Healing the Wounds, A Physician Looks at His Work

by David Hilfiker

Healing the Wounds is the most revealing book ever written by a doctor about his own profession. In it, David Hilfiker breaks the code of silence surrounding the everyday practice of medicine and gives is a dramatically different personal account of how the family doctors gets by in a world of spiraling information and high anxiety. Drawing on his years of rural and urban experience, Dr. Hilfiker lets us all know what it really feels like to be a doctor. What do you do when you make a serious medical mistake? Is it enjoyable to play God? What do you say to a patient who wants reassurance when the essence of diagnosis is uncertainty? What about money? What happens when a patient is taking forever, your waiting room is full, and you want to get home?
 
Dr. Hilfiker uses incidents from his own practice to examine many of the kinds of behavior for which doctors are criticized—aloofness, authoritarianism, lack of caring, and money. With compassion for doctor and patient alike, he shows how the stresses of medical practice lead to a climate of misunderstanding and hostility in which the goal of healing is the first casualty.
 
Never before have we heard the voice of the doctor ever American is most likely to meet—the family doctor—telling the often painful truths of medical practice. A book for the medical community and the lay person alike, Healing the Wounds is a powerful exploration of what frustrates doctors (and infuriates patients) and what might be done about it).

Genres: Medicine, Medical, Memoir

Hardcover

First published January 1, 1985

Reviews

[Lobstergirl]

David Hilfiker was a family practice doctor from 1975-1982 in rural Minnesota, about 110 miles from Duluth. This book is his memoir about the patients he saw and his eventual burnout, which he ascribes to flaws in both the system, and himself. The title, "Healing the Wounds," refers both to his patients and to him and is borrowed from Henri J.M. Nouwen's book The Wounded Healer. He worked in a clinic and neighboring hospital with one other doctor and several nurses. He became dissatisfied with the way the limited time he had to spend with each patient turned him into someone who avoided treating the whole person and listening deeply to their problems. He developed an emotional remoteness around patients in order to deal with the job, and when he got home each day was too tired and distant to relate as a loving father with his three children. His other dissatisfactions related to the hierachical nature of medical practice, with physicians authoritarians over nurses and other medical staff, and the constant pressure to earn more money for the clinic, which meant spending less time per patient and prioritizing more complex procedures.

Hilfiker is exceptionally honest; it's very rare to hear professional people being this honest about their jobs and especially the mistakes they make. He tells many stories about his patients; the most harrowing one is the time he accidentally aborted a baby. His patient was pregnant, or at least thought she was. She'd had a baby before and was familiar with how a pregnancy "felt," but she'd had four pregnancy tests and they were all negative. Hilfiker was certain she'd had a miscarriage. Their small hospital didn't have the equipment to confirm whether she was truly pregnant, so she would have had to travel to Duluth to get an ultrasound. Hilfiker suspected that she and her husband couldn't afford the scan, so he scheduled her for an abortion to remove the dead fetus. He was surprised during the abortion that there was more blood than normal, and the fetus's limbs were larger than they should have been. He realized with horror that he was probably aborting a living fetus. At home, the patient expelled some more body parts. A pathologist confirmed that the baby had been living and was 11 weeks old. Hilfiker explained to the woman and her husband what had happened, and they were very understanding.

After working in Minnesota, he took a leave of absence to figure out what to do next, and got an invitation to work at a clinic for indigent and homeless patients in Washington, D.C.

This would be a good book to read in conjunction with Heirs of General Practice by John McPhee.

Hilfiker wrote about his medical mistakes, including the abortion, in a famous article for the New England Journal of Medicine in 1984. You can read it free here:

https://physiciansindex.org/feature-a...

[Joel]

This book is a must read for anyone who is in healthcare. This is a book about healing the wounds that are inflicted to and on the healer. This is a well articulated cathartic expression of what happens to those who provide health care in general, but specifically to those in poor, underserved, and homeless health care settings. We need to take better care of ourselves so we can better care for others. Cynicism and burn out are prevalent within medicine, for a myriad of reasons, many of which are unlikely to go away. Hilfiker calls for addressing these issues and does so in a brave, transparent, vulnerable way. I applaud him for say what we all think and experience but are too ashamed, embarrassed, or egotistical to say.

[Noel]

I found out about this book from my Medical Ethics course that I took. Hilfiker’s book immediately drew me in by the main focus of the book, because rather than just getting the stories of missed diagnosis and physician errors, you also get the emotional turmoil that physicians are faced with on a daily basis. It expertly encompasses the phrase "things they didn’t teach you about in medical school." I think this is a good book for not only those that are venturing into a career related to health and medicine, but also for the everyday people, essentially the patients. It gives a better and, what I feel like, is a necessary understanding of our physicians.

[Jennifer Robb]

My mom found this book on a book exchange rack at her local library and gave it to me after she read it. It was interesting and I can identify with much of what Dr. Hilfiker talked about with regard to the medical/healthcare professions and the mental aspects of it, many of which can cause burnout.

It's interesting because during training there is a lot of "support" but once practices are established, it seems that the group aspect disappears. Medical students are supervised by interns who consult residents, who consult attendings and specialists. Dental students are supervised by licensed dentists (instructors), some of whom practice in recognized dental specialists. There's somewhat of a group process to diagnosis in these--yet many doctors and dentists, even if they practice within a group, don't use the group diagnosis available to them. Group practices are still more common for medical than dental--though that is changing from what I understand.

In the end I'm unsure what Dr. Hilfiker decided regarding his practice of medicine. Did he return to his rural practice in Minnesota? Did he stay at the clinic in Washington, D.C. instead?

[Debbie]

A very honest look into a doctor's struggles

David Hilfiker was a dedicated family in rural Minnesota from 1970s to 1982. Once the starry eyed optimist eager to serve his patients, years of death, demands on his time, advancing medical technology, and the corrupting influence of power and money began to erode the relationships he had with his patients. He listener's and prescribed more. A gulf widened between him as his office staff. He had become efficient and productive, but less human.

This book, along with Brendan Reilly's book One Doctor, has given me much to contemplate regarding my relationship with my doctors an the expectations I might have concerning my care.

[Carole Duff]

Hilfiker’s journey as a doctor has all the marks of a quest for one’s true self, living an honest life. For most, however, doctoring in the United States is anything but. Doctors hide mistakes and uncertainty; their detachment and efficiencies are rewarded with money and god-like adoration. Some might read Hilfiker’s book as an expose, but many in his profession applaud with a sigh of relief. Finally, someone who has the courage to stand up and tell the truth.

[Rachel]

Originally read in 1996 (originally published in 1985). My review from then: A physician looks at his work. He freely admits his mistakes, and talks about his conflicts with the enormous responsibility and about the financial pressures that keep doctors from doing the best they can with each patient.

[Ana Laura]

Pra quem faz medicina, uma leitura que é uma imersão (as vezes pessimista, mas muito real) na reflexão da profissão. Li em português, versão que chama Curando As Feridas.

[Iowafarmstud]

Going into the medical field, I thought this book was awesome! It gives a great inside to ethical, physical, and emotional conflicts that physicians face each day. It really made me appreciate the medical field even more and it has given me a foothold for what to expect in the coming years. There were a few stories that were not necessary in my opinion, and the end was kind of strange. Other than that, a MUST read for any pre-med!

[Jonathan Yoder]

Helpful, if painful, reflections on the issue/reality of mistakes in medicine.