Being a physician, and in my 88th year, I can appreciate Dr. Atul Gawande’s book “Being Mortal: Medicine and What Matters in the End” for many reasons, but I think end-of-life issues predominate. Therefore, my thoughts are multiple and difficult to contain.

Gawande eloquently describes the current “treatment” of the elderly sick and disabled in nursing homes and assisted living residences, as well as the lack of human interaction involved, all in the name of caring.

In contrast, in my early practice as a general practitioner some 60 years ago, with $3 office visits and $5 house calls, doctors were on call 24 hours a day, went to homes and routinely knew their patients on a personal basis — a situation rarely if ever true now.

Over several decades, technology — computers, automated record-keeping, highly refined tools such as CAT scans and the MRI — has transformed the practice of medicine. In addition, doctors have become “employees” of the insurance industry and are no longer individual practitioners. They are insulated from meaningful patient contact by multiple staff, sterile exam rooms, large office buildings and multiple layers of paper.

Of even greater import, though, is the isolation of those nearing the end of life, whether in nursing homes or a similar setting with a more catchy name. Gawande illustrates these problems with several emotionally charged case histories.

As a physician, I can see clearly how we have moved from caring for and about the person whom we face to treating a condition that challenges us. To be sure, “do no harm” is still a basic ethical principle, but the understanding of “harm” may have changed, and “harm” may have taken on a much broader meaning in the context of hugely advanced technology.

Many years ago, in a less complex society, where the ultimate harm seemed to be death, our ethical task was at all costs to prevent this. It would appear, in that regard at least, we have been rather successful, and life has been, in most cases, greatly prolonged.

It also seems, however, that such gains as these are accompanied by rather significant challenges. In today’s highly complicated technological world, there is a need to re-examine what is “harm,” which Gawande attempts to do.

Is it harmful, despite routine nursing care and regular medication, to be without meaningful contact with other living entities for days, weeks or longer? Or is it harmful, after extensive discussion between patient and doctor, followed by deliberation and thought, to take medication and fall permanently “asleep”?

Of the greatest importance, however, is it harmful, after clearly and carefully, even with “do not resuscitate” directives and living wills, opting for a death with dignity, to have others — often loved ones, but sometimes emergency care workers — militate against this?

In my opinion, medicine has taken the wrong track, surrendering our autonomy and becoming employees of the monied interests, insurance companies and their allies.

We’ve allowed ourselves to be driven into a technological nightmare, using machines instead of our own good judgment, resulting in “just in case …” decisions, impossible health care costs and, more important, a wasting away of the doctor-patient relationship.

For example, I recently sought care for a painful ankle. After a very careful, adequate exam and an accurate diagnosis, an MRI was suggested in case the doctor had missed something. This was done; it gave supporting, but no new, information, and did not change the diagnosis or treatment. A week later, I learned that the procedure had cost “insurance” (that is, all of us) $1,800. Had I known how much it would cost, I would have refused to have it done.

Everyone, but physicians in particular, will benefit greatly from reading this book. Patients should read it, and then ask their doctors if they have, and explain why they must. When they do, it may start a return to the care common in Scandinavia and other parts of the world, but now existing only rarely here.

Richard K. Jennings, M.D., is a resident of Brunswick.

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