ON THE LEDGE: A Doctor's Stories from the Inner City

Disheartening, touching stories of a young doctor's two challenging years practicing family medicine at a clinic near a Philadelphia housing project. (Portions of this volume have appeared in the Philadelphia Inquirer and Philadelphia magazine.) From 1987 to 1989, Skolnik, now associate director of a family practice residency program for Abington Memorial Hospital in Philadelphia, worked in an inner-city clinic where most of the patients were on Medicaid. In Skolnik's stories, his patients often come to him too late, distrust his advice, sell the medications he prescribes, and fail to return for tests or follow-up care. He can examine their bodies, take out stitches, and give their children shots, but he is powerless to make a real difference, for their lives have been shaped by drugs, alcohol, physical violence, and other ills of a society that has broken down. He can only watch helplessly as one young woman dies of tuberculosis, another returns to the man who has beaten her, an old man with syphilis flees out of fear that doctors are experimenting on him, and an unwed teenage mother spurns birth control pills. Skolnik's account is reminiscent of David Hilfiker's Not All of Us Are Saints (1994), which described medical practice in an inner-city clinic in Washington, D.C., and like Hilfiker, Skolnik suffers burnout. He describes himself as becoming more and more cynical, and by the time budget cuts force the university-subsidized clinic to close in 1989, he has already made the decision to move on. Looking back, Skolnik says he could not have predicted the depth of human encounters his work brought him. Fortunately for the reader, he has skillfully recreated them here. At the book's end he is both sadder and wiser, and so are we. Makes woefully clear the enormous task society faces in providing health care to the poor.