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April 23, 1997

On the Ledge: A Doctor's Stories From the Inner City

Author Affiliations

Medical Center of Delaware Wilmington

JAMA. 1997;277(16):1327-1328. doi:10.1001/jama.1997.03540400079043

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All doctors are trained to tell stories: "This 45-year-old man was awakened from sleep by..." While it is possible that such a routine case presentation might include the fact that the patient is a truck driver or a former drug addict, such details are not considered as important by most presenters as the details of the patient's symptoms. Only after their training are doctors apt to learn differently, sometimes to their great surprise, the importance of their patients' lifestyles and environments to the care of their medical problems.

In On the Ledge, Neil Skolnik writes of his 2 years at a family medicine clinic serving Philadelphia's inner-city poor. He admits that his writing is a "purging of frustration." These fine and interesting accounts of the patients he saw arose from his dismay at the living conditions of the inner-city poor for whom he had medical responsibility. He seems surprised at