truth.

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San Francisco, California, physician David Watts takes this task seriously. As well as authoring several books on medicine, he is a poet, musician, and television personality. In the preface to The orange wire problem and other tales from the doctor’s office he writes that he is striving “not so much to document as to approach a truth that goes beyond nonfiction and dares to flirt with the realm of mystery.” As such a statement would suggest, this is an ambitious book.

In 26 short narratives, Watts provides sparse sketches of encounters between doctor and patient. Most of the clinical scenarios will be familiar to physicians, but Watts imbues them with importance and significance. He brings himself deeply into the encounters and does not back away from sharing his own emotions, whether he is dealing with a patient’s insurance company or talking to the physician caring for his own dying mother.

Description is kept to a minimum. Dialogue flows without quotation marks. At times this makes it difficult to tell whether words are spoken by the patient or the doctor, and the line between communication and internal reflection is indistinct. It’s a style of writing that differs from the norm among books written by doctors: It keeps the reader slightly off-balance and compels attention. Yet the book itself is easy to read and not without humour, despite its lofty ambitions.

There is a line in the book where Watts tells one of his patients: “A doctor is supposed to share not just truth but wisdom, which, if you will, is a commentary on the truth.” This goal can apply not only to clinical situations, but also to the process of writing creatively.

Bravery is one of the virtues we don’t often talk about in medicine, but it takes a special sort of courage to be present with a patient’s pain, to hold the experience long enough to examine it and then to bare one’s soul in the commentary on the truth.

This is a book that aspires to be not only brave, but wise.


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