Medicine is full of young recruits writing veterans’ books, war stories full of hopes and fears for the next in line. As in the military, a couple of years’ service provides fodder for a thick volume, a decade enough material for a boxed set.

Out of medical school for just 12 years, Dr. Abraham M. Nussbaum has joined the ranks of physicians who write their memoirs even as they are paying off their student loans. These young people write to complain, to explain, to reflect, to crack jokes. A few feel destined for new and better careers in literature. Trained as a psychiatrist in North Carolina, Dr. Nussbaum now directs an inpatient psychiatric ward in Denver, where he meets the mentally ailing of a large portion of the West. Some show up straight from the local Greyhound station, troubled souls from places without mental health resources.

None in recent memory has wielded a set of intellectual and writerly tools to such dazzling and instructive effect as Dr. Nussbaum’s “The Finest Traditions of My Calling: One Physician’s Search for the Renewal of Medicine.” Dr. Nussbaum contemplates his charges with a perspective composed of roughly equal parts philosopher, theologian, scientist and comic, musing at length on exactly how he is supposed to make them better.

A retired nurse cycles between depression that keeps her firmly in bed and mania that sends her hurtling gleefully down the locked ward to give Dr. Nussbaum their special secret buddy handshake: “It’s the Nussbaum sandshake,” she hollers, “the Nussnutt landrake, the Fussbutt bandlake, the Cussbutt taketake!’” Another patient reports that she has fled New Mexico to escape “vampire dealers selling me poisoned shards.” She is addicted to methamphetamine, but whether that has precipitated her psychosis or resulted from it is unclear.

She herself sees little problem: “I do fine,” she tells Dr. Nussbaum. “I mean, sometimes I have to hide behind the dresser to keep calm. I stay there a few days. It’s O.K. I get hungry? My husband will chuck a burrito over the dresser. No problemo.”

Another patient stands silently in the center of the hospital’s cardiac catheterization laboratory, arms held stiffly behind her like a human rocket. An older woman, she is about to undergo a catheterization when she suddenly realizes that it is time for her to head back to her home planet, and positions herself accordingly.

Great stories all, and a less ambitious writer would have contented himself with the details. But Dr. Nussbaum steers his narrative directly to the hard questions about 21st-century medicine, a profession just about as variously troubled as his patients.

Call him a medical millennial questioning a past that seems barely relevant to his present. None of the usual medical heroes apply. Even the enduring William Osler, who started the hospital residency system at the turn of the 20th century and is routinely worshiped as a medical saint, comes up short. Osler was all about the physical evidence of illness, and Dr. Nussbaum faults him for seeing the body primarily as a collection of diseased parts, “a decidedly incomplete view.”

Few of Osler’s heirs strike Dr. Nussbaum as free of their own shortcomings.

He notes that partisans of today’s much promoted evidence based medicine must determinedly finesse the fact that medicine is riddled with flawed, incomplete evidence. The leaders of genomic revolution trumpet a future that keeps being postponed. Quality-control gurus abound, but their work often fails to yield actual quality.

And those who would update and streamline medical routines offer up paradigms Dr. Nussbaum finds simply bizarre. He points to Atul Gawande, the Harvard surgeon and health policy writer who in a New Yorker article lauded the ability of large chain restaurants like the Cheesecake Factory to serve a uniform, reproducible product thousands of times over. Dr. Gawande charged medicine to do likewise, but that image of the physician as a line cook feeding faceless strangers does not inspire Dr. Nussbaum.

Still, if a doctor is to be neither parts mechanic nor line cook, then what? Dr. Nussbaum considers some alternatives.

Perhaps, he muses, doctors should emulate ballroom dancers, gently leading patients in a series of measured classic routines. Or perhaps they should model themselves on gardeners, as proposed by Dr. Victoria Sweet and others who urge modern medicine to nourish patients’ innate vital force rather than simply replace their parts.

Or perhaps the contemporary doctor is best considered a breed of personal trainer, teaching the health equivalent of the pull-up.

Or perhaps the doctor should be a servant — but what kind of servant? A servant in the ancient religious sense, binding up the feet of the suffering? A servant in a somewhat lesser sense, charged with supplying patients with commodities they may not even know they want? Or a servant in the basest possible sense, an enabler bent on fulfilling every one of the patient’s desires?

Dr. Nussbaum considers the alternatives in a flowing, complex stream of anecdotes and reflections, all the stronger for its frequent uncertainty. He writes beautifully, in a lucid prose as notable for its process as its conclusions: The reader can actually watch him think. Even the occasional false notes (a few too many patients are likened to trembling trees) are easily forgivable.

Many medical memoirs are one-shot deals, offered to the public purely to unburden the author. From these books, readers and writer all move on with some relief. In Dr. Nussbaum’s case, we will eagerly await the next volume in the set.

From The New York Times, April 5, 2016. By Abigail Zuger, MD