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Demanding Medical Excellence: Doctors and Accountability in the Information Age 1st Edition

4 out of 5 stars 18 customer reviews
ISBN-13: 978-0226525884
ISBN-10: 0226525880
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Editorial Reviews

Amazon.com Review

Michael L. Millenson's Demanding Medical Excellence is guaranteed to make you feel good about the managed care industry--especially after he gets finished chronicling the medical nightmares of the past. Prior to the days of HMOs, doctors were like the gunslingers of the Wild West, operating under their own rules, with no standards by which to measure the quality of their care and no systems to regulate consistent practices. Millenson, a science writer, shows that--until the mid-'80s, when managed health care became more in demand--medical practices varied wildly from place to place and doctor to doctor. In some areas of Minnesota, for example, cesarean births were as high as 48 percent, while in others, they only comprised 9 percent. Even worse, many doctors are still unaware of the latest discoveries in treating life-threatening conditions. For Millenson, managed care is a way of systematically assuring quality control in the health field, making sure that information about new techniques and treatments are widely disseminated, and that the caliber of care is consistently high. --This text refers to an out of print or unavailable edition of this title.

From Library Journal

A former Chicago Tribune reporter turned healthcare analyst, Millenson has done yeoman's work in amassing and understanding the avalanche of data that lies beneath most of the managed-care headlines, with such medical horror stories as "drive-through deliveries." What he finds is both important and well explained: inconsistency, overlap, and inattention to quality measures in medical treatment cost more and are more dangerous than most cost-cutting measures. Millenson uses examples to show that quality healthcare is in fact cheaper, obviating the need for mindless "savings" that can cost money and lives. To assure such care, he urges that the mountain of available statistical information be made accessible to healthcare providers. Though his book can make for tedious reading (every sentence is a statistic), it elevates the healthcare debate to a new level and deserves a wide readership. Essential for health science and academic collections and worthwhile for general collections with health-conscious readerships.?Mark L. Shelton, Univ. of Massachusetts Medical Ctr., Worcester
Copyright 1997 Reed Business Information, Inc. --This text refers to an out of print or unavailable edition of this title.
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Product Details

  • Paperback: 469 pages
  • Publisher: University of Chicago Press; 1 edition (February 15, 2000)
  • Language: English
  • ISBN-10: 0226525880
  • ISBN-13: 978-0226525884
  • Product Dimensions: 6 x 1 x 9 inches
  • Shipping Weight: 1.5 pounds (View shipping rates and policies)
  • Average Customer Review: 4.0 out of 5 stars  See all reviews (18 customer reviews)
  • Amazon Best Sellers Rank: #1,714,665 in Books (See Top 100 in Books)

Customer Reviews

Top Customer Reviews

Format: Paperback
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.
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Format: Paperback
Experts estimate that over one hundred thousand patients die each year as a result of medical malpractice. Why does this continue to happen in a country as sophisticated as ours, and what can we do to stop it? In "Demanding Medical Excellence", Michael Millenson, a three-time Pulitzer Prize nominee and former reporter for the Chicago Tribune, believes that he has found a few solutions to this overwhelming problem. "The keys to medical excellence," Millenson writes, "are information and accountability."
Millenson, who was thrust into the middle of this country's health care crisis, while researching patient's horror stories, examines our health care system from every angle. He believes that the breakdown in this country's health care system can be traced to two things - the sudden plethora of medical information and technology, and the failure of the health care system to distill this knowledge to its physicians in a way that is understandable and useable. In other words, the knowledge may be there, but is it really helping American patients get well and stay healthy? From his research, the answer is no.
In his book, Millenson makes a strong case for making our health care system as quality-minded as other previously antiquated industries. He tests his theories by examining health care systems that have redesigned themselves into well-oiled machines that would make Deming proud. For example, Salt Lake City's LDS Hospital. LDS has designed a technologically-advanced computer system, that gives physicians the data they need to treat a patient right at the bedside, enhancing the physician's knowledge, with data culled from the treatment of thousands of patients with the same illness.
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Format: Hardcover
"Demanding Medical Excellence" is a thoughtful, well-researched, credible illumination of both the stumbling blocks to providing efficient, quality health care and the opportunities afforded by new information technologies. I am an experienced health care professional and am very involved in efforts to influence health policy and health services delivery. "Demanding Medical Excellence" added depth to my understanding of the issues of accountability in medicine and information as a currency of power. I highly recommend this book to anyone interested in understanding the facts and implications of current efforts to change the way health care is delivered. It is engaging, informed and important.
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By A Customer on September 7, 2003
Format: Paperback
A fairly thought provoking book, but does leave a little to be desired. Millenson uses individual cases to thoughtfully express the challenges of healthcare which makes for fairly interesting reading. His biases are fairly open with a range of emotion from enthusiasm to anger of the complexities of healthcare. This is not your cup of tea if you're averse to journalistic hyperbole.
While technologic successes have left many in the public optimistic about medical care in the U.S. and serious public health lapses would make one conclude otherwise, healthcare has evolved into a combination of a success and mess. Unfortunately there are few easy answers.
One caveat: there are some errors in this book: On page 90 he notes, "In 1897, the Austrian physician Ignaz Semmelweis realized..." and on page 156 he states, "...postoperative damage to the kidneys, a condition widely known as massive hepatic necrosis."
I'm no genius, but Semmelweis of handwashing fame made his case 50 years earlier. Also, hepatic necrosis would be the liver, not the kidneys. Fortunately, Millenson is only a reporter and not a doctor who he repeatedly lambastes. At least no was injured by his errors. Makes you wonder if there aren't many other mistakes, though.
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