A Thousand Steps

A Thousand Steps
A Thousand Steps by T. Jefferson Parker

Wednesday, April 18, 2018

No Apparent Distress: A Doctor's Coming of Age on the Front Lines of American Medicine by Rachel Pearson, MD- Feature and Review


In medical charts, the term “N.A.D.” (No Apparent Distress) is used for patients who appear stable. The phrase also aptly describes America’s medical system when it comes to treating the underprivileged. Medical students learn on the bodies of the poor—and the poor suffer from their mistakes.

Rachel Pearson confronted these harsh realities when she started medical school in Galveston, Texas. Pearson, herself from a working-class background, remains haunted by the suicide of a close friend, experiences firsthand the heartbreak of her own errors in a patient’s care, and witnesses the ruinous effects of a hurricane on a Texas town’s medical system. In a free clinic where the motto is “All Are Welcome Here,” she learns how to practice medicine with love and tenacity amidst the raging injustices of a system that favors the rich and the white. 

No Apparent Distress is at once an indictment of American health care and a deeply moving tale of one doctor’s coming-of-age.



No Apparent Distress: A Doctor's Coming-of-Age on the Front Lines of American MedicineNo Apparent Distress: A Doctor's Coming-of-Age on the Front Lines of American Medicine by Rachel Pearson
My rating: 4 of 5 stars

No Apparent Distress: A Doctor's Coming of Age on the Front Lines of American Medicine by Rachel Pearson, MD is a 2017 W.W. Norton Company publication.

This book is an eye-opening shocker told from the personal experience of Rachel Pearson a young woman who enters the medical profession and trains in various public hospitals and small town clinics, learning the hard way that despite her compassion and will to care for patients, the poor and uninsured face more challenges in getting the care they need, due to an incredibly flawed system.

Rachel relates to the reader the many ways mistakes can be made, unnecessarily putting patients at risk, the bias that can affect treatment options, and the limited resources available to patients who are uninsured.

But, we also watch Rachel's struggle with the inclination to offer basic human compassion and the way she was being taught to keep her emotions in check and remain professional. These cases are difficult to read about, but exposes the system's flaws, in a way many people just can't understand or don't want to admit to. The fact that Rachel experienced this first hand, and is a doctor, not a politician, or pharmaceutical salesperson, or insurance agent, but someone who has been there on the front lines, so to speak, should convince anyone who may be skeptical that this is a stark reality in our country. It's shameful to be frank.
But, I will say, that as someone who has seen even the most privileged, affluent, and well insured patients herded through hospitals like cattle, with little or no bedside manner to be seen, or with doctors literally rolling their eyes at patients who ask questions or express concerns about their treatment, Rachel's struggle with her initial innocence and idealism which contrasted sharply with the reality of her situation, proved that there really are doctors out there who care about their patients, whether they are insured or not. I highly recommend this book for no other reason than to educate yourself about how the poor are basically used as training specimens, the many disadvantages they have compared to those have insurance, and the heartless blind eye that is turned on this ugly, hidden truth.

Rachel also reminded my cynical self that doctors are human beings too, and helped me see a different side of the equation. Some of these cases still haunt Rachel, but I hope she will focus on the good things she will do for her patients now, and that she did learn something from this experience.

On a more positive note- While this book highlights an area of healthcare that many are unaware of unless they are in the trenches, there are many heroes in the health care business who perform miracles every day. This book merely draws attention to some of the issues we need to work on, especially in public hospitals.





Rachel Pearson, M.D., Ph.D., is a native Texan and a pediatrics resident. She wrote No Apparent Distress: A Doctor’s Coming-of-Age on the Front Lines of American Medicine.

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