What Matters in Medicine (2013)


What Matters in Medicine (2013)

Lessons from a Life in Primary Care

David Loxterkamp, MD

What-Matters-In-Medicine-LoxterkampWhat Matters in Medicine: Lessons from a Life in Primary Care is an exploration of the practice of medicine. It focuses on the essence of the physician’s art– an alchemic blend of self-sacrifice, common sense, and beguiling bedside manner. The topic could not be more timely: initiatives such as the Affordable Care Act, Patient Centered Medical Homes, and Accountable Care Organizations, along with a precipitous decline in independent practice, are inexorably changing the look and feel of primary care medicine. It remains to be seen how well it will balance the needs of an aging population with a compassionate awareness of their cost.

David Loxterkamp grew up in rural Iowa. His mother was a nurse, his father a solo general practitioner who died when David was thirteen. He witnessed first-hand the rewards and sacrifices that can temper a medical family in close-knit community. Dr. Loxterkamp brought that knowledge and sensibility to the midcoast of Maine, where he has practiced and lived for the last 28 years with his wife, Lindsay, and their children. He was trained like his father to deliver babies, attend hospitalized patients, perform minor surgery, visit the nursing homes, and call on the homebound. Over the years, he saw medicine change, his patients adjust to age and illness, and firm beliefs begin to bend. And change comes hard, not just for patients but for their doctor, too.

What Matters in Medicine begins with three stories of general practice (Dr. John Eskell of St. Briavels, England; Dr. Ernest Ceriani of Kremmling, CO; Dr. E.O. Loxterkamp of Rolfe, IA) from the middle of the 20th Century. It then introduces the reader to Belfast, Maine and the people who call David Loxterkamp their doctor. It concludes with a multifaceted description of primary care at the level and pace of daily practice, with insights that should interest and instruct students, practitioners, consumers, insurers, and leaders of American health care.

What Dr. Loxterkamp continues to discover and affirm lies at the heart of primary care: that patients need a doctor who offers them a measure of conversation, friendship, and hope. And offers it with each visit, no matter the patient’s chief complaint or the complexity of care it may require. Medicine may run on the machinery of procedures, metrics, and optimized reimbursement, but it is lived in the context of human relationships that remain the source of courage and companionship that real change requires.


What Matters in Medicine: Lessons from a Life in Primary Care. $30.00 hardcover. The University of Michigan Press, Spring 2013. 192 pages, including 8 pages of B&W photographs from W. Eugene Smith’s photoessay “Country Doctor (LIFE Magazine,1948), John Berger/Jean Mohr’s “A Fortunate Man” (1967), and Claudia Dowling/ Lynn Johnson’s photoessay “What Makes a Good Doctor?” (LIFE Magazine, 1998).

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