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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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The Manual of Medicine and Horsemanship

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Horses are inextricably linked to wild places, as beasts of transportation, burden, and companionship. They are remarkable animals. In the best of situations, they are beautiful and remarkably powerful, revered for their strength and speed. In other less fortunate circumstances, they are agents of injury. A good friend of mine who is an emergency physician in Jackson, Wyoming once told me that if it weren't for horses, he wouldn't see half the number of patients. Having ridden extensively at one time in order to reach my patients, and occasionally for pleasure, I have a healthy respect for sitting atop an animal that is fantastic when it cooperates, but frightening when it is scared or obstinate.

Beverley Kane, M.D. has written an intriguing book entitled The Manual of Medicine and Horsemanship, which describes how medical students and doctors working with horses can be taught patience, gentleness, and respect, emphasizing the power of nonverbal communication and attention to the details of a compassionate approach to other creatures. Dr. Kane is Clinical Instructor and Program Director of Medicine and Horses at Stanford Medical School in Palo Alto, California. She has a private practice, Horsensei Equine-Assisted Learning and Therapy.

Subtitled "Transforming the Doctor-Patient Relationship with Equine-Assisted Learning," The Manual of Medicine and Horsemanship has much to recommend it. It is a blueprint for how to create a course that demonstrates the value of communication in a doctor-patient relationship, and how, specifically, to teach it using the recommended approach. In this regard, the book is excellent and fascinating. In other regards, where superfluous (to this reader) quotes were inserted to analogize certain aspects of the content that stand strongly without embellishment, the author could have been less poetic and more prosaic. Interspersed with the instructions are spiritual-philosophical comments that would have been better consolidated into a commentary session apart from the didactic and instructive elements of the book.

There were aspects of this book that were terrific and others that I hastened to complete, so that I could maintain a thread of continuity in my reading. Dr. Kane makes a good case for the need for young doctors to understand their innate deficiencies in understanding patients, and that better relationships across the board lead to joy and satisfaction in learning and caregiving. Working with horses is a unique approach, and so this book and what is espoused within is quite unique, and in my opinion, highly laudable. Reading about the nuts and bolts of a Medicine and Horses program made me want to participate and learn, which is the highest compliment. As a wilderness medicine physician who has always looked upon his steed as a way to get from the hospital to the outback, and been mostly concerned about not falling off his mount, I understand how horses (and other animals) should be appreciated in an entirely different light, as they have much to teach us. However, I think a note of caution is in order, because while we have much to learn from horses about body language, gestures, and a non-threatening approach, we must take care to recognize that human thoughts and needs add a layer of complexity to the task that often makes it all the more difficult to be an efficient, yet sufficiently communicative, caregiver in our hurried and harried healthcare environment. In other words, learning around horses may be necessary, but it is not sufficient. We need to spend at least as much time in observation around humans as around horses, and learn to recognize the cues and behaviors that lead to acceptably intimate interactions as confidants and doctors.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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