Bad Medicine: How the American Medical Establishment is Ruining Our Healthcare System [Hardcover]

Lawrence J. O'Brien (Author)

Book Description

ISBN-10: 1573922609 | ISBN-13: 978-1573922609 | Publication Date: January 1999 | Edition: 1

Reformers have tried to solve the U.S. healthcare crisis by focusing on costs, coverage, and benefits. But this doesn't get to the heart of medicine's problem, says veteran health services consultant Lawrence J. O'Brien, who argues here that the real solutions require a complete overhaul of the medical mindset of doctors and the institutions that train them. O'Brien prescribes needed reforms to doctor education and reconstruction of the government's policies within the healthcare system to clean up the growing medical mess.

Editorial Reviews

About the Author

Lawrence J. O'Brien (Arlington, VA) has worked for many years in the healthcare industry as a consultant for health services, managed care, and federal affairs. --This text refers to the Paperback edition.

Product Details

• Hardcover: 225 pages
• Publisher: Prometheus Books; 1 edition (January 1999)
• Language: English
• ISBN-10: 1573922609
• ISBN-13: 978-1573922609
• Product Dimensions: 9.1 x 6.2 x 1.1 inches
• Shipping Weight: 1.2 pounds
• Average Customer Review: 4.4 out of 5 stars  See all reviews (7 customer reviews)
• Amazon Best Sellers Rank: #2,058,940 in Books (See Top 100 in Books)

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Customer Reviews

Most Helpful Customer Reviews

21 of 22 people found the following review helpful:

5.0 out of 5 stars An excellent critique of American Medical priorities., September 27, 1999

By A Customer

This review is from: Bad Medicine: How the American Medical Establishment is Ruining Our Healthcare System (Hardcover)

O'Briens' Bad Medicine is an excellent discussion of how medical schools and teaching hospitals have contributed to the current health care crisis. As a family health psychologist on the clinical faculty of Harvard Medical school these last 20 years and an advocate for the collaborative family health care paradigm, I welcome this hard hitting, insightful, philosophically grounded presentation of how American medical priorities have often given us both poor health care and impossibly high health care costs. Many of my colleagues, health care practioners and medical school faculty are unhappy with what is happening, for our patients and ourselves. Some of us are beginning to see that we as doctors, medical school faculty and teaching hospital administrators, have been part of the problem. An example is an editorial (Aug 1,l999 Boston Globe) by Dr. Bernard Lown, senior physician at Brigham and Women's Hospital and Professor Emeritus at Harvard University School of Public Health. Dr. Lown writes, "Our health care system is on the verge of collapse..it began when doctors were seduced by financial incentives, with unquestioning third-party payers providing an open till. Care was fragmented among a bevy of super-specilists, with multiplication of mindless procedures, encouragement of un-called for office visits, and exposuer of patients to a glut of unnessary surgical intervention. Each procedure was converted into a profit center". Larry Obrien has written a strong book on the problem, tracing the history and philosophy of this medical/financial train wreck using his 25 years of experience in HMO administration. Bad Medicine is a great public policy contribution because it shows how and why the American government has colluded over the course of the 20th century. Congress has subsidized too many medical schools producing an oversupply of specilists, functioning for profit, with extraordinary high technology, to do often unnecessary procedures on individual body parts with an 18th century mechanistic mind set of repairing bodies like they were broken clocks. All this is still going on, when we health providers, consumers, administrators and legislators could and should be maintaining health defined as dynamic biopsychosocial functioning of human beings as we understand ourselves from the perspective of 20th century neuromolecular biological medical science and philosophy. Bad Medicine concludes with recomendations for collaborative health care, treating whole human beings by teams led by primary, family generalist health care doctors in local settings, in organizations given financial incentives to maintain health care with information systems that really help care and cost.

10 of 10 people found the following review helpful:

5.0 out of 5 stars A treasure trove of insight, August 20, 1999

By A Customer

This review is from: Bad Medicine: How the American Medical Establishment is Ruining Our Healthcare System (Hardcover)

As a former federal health policy analyst I can't help but say "right on" to Lawrence O'Brien's thoughtful analysis of the problems endemic in the U.S. health care system and his carefully laid out steps for reform.

Certainly, the medical economic system and its incentives are awry, with demand set by the seller and the true price hidden from the consumer. But O'Brien also succinctly shows that the product is flawed explaining how and why the U.S. falls so far behind many other countries in indications of health and well being.

The litany of problems, linked to their roots, is a treasure trove of insight. Among them: How medical records are stored and handled contributes to the dearth of clinical science and evaluation. How medical schools create and then reinforce system problems. The effect on both medical outcome and economics of too many doctors practicing the wrong spcialties. How federal interventions have exacerbated problems.

Perhaps most instructive is O'Briens clear description and examples in everyday medicine of the important distinction between advances in true medical science, which discovers the causes and preventions of illness and disease, and advances in medical technology, which develops interventions designed to lessen the impact of disease for which no cure has yet been found. This is reflected not only in the banks of blinking and beeping machines in today's hospitals, but in the increasing specialization of physicians where technical skills are rewarded highly and payment for services aimed at preventing disease is almost non-existent.

O'Brien outlines steps needed for significant health care reform, adknowledging that the full-scale upheaval needed will be difficult to achieve. Nevertheless, he serves up an insightful and cogent framework for reform and, perhaps most importantly, prompts consumers to view the system in a different light. And that is perhaps the hardest task of all, convincing the patient that changes need to be made.

10 of 10 people found the following review helpful:

5.0 out of 5 stars The right answer to the right question, August 17, 1999

By A Customer

This review is from: Bad Medicine: How the American Medical Establishment is Ruining Our Healthcare System (Hardcover)

Finally, someone who's asking the right question.

Washington policymakers and the media ask the wrong questions about health care. How do we provide access? Control expenses? Pay the bills?

O'Brien asks: What are we buying? His answer is: "not much."

O'Brien is not a brainless firebrand. He drags us through the history of Western thought to make sure we understand the underpinnings of medical thinking. He wades through studies and statistics. Footnotes are everywhere.

In the end, he makes a levelheaded case: Medicine may not be good for you. His material about nosocomial infections--diseases you pick up in the hospital--was particularly frightening.

Pundits and policymakers are so busy yakking that they won't read this book. So you should.

Maybe you can convince them to stop trying to find the right answer to the wrong question.

And, you can be very careful when you go see the doctor.....