Deep disorder pervades medical practice. Disguised in euphemisms like "clinical judgment" and "evidence-based medicine," disorder exists because medical practice lacks a true system of care. The missing system has two core elements: standards of care for managing clinical information, and electronic information tools designed to implement those standards. Electronic information tools are now widely discussed, but the necessary standards of care are still widely ignored. Because these two elements are external to the physician's mind, they address a root cause of disorder: dependence on the internal capacities of autonomous physicians-their personal knowledge, intellect, habits and judgment. In this dependence on the limited, idiosyncratic capacities of individuals, medical practice lags centuries behind the domains of science and commerce. Breaking that dependence is the subject of this book.Going back 400 years to the philosophy of Francis Bacon, and examining parallel ideas from 20th Century thinkers, this book illuminates the origin of medicine's disorder. The analysis is more than theoretical. It grew out of decades of development and clinical experience in finding a new approach to medical practice. Designed to create order and transparency, this new approach involves not only standards and tools but also institutional changes essential to building a true system of care. In the current non-system, physicians bear impossible burdens of performance, other practitioners are barred from sharing those burdens, patients do not participate effectively in their own care, the U.S. spends $2.5 trillion annually without clinical accounting standards, third parties manipulate the situation for their own advantage, and none of the stakeholders are accountable for their own behaviors.This book offers a clear blueprint for building a better system of care, a system that patients, practitioners and third parties could trust. A better system could make health care a source of hope for our economic future, rather than its greatest threat.

Doctors in Denial examines the relationship between the Canadian medical profession and the pharmaceutical industry, and explains how doctors have become dependents of the drug companies instead of champions of patients' health. Big Pharma plays a role in every aspect of doctors' work. These giant, wealthy multinationals influence how medical students are trained and receive information, how research is done in hospitals and universities, what is published in leading medical journals, what drugs are approved, and what patients expect when they go into their doctors' offices. But almost all doctors deny the influence and control the drug companies exert. In this book Dr. Lexchin urges the medical profession to make the changes needed to give priority to protecting and promoting patients' health and benefitting society, rather than enabling Big Pharma to dominate health care while raking in billions in profits from citizens and governments.

Environmental Health I Health Care Policy I History Of Medicine --

A first-hand account by one of the doctors who exposed the truth at National Women's Hospital. Jones sets the record straight with his personal story: a story of the unnecessary suffering of countless women, a story of professional arrogance and misplaced loyalties, and a story of doctors in denial of the truth.

You’ve argued politics with your aunt since high school, but failing eyesight now prevents her from keeping current with the newspaper. Your mother fractured her hip last year and is confined to a wheelchair. Your father has Alzheimer’s and only occasionally recognizes you. Someday, as Muriel Gillick points out in this important yet unsettling book, you too will be old. And no matter what vitamin regimen you’re on now, you will likely one day find yourself sick or frail. How do you prepare? What will you need? With passion and compassion, Gillick chronicles the stories of elders who have struggled with housing options, with medical care decisions, and with finding meaning in life. Skillfully incorporating insights from medicine, health policy, and economics, she lays out action plans for individuals and for communities. In addition to doing all we can to maintain our health, we must vote and organize—for housing choices that consider autonomy as well as safety, for employment that utilizes the skills and wisdom of the elderly, and for better management of disability and chronic disease. Most provocatively, Gillick argues against desperate attempts to cure the incurable. Care should focus on quality of life, not whether it can be prolonged at any cost. “A good old age,” writes Gillick, “is within our grasp.” But we must reach in the right direction.

Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

The history of science abounds with momentous theories that disrupted conventional wisdom and yet were eventually proven true. Ajit Varki and Danny Brower's "Mind over Reality" theory is poised to be one such idea-a concept that runs counter to commonly-held notions about human evolution but that may hold the key to understanding why humans evolved as we did, leaving all other related species far behind. At a chance meeting in 2005, Brower, a geneticist, posed an unusual idea to Varki that he believed could explain the origins of human uniqueness among the world's species: Why is there no humanlike elephant or humanlike dolphin, despite millions of years of evolutionary opportunity? Why is it that humans alone can understand the minds of others? Haunted by their encounter, Varki tried years later to contact Brower only to discover that he had died unexpectedly. Inspired by an incomplete manuscript Brower left behind, Denial presents a radical new theory on the origins of our species. It was not, the authors argue, a biological leap that set humanity apart from other species, but a psychological one: namely, the uniquely human ability to deny reality in the face of inarguable evidence-including the willful ignorance of our own inevitable deaths. The awareness of our own mortality could have caused anxieties that resulted in our avoiding the risks of competing to procreate-an evolutionary dead-end. Humans therefore needed to evolve a mechanism for overcoming this hurdle: the denial of reality. As a consequence of this evolutionary quirk we now deny any aspects of reality that are not to our liking-we smoke cigarettes, eat unhealthy foods, and avoid exercise, knowing these habits are a prescription for an early death. And so what has worked to establish our species could be our undoing if we continue to deny the consequences of unrealistic approaches to everything from personal health to financial risk-taking to climate change. On the other hand reality-denial affords us many valuable attributes, such as optimism, confidence, and courage in the face of long odds. Presented in homage to Brower's original thinking, Denial offers a powerful warning about the dangers inherent in our remarkable ability to ignore reality-a gift that will either lead to our downfall, or continue to be our greatest asset.