BMJ  2004;329:355 (7 August), doi:10.1136/bmj.329.7461.355-a

reviews

Book

The Renewal of Generosity: Illness, Medicine, and How to Live

Arthur Frank, professor of sociology at the University of Calgary, Canada, makes two surprising and perhaps disturbing statements. He confesses to not being "unqualifiedly grateful" to his physicians for having treated him for cancer. Equally important is his perception that his doctors did not care for him with unqualified generosity at all times. Why has medicine come to this state of affairs? And what can be done about it?

Frank adopts a narrative based approach to illustrate his beliefs. Narrative based medicine, a relatively new field, seeks to incorporate a crucial factor often lacking in modern medicine—the human factor. Frank draws on the works of a diverse population of generous people to explain his views. They include the respected physician writers Abraham Verghese and David Hilfiker. Frank's stories involve patients (including cancer survivor and cyclist Lance Armstrong, who has just won the Tour de France), doctors, and nurses. The Russian literary critic Mikhail Bakhtin, and the philosophers Emmanuel Levinas and Marcus Aurelius (a stoic) offer important advice in this book.

The author uses the phrase "fundamental medicine," by which he means healing those who are suffering (he calls them "guests") by those who are offering care (hosts). However, many things currently result in the not uncommon practice of treating diseases, rather than patients with disease. Frank shows that a fair amount of medicine is symbolic, yet is crucial to healing. Dialogue is essential if fundamental medicine is to be practised, he states.

While the book addresses both doctors and patients, many of the messages about compassion and generosity could apply to society in general. Medicine is the medium that Frank uses to transmit his message because medicine sets a standard, and besides, illness is universal.

That the proportion of demoralised physicians is increasing is no secret. That reversing this slide will not be easy is also obvious. I suspect that most people do not read philosophical or reflective volumes. This is a pity because The Renewal of Generosity contains many commonsense but profound statements for doctors (and patients). Three stood out, in my opinion: "In order to lead a human life, people need the generosity of their fellow humans"; "To be generous, first feel grateful"; and, most importantly, a statement made to Frank by a technician and which made a great impact on him, "Everyone who touches you affects your healing." All of us who are in the healing profession would do well to remember this.

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Manipal Hospital, Bangalore, India s_pai{at}vsnl.com

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