Island Practice: Cobblestone Rash, Underground Tom, and Other Adventures of a Nantucket Doctor by Pam Belluck, 2012, * * * * *

Dr. Timothy J. Lepore (pronounced to rhyme with peppery) has earned a reputation as an idiosyncratic, contrarian family practice physician in his decades on Nantucket Island but as Pam Belluck writes in this highly readable book he is really a survivor from a not-too-distant past when family doctors were not as money-driven and impersonal as they have been forced to become in today's medical-industrial complex.  The American health care system works - when it works - by shuttling patients around a network of specialists. The highest obstacle to access is usually a lack of money.  The 10,000 permanent residents of Nantucket must also cope with the elements: routine fog or storms can put a stop of all transportation between the island and the doctors on the mainland, 30 miles away.   Pam Belluck, a reporter to the New York Times, has devoted her first book to a study of Timothy Lepore and his anachronistic approach to medicine.  Island Practice is a tale of quirkiness and peculiarities as well as nuanced reporting on moral and political issues like abortion, substance abuse, suicide and, in particular,  medical care as it has been practiced but may not be practiced in the future.  Belluck's description of Nantucket's only surgeon's behavior gives insights about his pragmatic dealings with real people in tough situations as well as showing this unique doctor plying his trade while holding onto his values and persona. The lesson is that medicine is a micro and macro issue and where you sit defines what you see.  Dr. Lepore and his special patients need a kind of care that is uniquely available because of his personality and the unusual characteristics of Nantucket. Anyone who is a patient wants a doctor to go above and beyond the crazy quilt of the insurance, hospital and malpractice "rules" to get us the care we need. Island Practice entertains with stories, yet leaves you wondering how well that care will be provided in the future -  not just on Nantucket but in other isolated communities.  If you loved John Berendt's Midnight in the Garden of Good and Evil, or Susan Orlean's The Orchid Thief you will find great pleasure in Island Practice.