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Title: Internal Bleeding : The Truth Behind America's Terrifying Epidemic of Medical Mistakes by Robert Wachter, Kaveh Shojania ISBN: 1-59071-016-9 Publisher: Rugged Land Pub. Date: 07 February, 2004 Format: Hardcover Volumes: 1 List Price(USD): $24.95 |
Average Customer Rating: 4.2 (15 reviews)
Rating: 5
Summary: Internal Bleeding : The Truth Behind America's Terrifying Ep
Comment: At first glance, a book about medical errors might lead the reader to expect scare tactics or, particularly since it is written by physicians, a defense of the medical profession. Internal Bleeding is a pleasant surprise-it provides a brilliant, well-balanced, and easy-to-comprehend look at how medical mistakes occur and how they might be minimized. Many people think that medical errors are simply the result of bad caregivers. The authors, who also edit a government-sponsored e-journal on healthcare quality, use numerous case studies to show that medical errors are more commonly the result of a progression of systemic mistakes, slips, or miscues that lead to an adverse outcome. The bibliography, the supplementary tips on medications, and the list of questions to help the consumer determine if a hospital has a culture of safety add value. Marilyn Sue Bogner's Misadventures in Healthcare provides similar content but assumes some prior knowledge of systems thinking and error analysis. Highly recommended for public and academic libraries
Rating: 1
Summary: Brilliant, Inclusive and Wrong!!
Comment: This major effort seems to have touched all the bases. It leaves virtually no possible cause of medical errors unexamined. It does, however, seem to employ its excellence in describing gripping case studies as a distraction much of the time, leading one away from root causes it seems to prefer not to pursue.
I refer to, to cite but 2 examples, the touch-and-go treatment of selection and education of medical students and the issue of the cover-ups that are the consequence of the "Brothrhood" of physicians.
Our impressively literate authors manage to leave issues like them without much examination at all and to virtually leave them out of their "solutions."
They properly make much of the "culture" of physicians, yet offer no ideas as to how to modify it at the med school (blunt end) level rather than after the wrong people (drug addicts, among others)have been trained and are wreaking havoc (sharp end.) Drug addicts, by the way can be picked up by tests before during or after med school - as can asocial individuals. Such tests are not employed (as they are in industry - which the authors employ as examples elsewhere.)
Nor do they seem to be aware of the possiblity of, or to encourage the employment of, others than physicians and their handmaidens to try to right the problems that are killing hundreds of us each day. And, given the culture they describe, this traditionaly hubristic practice (self-policing) virtually insures that proposed solutions will be top-heavily doctor friendly.
Their systems oriented approach, which the Bush administration and the AMA seem to have picked up on, is advantageous in that it is relatively easy to implement. (Bush and the AMA are all for electonic help for doctors) and advanced computers will certainly help but such solutions ignore at least equally important needs such as those mentioned in the 2 examples noted above - without which meaningful reform of medicine will not occur. And so, I see their "solutions" as mere paliatives awaiting the more difficult and realistic changes that I hint at.
Reading this book is tremendously informtive (and entertaining) but don't confuse it with a meaningful solution to the problems of American health care. It isn't
Rating: 5
Summary: Riveting AND educational!
Comment: I strongly suspect that the publishers insisted on the title of this book over the objections of the authors, because (as another reviewer has noted) the title is clearly sensationalistic and very much out of line with the even-handed and level-headed treatment of the rest of the book. Indeed, the title is perhaps the ONLY thing I would criticize about this otherwise excellent and gripping description of the underlying causes of medical mistakes and what can be done about them.
I cannot praise the quality of the writing enough. The authors accomplish just the right blend of fascinating case studies and theoretical analysis. They make their basic point (that any system run by humans is fallible and medical mistakes are inevitable) very effectively in the beginning pages of the book by describing two case studies where mistakes were made...with the punch line being that the mistakes were committed by the authors themselves. Beginning the book this way was in part so effective because it gets across the message that the vast majority of mistakes that are made are not the result of negligent, careless, or malicious physicians; rather, they are the inevitable consequence of a system that struggles to cope with the complexity of the ever-changing demands of a never-ending stream of patients.
The second most admirable feature of this book, in my opinion, is that it does not merely criticize but also offers suggestions for improving the delivery of medical services to eliminate errors, from such simple steps as physicians "signing their sites" (to prevent, say, amputation of the wrong limb) to computerizing medication orders (to prevent errors due to physicans' notoriously poor handwriting) to more systemic changes in malpractice law. I thought the authors' suggestions on this latter topic to be highly intriguing and novel. The idea of adopting a modified no-fault system for compensating patients injured by medical errors is, in my mind, a terrific idea, and I would love to see the authors' recommendations in this regard enter the national debate on malpractice litigation reform.
Perhaps the only part of the book I found even slightly disappointing was the authors' reluctance to deal more bluntly with the problem of incompetent or alcoholic/drug dependent doctors. The authors acknowledge that these "bad apples" exist, but they do little beyond saying that hospitals and physicians tend to cover up for the incompetents in their ranks. My mother-in-law died from botched surgery; after she died, the hospital risk manager told us to our faces that this particular surgeon had had "other surgeries that did not turn out as he had planned." I think if I had read this book before my mother-in-law died, I would have been more proactive in pressing our complaints about this surgeon, who--a scary thought--is still operating on people but probably should not be.
But these kinds of physicians are in the minority, and the contribution this book makes is to describe the much more common ways in which patients end up being hurt by medical care designed to help them.
I read a lot of nonfiction, and this book is one of the rare examples of nonfiction that can keep you glued to your chair and turning the pages eagerly. I think it ranks right up there with Jon Krakauer's "Into thin air" and Richard Preston's "The hot zone" in terms of readability and interest value. Yet it also probably outranks those and other books in terms of potential social value. It could well be one of the few books with potential to inform and enable real changes in social policy that has been published lately.
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