tice of medicine and the life of the practitioner in the community. David Loxterkamp is a family physician in a small coastal town in Maine. In his 10th year in practice he chose to record his life with regular journal entries, which he then worked into this book. In doing so, he pulls the reader into his life and provides a very enjoy- able reading experience. In the process of examination he seems to have developed a fuller sense of self, home, family, and community, and we are privileged to share that journey. There is a chapter for each month of the year and for each of the four seasons, but the book is much more than an accounting of those days. By moving from the events of the day back into memory of earlier years and by anticipating the future, the author weaves a captivating narrative. The title indicates that the pages will reveal the daily life of a country doctor, and the book delivers on that promise. It reveals with hon- esty and candor the highs and lows and the growth of its author as physician, husband, father, and person of faith. It is a book about community and a deepening commionent to one community as home. Dr. Loxterkamp's gift with words ensures that the reader will experience the events and emotions of the days recorded. During the several days I was reading the book, I found myself experiencing elation, depres- sion, anxiety, and contenonent. At first I thought these emotions reflected the undulating circumstances of my own days, but I later concluded that was not so. I be- lieve the writing evokes in the reader the emotions and feelings of the author as he reacts to the circumstances of his life. I suspect also that each reader will react dif- ferently to the events described through memory of personal experience. A physician with community practice background will find this journal stimulates recall of the early years of establishing practice, home, and family. Some who felt isolation and frustration in those years might find reassurance that their experiences were not unique. Anyone who seeks to understand the practice of medi- cine in community would benefit from reading this work, as would those considering such a career. This book should be read by persons responsible for plan- ning, shaping, financing, or regulating community health care systems and organizations, for in doing so, they would develop an intimate understanding of the workings of such systems and the very personal needs they try to meet. Such an understanding cannot be found in the collection of diagnostic classifications, lists of symptoms, reports of encounters and proce- dures, and similar tabulations used to describe or eval- uate a medical practice. Dr. Loxterkamp reveals his life to be one of inten- sity, commitment, and searching. He also shares his contenonents and satisfactions. One might wish him more sheer joy and happiness than what seems to come through in the narrative. But, he says of himself (page 136): "There is always a tension between enjoying life and examining it." Theodore J. Phillips, MD Lopez Island, Wash Patients Are a Virtue: Practicing Medicine in the Pennsyl- vania Amish Country. By Henry S. Wentz. 175 pp. Morgan/GUm, Pa, MasthofPress, 1997. 112.95. ISBN 1-883294-49-5. Have you wondered what it would be like to practice medicine from 1948 to 1988 among the Amish in Lan- caster County, Pennsylvania? This fascinating period in medicine spanned the early years of antibiotics, the scourges of polio and rheumatic fever, the shift from solo to group practice, and the changes in health care financing from the $2 fee-for-service office visit to medical insurance to managed care. Dr. Wentz chronicles these events, covering four decades, through 39 short vignettes. He writes in a matter-of-fact, straightforward, conversational style that is most likely consistent with the way in which he practiced and cared for his patients. As he relates the satisfactions and frustrations of his practice, he inter- sperses reflections on lessons he learned, such as the value of nurses, the power of suggestion, the courage of patients facing adversity, and the importance of a supportive family and community for both patient and physician. Perhaps his most interesting insights evolve from experiences with his Amish patients that illustrate how their beliefs sustained them as they dealt with the challenges of life and death. He also describes the diffi- culties of getting the Amish to accept such preventive measures as prenatal care, well-baby examinations, and immunizations. Throughout these episodes Dr. Wentz conveys ac- ceptance of his patients, himself, and his times without undue moral judgment or philosophical speculation. Nevertheless, the reader becomes aware of the unique problems associated with practicing alone out of an of- fice in one's home, the stresses on marriage and chil- dren, the interruptions of family gatherings by patients with emergencies, and the concerns of losing patients to a competing physician in the community. Most of these stories are not particularly dramatic. Their impact arises from the cumulative descriptions of a type of practice that will not be repeated. A physi- cian emerges who appeared to possess the qualities necessary to succeed during a unique time in medical history within a geographical location enriched by people with distinctive motivations and moral princi- ples. Thus, this book might be of interest to those physicians who would like to know more about this way of life, to people living in the vicinity of Lancaster County, and to lay persons who wonder about the daily activities of a busy general practitioner. Vincent R. Hunt, MD Brown University-Memorial Hospital of Rhode Island Pav.'tUcket Book Reviews 85 o n 5 A p ril 2 0 2 1 b y g u e st. P ro te cte d b y co p yrig h t. h ttp ://w w w .ja b fm .o rg / J A m B o a rd F a m P ra ct: first p u b lish e d a s 1 0 .3 1 2 2 /1 5 5 7 2 6 2 5 -1 1 -1 -8 5 o n 1 Ja n u a ry 1 9 9 8 . D o w n lo a d e d fro m http://www.jabfm.org/