Showing posts with label hospital. Show all posts
Showing posts with label hospital. Show all posts

9/06/2012

The House of Hope and Fear: Life in a Big City Hospital Review

The House of Hope and Fear: Life in a Big City Hospital
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Dr. Young's new book is an engaging account of life at the large mission-driven county hospital in Seattle. I spent most of my 3rd year med school rotations there myself 12 years ago and am now working in a mission-driven community health center 18 miles away. My desire to serve the poor was a direct result of the dedication from the doctors and staff that I witnessed at Harborview. Now, I spend more than half my time educating and mentoring medical students and I plan on incorporating this book into our 2nd year curriculum.
The stories are diverse: some are about incredible patients and their challenging situations - socially, medically, psychologically; some are really more about the ethical dilemmas faced by providers, and faced by patient's families; other stories point out the inequities in healthcare, while demonstrating how this institution has creatively found a way to thrive financially while serving the least able to pay.
Most importantly to me - this book is hugely interesting, well written, easy to read, hard to put down and deserving of high praise. The reason this book is so good and the messages conveyed so well is that Dr. Young has incredible skill at portraying the humanity of her subjects. This is a book of true characters; unforgettable characters. The characters are patients, their loved ones and families, the infamous ER director, a remarkable specialist in nephrology, Dr. Young herself, and the staff of the hospital. I read their stories and can picture them on a gurney, in their offices, on the wards, in the ER; I can smell the smells again; and hear the sounds in the ICU.
This text can easily and effectively (each chapter is pretty well able to stand on its own as a separate reading - though together it reads as a cohesive story) be used regularly with medical students and public health and policy students - the examples in it are perfect for igniting debate about healthcare inequality, social justice, medical ethics, professional development, difficult patients, allocation of resources and care for the underserved.

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Opening with the view of an idealistic, young doctor entering her first post-graduate job at the local county hospital, The House of Hope and Fear explores not only the personal journey of one doctor's life and career, but also examines the health care system as a whole. The county hospital setting provides the author with a second education. With clear, eloquent text, she chronicles attempts made to treat those tossed aside by society along with the personal and ideological shifts that accompany this daunting task. All of the political aspects of the hospital's executive board are detailed in a gripping account of the hospital's inner workings, and a human face is expertly given to the healthcare crisis in America.

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8/28/2012

Partners in Health: How Physicians and Hospitals can be Accountable Together (J-B Public Health/Health Services Text) Review

Partners in Health: How Physicians and Hospitals can be Accountable Together (J-B Public Health/Health Services Text)
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A review of the need for collaboration between hospitals and doctors to improve quality and safety while increasing cost. Demonstrates how the reimbursement and legal environment create skewed and inappropriate incentives, but leaves out nursing and addresses outpatient medicine only superficially. As far as it goes, it is timely and practical. Its insights are useful for physicians in particular, especially physician managers. It does give an impression of some of the successful institutions, but the discussions are dry and technical but leave one wishing for more depth and detail. Storytelling would have strengthened the arguments.

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4/12/2012

Brain Warp: A Medical Thriller Review

Brain Warp: A Medical Thriller
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I couldn't put this book down! I stayed up until 3:00 am reading. There is a lot of suspense that will keep you turning the pages. I can actually see this book being made into a movie and doing quite well. I look forward to Gil Sniders next book.

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Doctor Peter Branstead's neurology department at St. Mark's Hospital in New York's picturesque Greenwich Village is flooded with a series of critically ill vagrants exhibiting identical symptoms. Confused and agitated upon admission, they rapidly progress into convulsions, cardiac arrest, and death. The deaths are too methodical to be a coincidence, but how—and why—are they being killed? Peter's investigation leads him into a dark underworld of international intrigue and into the center of a plot to destroy the president of the Ukraine, Anatoly Labrinska. Peter learns that his patients have been given a mysterious drug that is also being administered to President Labrinska. But tracking Peter's every move is a savage Ukranian Mafia killer—an assassin so ruthless that the most vicious criminals on two continents live in fear of his wrath.With the political stability of Europe hanging in the balance and the lives of those he loves in jeopardy, Peter desperately works to foil the plot and escape with his life.

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2/08/2012

Who Killed Health Care?: America's $2 Trillion Medical Problem - and the Consumer-Driven Cure Review

Who Killed Health Care: America's $2 Trillion Medical Problem - and the Consumer-Driven Cure
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According to information released by the Centers for Disease Control and Prevention on June 24, 2007, about 43.6 million people in the United States, or 14.8 percent of the population, had no health insurance in 2006. The finding, based on a survey of 100,000 people, is lower than previous federal estimates of 46 million. The estimate is based on those who did not have insurance at the time of the interview. About 54.5 million people in the country, or 18.6 percent of the population, had no insurance for at least part of 2006. Whatever the exact numbers, there is obviously a very serious problem with health care provision in the U.S. In fact, dozens.
In her previously published book, Consumer-Driven Health Care, Regina Herzlinger explains that consumer-driven health care is "fundamentally about empowering health care consumers - all of us - with control, choice, and information." Such control will "reward innovative insurers and providers for creating the higher-quality, lower-cost services we want and deserve." What would be the role of government? She asserts that "government will protect us with financial assistance and oversight, not micromanagement." The material in this substantial volume is organized within five Parts. Herzlinger wrote the first, "Why We Need Consumer-Driven Health Care," then edited the contributions by others that comprise Parts Two-Five. She also wrote Chapter 78, "A Health Care SEC: The Truth, the Whole Truth, and Nothing But the Truth." For most of us who are not health care professionals, this volume provides about as much information as we could possibly need, much less process. I especially appreciate the fact that Herzlinger and her associate contributors make a conscious effort to avoid jargon, vague theories, oblique hypotheses, etc. They obviously believe that major health care issues are too important to be packaged as flimflam, swamp gas, and flapdoodle. Hence their rigorous focus on explaining (from a variety of perspectives) why consumer-driven health care is needed, and, how to establish and then sustain it.
In this volume, Herzlinger focuses her attention on what she describes as "America's $2 trillion medical problem" (about the current size of the economy in China) and explains why consumer-driven initiatives offer a "cure." More specifically, she exposes "the iron triangle" of third parties (i.e. Congress, health insurers, and hospital administrators) that have opposed consumer-driven health care and thereby subordinated, if not totally ignored the welfare of patients as well as their personal physicians (if they have any). These third-parties are the ones who have "killed" health care for tens of millions of uninsured or under-insured people who, Herzlinger insists, have been deprived of power, information, and choice. She is a passionate and well-informed advocate of nothing less than major, extensive, and comprehensive health care reform.
"Four armies are battling to gain control [of health care]: the health insurers, hospitals, government, and doctors. Yet you and I, the people who use the health care system and who pay for all of it, are not even combatants. And the doctors, the group whose interests are most closely aligned with our welfare, are losing the war." What to do? Herzlinger's convincing, indeed compelling and eloquent response to that question is best revealed within her narrative. However, for present purposes, here are a few key recommendations:
1. Consumers must take back the money their employers and government now take from their salaries and taxes to buy health insurance on their behalf so they can make their own purchase decisions.
2. Physicians must be empowered to design better, cheaper health care.
3. The destitute must be subsidized by "the rest of us" so that can purchase health insurance "like everybody else."
4. The federal government must help subsidize the destitute, provide transparency (a key factor for all consumers, actually), and prosecute fraud and abuse.
In Parts 1 and 2, Herzlinger explains who is killing health care and how they are doing it. She identifies both "villains" and "heroes." In Part 3, she "lays out the principles as well as the specifics of consumer-driven health care - what it is, why it will work, what it offers to all of us - and analyzes the lessons from consumer-driven systems like Switzerland's." Then in Part 4, Herzlinger provides a step-by-step plan "of the carrots, the sticks, and the laws that will make this consumer-driven system happen."
Many of those who read this brief commentary of mine may ask "So what?" Perhaps they are satisfied with their current health care coverage. It is possible but unlikely that many (if any) of those who are destitute - who have no health care insurance coverage whatsoever - check out reviews of books, much less purchase and then read them. The fact is, those who are satisfied with their current health insurance coverage are probably paying too much for their share of its total cost. And a separate but related fact is that their employer is also paying too much for its share of the health care coverage that it is required by law to provide to its full-time employees.
Herzlinger has a crystal clear vision of what health care should be and do but she is also a pragmatist. She fully understands that unless and until, in a democratic capitalistic society such as the U.S., incentives and rewards are changed, there can be no reform of the current health care system. It is wholly understandable that "the iron triangle" of third parties (i.e. Congress, health insurers, and hospital administrators) oppose consumer-driven heath care, especially given the fact that about $2 trillion is involved and would be at risk if (huge "if") patients were entrusted with the power to decide how that money would be spent.
My concerns, frankly, are these: How many people will read this review and others, then purchase and read Herzlinger's book? Then what (if anything) will they do? All change initiatives inevitably encounter what James O'Toole has aptly characterized as "the ideology of comfort and the tyranny of custom." The power and resources of those who defend the status quo of "the iron triangle" must not be underestimated. All by herself, Regina Herzlinger cannot reform the current health care system. Who will join her in doing everything humanly possible to make consumer-driven health care a reality? If you think you wish to enlist in this "war" and help win it, I suggest you read and then re-read Pages 254-258, then contact your representatives in the House and Senate and insist - not request - that they read this book or at least have a staff member do so. Will that do any good? I have no idea. But I do know that by remaining silent and compliant, we empower "the iron triangle" rather than ourselves.

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1/23/2012

The Treatment Trap: How the Overuse of Medical Care Is Wrecking Your Health and What You Can Do to Prevent It Review

The Treatment Trap: How the Overuse of Medical Care Is Wrecking Your Health and What You Can Do to Prevent It
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I am a physician who specializes in geriatrics and palliative medicine. I work in a busy tertiary care teaching hospital where some of the world's best specialists practice. Miracles of cure and life prolongation occur every day- liver and heart transplants, for example. But much more common is patients caught up in a system- marketplace is a more accurate description- of interventions- interventions that our specialists spent years in training learning how to do, and that they strongly believe are beneficial to their patients; interventions that are generously compensated by insurers; interventions that are not coordinated with all the other interventions provided by all the other specialists; interventions that have not been studied in the patient groups who are being subjected to them; interventions with significant side effects and consequences for many of the patients receiving them. Yet the unexamined belief- almost an article of faith among doctors and their patients- is that it is always better to do something than nothing in health care. Paradoxically, the truth is often just the opposite. Much of the time it is better to follow a different set of assumptions- when uncertain "don't just do something-- stand there." The Treatment Trap brings this situation to life through stories of real people- real people and their well-intended and very well-trained doctors- all doing what they were taught was right. For patients- See a doctor- do what they recommend. For doctors- See a patient, do something to show the patient you care, to make your living, to keep your practice above water. Interestingly, in support of the thesis of this book- that overtreatment is hurting and killing us- an increasing body of research shows that patients who get palliative care and hospice actually live LONGER than control patients receiving usual care- the usual care that Gibson and Singh reveal by listening to patients and families who have been there.


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11/07/2011

Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience Review

Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience
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The more you know about lean transformation the more you'll envy the Virginia Mason Medical Center (VMMC) for having the right people in the right places at the right times. At the end of the 1990s VMMC faced a struggle for survival as an in-the-black, separate entity. The CEO, Gary Kaplan, an MD and highly regarded executive saw the need for dramatic action and found it, after energetic searching, in Toyota Way thinking and acting. He created and nurtured the informed consent of the board of directors and, through John Black, engaged the Japanese consulting firm Shingijutsu. The executive team joined in embracing what became known as the Virginia Mason Production System (VMPS) and, with the clinical staff, hammered out the Virgina Mason Medical Center Physician Compact, the basis for concordant action in the VMPS.
What's really to envy is the constancy of purpose that VMMC has maintained: when transformation efforts flagged or failed or worse - and they did, regularly - execs and docs, with board support, doubled-down and solved the problems. Each time that happened momentum increased: physicians saw better outcomes and less wasted effort, patients had better experiences, nurses spent more time actually helping patients, payers got to spend money where it mattered more, medical errors (and malpractice insurance cost) dropped dramatically, the list goes on and on, each recovered success synergizing more successes.
As Donald Berwick points out in his Foreword, VMMC isn't perfect yet but, crucially, improvement continues apace: the board of directors, unified behind the VMPS, is chaired by Carolyn Corvi (the Boeing exec who, with Shingijutsu guidance, made the moving line in 737 final assembly happen), executives have become sophisticated in lean system dynamics, clinical staff are well aligned with the VMPS, and VMMC runs significantly in the black. Now all VMMC needs is a rational system of health care payment in which outcomes are rewarded instead of procedure delivery.
The author, Charles Kenney, has produced a highly readable book with plenty of rich, authentic-seeming detail. I am a fast reader somewhat familiar with the sorts of issues addressed in the book, yet despite this being a relatively short book Kenney presents so much to think about that the pleasure of reading the book lasted much longer than anticipated.

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