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Summary: Will be regarded as a classic
Review: Millenson has done an extraordinary thing. Like David Halberstam's best work, his book gives the human drama without cheapening his subject. He's taken an arcane but crucially important issue--the attempt to apply industrial notions of quality and process improvement to health care--and made it exciting. But more than that, he's unearthed a hidden history of medical politics, innovations that emerged before their time, and crusaders who cared more about the patient hidden behind the "statistical" life than improving their position in a cosy profession. In so doing he's written a gripping story that doubles as a scholarly thesis that explains where medicine has gone wrong in the past. Whether we live in a future of managed care or something else, this book contains the seeds of how medicine ought to be in the future. Like Paul Starr's "Social Transformation of American Medicine", this is a "must-read" for anyone with an interest in health care.
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Summary: Medical thriller keeps you turning the pages!
Review: Millenson's remarkable survey of the lesser known activities that constitute or impact the direct or indirect delivery of medical services is a 'must read' for those of us in the health care industry. While his analysis of the evolution of health care quality drives his narrative, its compelling appeal for me are the revealing insights on how well the medical community has consistently avoided acceptance of data driven research into day to day medical practice. Relying instead on practice behaviors learned during school or internships, there is strong evidence of the astonishing variability in how patients are medically treated. If medicine is now a marketplace commodity, the medical community has no one to blame except themselves. As a health care consultant, I can attest to the lost opportunities physicians had to take hold of their own destiny. Millenson cites many of them in this exciting journey of lost accountability. This book is a wonderful adjunct to Paul Star's "Social Transformation of American Medicine" and makes for fascinating, page turning, reading.
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Summary: Those mistakes were corrected
Review: Perhaps the worst text I have ever read. The book is poorly written and painfully dull. Mr. Millenson lack of personality is quite evident, as well as his arrogance.
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Summary: Those mistakes were corrected
Review: The mistakes mentioned by a reviewer above concerning hand-washing and hepatic necrosis were either not present or corrected before the printing of my copy of the book.
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Summary: This book could save your life ...
Review: The National Academy Institute of Medicine reports in their new book "To Err is Human":"Two large studies, one conducted in Colorado and Utah and the other in New York, found that adverse events occurred in 2.9 and 3.7 percent of hospitalizations, respectively. In Colorado and Utah hospitals, 8.8 percent of adverse events led to death, as compared with 13.6 percent in New York hospitals. In both of these studies, over half of these adverse events resulted from medical errors and could have been prevented. When extrapolated to the over 33.6 million admissions to U.S. hospitals in 1997, the results of the study in Colorado and Utah imply that at least 44,000 Americans die each year as a result of medical errors. The results of the New York Study suggest the number may be as high as 98,000. Even when using the lower estimate, deaths due to medical errors exceed the number attributable to the 8th leading cause of death. More people die in a given year as a result of medical errors than from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516)." These are only confirmed and documented hospital deaths induced by error (wrong medication, wrong operation, failure to deal with documented symptomology, etc.) For example, Millenson points out one study that showed in a single hospital there were 51000 errors in a year and only 36 reported. There are at least 180,000 deaths and over a million injuries caused by medical error every year in the U.S. Many professionals (including the reviewer who was funded by NIH for eight years to do risk analysis in healthcare) believe that these numbers are severely undereported and that medical error is the third leading cause of death after heart disease and cancer. This book is the best available overview on the topic. If you value your life you will read it. The patient must take responsibility for monitoring treatment. If the patient is unable, family or friends must closely monitor it. Every time I give a talk on this subject someone in the audience has a personal horror story to share. Last month it was the son of the Chair of a conference I was attending whose child had a brain tumor and was in surgery the week before my talk. After surgery, the nurse was about to overdose the kid on morphine. A family member had been sleeping with the child in the hospital and logging every medication in a notebook. When they showed the log to the nurse and prevented her from administering the drug, she was shocked. These stories are not isolated events. If airlines were like hospitals, every time 200 people disembarked from a flight, 7 passengers would be injured or dead. The most tragic part of this story is that if healthcare institutions where automated like most industries, over 50% of these errors would disappear the first day they turned on the computers.
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Summary: Great review of medicine's struggle for accountability
Review: This is a tremendously readable study of a very dry subject. While meticulously documented, Millenson's style is so entertaining that this book makes for good vacation reading for anyone involved in the health care industry. I am one one of those company benefit managers described at the start of Chapter 10, caught between employees unhappy with managed care rules and a management intent on holding the line on costs. This book gives me hope. With time and the right incentives, managed care can be the framework in which quality management in health care becomes visible to consumers. Congress and the medical profession ought to focus on making it happen.
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Summary: "Excellence" Describes Book Also
Review: What a wealth of information! And a guided tour of what can and is being done at hospitals and with the medical profession to provide better care and avoid what is termed "iatrogenic" (unplanned results)problems arising from medical care! Anyone who'll become or was a "subject" for hospital stay or operation can also derive some comfort from the book by being informed as to what is going on beyond the silken curtain of medical care. Worth reading--and keeping on the shelf to re-read from time to time as information contained is timeless. Author has done tremendous research and presents info clearly--and unsensationally.
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