Book review: The Medicine by Karen Hitchcock

Karen Hitchcock’s insights into the healthcare system are refreshingly pragmatic, both compassionate and dispassionate.

Karen Hitchcock’s The Medicine offers a doctor’s insights into the healthcare system, health conditions, and people’s journeys through ill health and treatment in Australia. The essays in the book cover a lot of ground, from aged care to acute care, and from the personal to the systemic. Hitchcock writes about her experiences first as a medical student and then as a doctor, and shares her perspectives on some of the most interesting and complex health issues and challenges of our times.

The Medicine is a riveting read and Hitchcock is an engaging author. She is compassionate, humorous, pragmatic, sensible and down-to-earth. She comes across as empathetic but also objective and uncompromising.

Hitchcock is particularly good at analysing, and providing insights into, the emergence of substance use disorders and lifestyle-related conditions such as obesity. Her perspectives on these subjects are refreshingly pragmatic. She is both compassionate and dispassionate, psychologically attuned to the vulnerabilities of her patients but objective enough to critically assess their capacity for recovery and the potential efficacy of interventions. She can sympathetically analyse the social and economic conditions that can precipitate and exacerbate ill health (for example, the social isolation and lack of opportunity for meaningful work that might induce alcohol or drug misuse), yet also maintain a dispassionate view about the importance of personal responsibility in improving health outcomes.

She understands what compels people to become dependent on food and substances. She explains, without judgement, how pleasure-seeking behaviour can become pathological in socially isolated and economically precarious environments. She can write cogently about the circumstances that induce addiction. She also offers a persuasive and revealing analysis of the inadequacy of our current approaches to treatment. She maintains a healthy scepticism about the current paradigm where people vest all their hopes for salvation and deliverance in prescription medications.

Hitchcock frequently draws on personal experience – for example, she describes her own experience of tobacco addiction unabashedly and unapologetically – to make sense of others’ experiences, and offers illuminating insights into the experiences of both doctors and patients as they navigate challenging pathways to treatment and recovery.

She comes across as being politically and socially conscious, and offers a cauterising critique of the deleterious political and economic conditions that skew how societies deliver healthcare. Notably, she offers a devastating critique of the influence of the pharmaceutical industry on healthcare systems (and, particularly, its sometimes problematic influence in health and medical research).

Hitchcock’s sense of humour shines through in all her essays. She can laugh at herself and with her patients and colleagues. She helps us recognise and chuckle at our idiosyncrasies and foibles. She has a humorous way of pointing out the sometimes odd ways in which we interact with each other and make sense of our lives and experiences, as both seekers/recipients and providers of healthcare.

Hitchcock is particularly good at using anecdotes to illuminate complex issues. One of her memorable anecdotes is about a Holocaust survivor’s journey into the aged care system. The woman’s resilience is inspiring but deteriorating circumstances get the better of her. We see that, ultimately, even the most resilient can be overpowered. The inevitable physical and cognitive decline that accompanies ageing and changing social circumstances force many people into the most difficult and isolating situation imaginable at the end of life.

Hitchcock’s essays are reflective, informative and provocative. She can tell a good story and make complex information accessible and relatable. This is a book that would speak to anyone from any background but might have added resonance for those who work in healthcare; Hitchcock’s reflective and socially-conscious perspectives on healthcare offer a salutary lesson to many.

4.5 stars out of 5 ★★★★☆

The Medicine: A Doctor’s Notes by Karen Hitchcock
Publisher: Black Inc.
Format: Paperback
Categories: Non-Fiction, Australian
Pages: 272
Release Date: 4 February 2020
RRP: $29.99

Arjun Rajkhowa
About the Author
Arjun Rajkhowa is a writer and academic who divides his time between Melbourne and the Pilbara.