23 January 2012

Medicine, Health, and History: A Blog by Paul E. Stepansky, Ph.D.

I've been reading Paul E. Stepansky's memoir about his father, The Last Family Doctor: Remembering My Father's Medicine. Over the next few days, I'm going to post notes from this moving book and also review it. It is beautiful, heartfelt, nostalgic, and yet also says something very profound about modern medicine in the United States. This book is one that all doctors and medical students should read. I discovered that Paul Stepansky has also started a blog. Here's a taste:
Three decades after Peabody’s lecture [Francis Peabody on “The Care of the Patient"], I began riding shotgun when my father, William Stepansky, made his daily round of house calls in rural southeastern Pennsylvania. Sometimes, especially with the older patients he visited regularly, I came into the house with him, where I was warmly welcomed, often with a glass of milk and home baked treats, as the doctor’s son and travelling companion. From my time on the road, I learned how my father’s clinical gaze met and absorbed the anxious gazes of family members. It became clear, over time, that his medical obligation was not only to the patient, but to the patient-as-member-of-a-family and to the family-as-medically-relevant-part-of-the-patient. In a lecture to the junior class of his alma mater, Jefferson Medical college, in 1965, he made this very point in differentiating the scope of the family physician’s clinical gaze from that of the pediatrician and internist. Unlike the latter, he observed, the family physician’s interventions occurred “within the special domain of the family,” and his treatment of the patient had to be continuously attentive to the “needs of family as an entity.” It was for this reason, he added, that “family medicine must teach more than the arithmetic sum of the contents of specialties” (my father’s emphasis). Here, in the mid-60s, my father posited a medical-interventional substratum to what would emerge a decade or so later, in the realm of psychotherapy, as family systems theory and “structural family therapy.” And then, 12 years before [George] Engels came on the scene, he offered his conception of “a solid intellectual approach to medicine”:

“To me this means relating the effects of the body systems one upon the other in health and disease through knowledge of the basic sciences – i.e., biochemistry and physiology – through some understanding of the social and environmental stresses on the patient, and finally through insight into the psychological influences of personality structure as it affects health and disease.”
Beautiful, crisp prose and thoughtful - and that's the case for his memoir too.


  1. I just heard this blog from one of the physicians in nextcare urgent care and I think PAul Stephansky is quite an interesting doctor cause as I read the quoted part in the post you got re his family's medical background history is really very interesting. I hope to hear more about his thoughts regarding modern medicine now.

  2. The beauty of being part of a family of doctors is that you can really form a mutual state of relationship to all the patient and sometimes even think of them as part of your family too. Life is pretty short and I'm glad that you are have learned well. Just a quick question though, have you ever experience your patient asking whether to buy generic cialis or not? Funny right? That's one of my friend's joke every time we drink.

  3. It's nice that William Stepansky was able to leave such a great legacy to all of his patients. Urgent care was provided and at the same time, he treated each and everyone like his own family.

    1. I agree, a legacy like this should be kept well and passed on to be remembered in the medical field. Providing urgent care to your patients can be the best gift you can ever give to a community that depends their health to you.

  4. I'm impressed at how he tackled determining the proper course of treatment for a specific patient. Not only is he focusing on the medical history, he is also factoring in the patients environment and how he reacts to social and environmental triggers around him. Now that's my idea of holistic medical care.