“The Right Stuff” is populated by 2 very different sets of heroes. First there are the test pilots, represented by Chuck Yeager, a former flying ace who in 1947 became the first person to break the sound barrier during level flight in his X-1 rocket-powered jet.

By Wolfe’s account, the test pilots were men of daring who regularly pushed the limits of human flight, placing themselves in hazardous situations where failure to respond to problems in a split-second could result in mission failure and even death. In his introduction to the 1983 edition, Wolfe reports a pilot mortality rate of 23%. During the 1950s, this translated into about 1 death per week.


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Yet morale and camaraderie among the test pilots were high. They believed that they were promoting patriotism, expanding the human capacity for exploration, and bravely breaking what were thought to be unbreakable human limits. Said Yeager, “What good does it do to be afraid? It doesn’t help anything. You better try and figure out what is happening and correct it.”

Astronauts

Through no choice of their own, the later Mercury astronauts were a very different breed, Wolfe found. Though many had experience as both combat and test pilots, their role in space exploration would resemble that of passengers more than pilots. For example, they were selected based less on their bravery, judgment or skill than on their ability to withstand a battery of grueling and sometimes humiliating tests that included nausea-inducing centrifuge rides and castor-oil enemas.

In other words, the astronauts functioned less as test pilots than test subjects. The work of piloting the flights would largely be done by computers and ground control, and the astronauts’ role was largely to endure them. When it came to the design of the Mercury capsule, they had to fight for a window through which they could see where they were going, a hatch that they could open from the inside, and even minimal manual control over the rocket.

The astronauts and their families were revered by the American public, who marveled at the courage it took to ride a rocket into the unknown, but it was not enough for the men themselves. They longed to do something. In “The Right Stuff,” Yeager captures much of their frustration when he turns away from the project saying, “Anyone who goes up in that damn thing is going to be spam in a can.”

Physicians: Test pilots or astronauts?

The contrast between pilots and astronauts captures nicely some of the disappointments and frustrations facing US physicians. Having entered medicine believing that their own knowledge, compassion and experience would help make the difference between health and illness and even life and death for their patients, they have found themselves inhabiting a very different reality, 1 that often leaves them feeling more like passengers than pilots.

Consider how physician performance is assessed. In the past, physicians sank or swam based on their professional reputations. Today, by contrast, the work of physicians tends to be evaluated by the quality of their documentation, their compliance with policies and procedures, the degree to which their clinical decision-making conforms to prescribed guidelines, and satisfaction scores. Over the past few decades, the physician has become less of a decision-maker and more of a decision implementer.

This article originally appeared on MPR