Edition #16 – Rachelle Buchbinder answers 7 questions

by | May 27, 2022

1. Why are you an author?

I am a physician specializing in rheumatology (arthritis and musculoskeletal conditions) and a clinical epidemiologist, combining seeing patients with research. I love performing research and writing research papers (over 600 papers to date), as well as making the results understandable to the general public. The book Hippocrasy is the culmination of this work.

2. Who are your literary inspirations?

In the writing about medicine for a lay audience: Atul Gawande, Jerome Groopman, Irvin Yalom, Oliver Sacks, Siddhartha Mukherjee.

3. What is your writing routine?

Firstly some procrastination and then getting in the groove so that I am oblivious to what is happening around me; writing is my happy place. I wrote the book with Ian Harris, an orthopedic surgeon and also an academic and we each wrote drafts of sections and then swapped them. This part was lots of fun and also I learnt a lot too.

4. Why did you write this book?

By Rachelle Buchbinder and Ian Harris

Because a lot of health care is not improving health – not only is that sometimes harming the patient (up to 10% by some accounts), it is wasting valuable resources that could be better spent on people that need our care. It is also having a deleterious effect on the environment. Many doctors understand the problem but too few are doing anything about it and the public are generally oblivious to it. We wanted to raise awareness of too much medicine to a wide audience as one way of trying to address the problem. The book gives examples from across all fields of medicine of the problems of overmedicalisation, over diagnosis, over treatment and medicine as big business.

5. What were the biggest obstacles in writing this book?

The biggest obstacle was finding protected time to write the book as both of us are busy seeing patients, leading departments and doing research (not to mention family commitments). We were very fortunate to have been awarded a Rockefeller writing residency at the Rockefeller Center in Bellagio, Italy for four weeks. We wrote the first draft of the book in that idyllic setting with views of Lake Como and the town of Bellagio below. Further iterations were written during summer vacations and weekends. A second obstacle was explaining difficult concepts for a lay audience without lots of medical jargon – we mainly do this through stories.

6. Who are the key points of this book?

We used the pledges of the Hippocratic Oath (1964 version) as the focus of each chapter. The key points are First, do no harm; the importance of understanding science and using evidence to make health care decisions; the harms of relying on opinion and personal experience; the over reliance on medicine for normal human conditions like sadness and ageing, birth and death; making diagnoses that don’t help the patient and often harms them; the distorted view of many doctors that they need to ‘do something’ when simple assurance and explanation and empathy may be the better option; and the problems with fee for service, big business and perverse incentives. Finally we offer some solutions.

7. Where may we find you online?