Not since Samuel Shem’s iconic The House of God has a book about physicians had greater potential impact on our profession than the wisdom and knowledge contained in Still Life with Stethoscope and Typewriter, by Arthur Lazarus MD.  Written by one of the foremost medical thinkers of our generation, “Still Life” is a collection of short, thought-provoking essays, scribed with an almost mathematical clarity, that probe the many challenges facing practicing physicians, individually and collectively, in today’s upside-down medical profession.  Lazarus unmasks all the common pitfalls we encounter and the resulting negative emotions they ferment that slowly chisel away at our soul and threaten our fulfillment.  These articles are no mere superficial autopsy of a broken medical system; they are a forensic dissection.  Skillfully employing bone saw, rat-toothed forceps, and scalpel, Lazarus presents us with a coronal section of our profession’s pathology, which he then hangs on the lightbox of naked truth for all to review.

While Gross Anatomy is where medical students go to begin to identify and learn how the organs of the body interrelate with each other, Still Life is a place where physicians can go to understand their place in the cosmos.  It is a roadmap, a GPS in modern terms, to understanding and navigating the complexities and obstacles facing our profession.  With stethoscope, Lazarus listens to the heartbeat of our profession.  With typewriter, he analyzes and records what he hears.  He crystalizes his thoughts into a narrative still life, “each object placed in relation to the others, inviting the viewer--or reader--to slow down and notice what might otherwise be missed.” 

All the essays revolve around a central motif:  what it’s like to practice medicine in a system that is slowly leeching the humanity from the doctor-patient relationship.  Lazarus invites us to walk beside him as he examines the nature of both doctor and society, using philosophy, the arts, and literature to press his points.  Each dispatch is full of wisdom, like when he states, “Each specialist touches a different part of the body and mistakes it for the whole…” and “Empathy, once abundant, is gradually eroded, leaving behind a hollowed-out version of the healer they once aspired to be.”  He instructs us on the fine balance between how to care deeply “without being consumed by the suffering of others,” and, while he is critical, he often points out corrective strategies for both physician and profession.  A constant message of caution is that doctors need to remind themselves of the need to make space:  space to listen, space to feel, space to empathize and reflect, and space to heal, so that we may reinvigorate and maintain the very qualities that drove us into medicine; the very qualities the current system is eroding.

The essays in Still Life help define what we ourselves struggle to articulate:  the emotions of the practicing physician and how they relate to our increasingly chaotic experience.  Still Life defines the obstacles we face in clear and concise terms, written with an economy of words that rival Hemingway, and with the precision of a laser, as they invariably go straight to the heart of the matter.  Still Life is sprinkled with wit, humility, nostalgia, foresight, and most importantly, always returns to embrace the humanity naturally embedded within our profession.  To hold our interest and underscore points, Lazarus peppers us with references to Star Trek, the songs of Don Henley and The Kinks, the art of Jan Vermeer,  an 800 year old poem by Rumi, and our favorite films, all while exploring the burnout, moral injury, depression, disappointment, lack of gratitude, disrespect, and exhaustion we encounter as we move through our day, coupled with how to prevent these evil humors from suffocating us or further hardening our heart.  He even explains the unexplainable: specifically, why today’s young physicians are so different from us (“because the system is different!”). Far from identifying only trip wires, he offers insight, perspective, solutions, and hope. 

Like a slithering coil of Strongloides stercoralis, a nematode which clogs the health of our intestines and biliary tree, Lazarus vilifies the parasites affecting modern medicine:  Big insurance, private equity, expanding hospitals and healthcare systems--and the algorithms, guidelines, throughput and efficiency standards that come with them-- coupled with the infestation of hospital administrators and their thinly veiled efforts at corporatizing the practice of medicine.

As only a psychiatrist can, Lazarus probes the soul of what it means to be human and what it means to be a physician.  He explores difficult topics such as the rise in physician attrition rates, the vanishing art of empathy, the void in strong physician leadership, and how chart notes and time demands overshadow our encounters with the patient and are leaching what’s left of why we chose this profession.  Still Life weaves these complexities together into something we can identify as our daily experience and in such a way that we can finally connect the dots to our frustration and disillusion.

I can’t speak more highly of Still Life with Stethoscope and Typewriter.  Its most important ingredient is its relevance; it’s a veritable Wash Manual for the practicing physician.  Each essay, like a vital organ, has a specific purpose, one essential to maintaining the well-being of the mind and body of a practicing physician.  Arthur Lazarus writes with insight, as if he is up in the crow’s nest, not shoveling coal in the windowless, airless engine room like the rest of us.  I believe Still Life should be read by every patient, medical student, intern, resident, practicing physician, and hospital administrator for the deep insight it provides us on the practice of medicine and the woeful status of our healthcare system.  Like a fine aperitif, it should be ingested slowly, read as thoughtfully as it was written, pulled on and off the bookshelf in cycles, thus allowing the full weight of its insight to ebb and flow over our soul, cleansing us with salvational awareness, and putting us on track to a more satisfying and fulfilling career in what is historically the greatest profession of them all. 

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. He is the author of several books on narrative medicine and the fictional series Real Medicine, Unreal Stories. His latest book, a novel, is Standard of Care: Medical Judgment on Trial.