Laboratory Medicine in Clinical Practice. Practical and Efficient Use of the Laboratory in Patient Management

and suffering, life and death-all need examination and critique by the physician as the role of the healer is defined and clarified. Clarification and definition are the gifts of this well-written and lucid book by William F. May, Professor of Christian Ethics at the Kennedy Institute of Ethics, Georgetown University. Drawing upon both professional studies and literary works by Hemingway, Faulkner, Camus, and others, images of the physician are presented: the doctor as parent, fighter, technician, contractor, and covenanter. May ranges widely over many areas of concern in contemporary medicine. The intimate relation between the healer and the patient is examined in the varied images of the physician noted above. The parental image is examined-and criticized-for its seductive destruction of patient autonomy in the name of beneficence. The image of the doctor as the fighter is deftly displayed with a barrage of military terms describing the battle waged against disease. The explosion in medical technology and its impact upon the critically ill and/or dying patient is a major factor in the analysis of the physician as technician: doing what can be done without regard for the multiple personal and public concerns surrounding terminal care. In the discussion of the doctor as party to a contract, the inadequacy of the model as representative of the depth of patient-physician relationship is clearly drawn. There are, however, background noises of the perennial intra-professional argument among medical ethicists about the model for a physician as seen by the non-physician. It is in the exposition of the covenanter as the most desirable image for the physician that May describes superbly an ideal for the physician of our time. Allowing for the positive attributes of the other images which are needed to comprehend the rich tapestry which is the professional life of the doctor, May deepens and strengthens the fabric. Taking mutual indebtedness and intensity of relationship implicit in the covenant between God and the people, we are given a religious model which is inspiring. At a time when the incursion of evil forces seems inevitable and pessimism pervades our world view, a broader base for a life of service and responsibility is suggested. Ranging broadly, expertly, and sensitively over topics as diverse as primary and tertiary care, the hospital as institution, bureaucracy, and health care teams, May is emphatic in his insistence that teaching health and "accompanying the patient," as Paul Tournier would put it, are essential parts of the image of that complex and beset person, the physician.