Flatlined: Resuscitating American Medicine (Hardcover)

~ (Author)
Key Phrases: uninsured trauma care, unreliable emergency services, nerve sac, United States, Sumner Clinic, Los Angeles (more...)

Editorial Reviews

From Publishers Weekly

Starred Review. In this insider's polemic, neurosurgeon and clinical investigator Clifton warns that the U.S. health-care system is dying on the table, the victim of an insurance system using unnecessary, high-tech medical procedures and diagnostic tests to generate more fees, and a pharmaceutical industry pushing two-dollar prescription pills where a 24-cent Aleve would do. Clifton estimates that 30 percent of all delivered health care services (about $700 billion a year) qualify as unnecessary treatment; the results are skyrocketing costs, growing ranks of the uninsured crowding the nation's emergency rooms, and an underserved, often in-the-dark patient class. On the basis of his 30-year career as a neurosurgeon and administrator, with a two-year stint in Sen. Orin Hatch's office, Clifton advocates an independent agency, financed by congress, that would work with doctors and hospital administrators to set standards for treatment and fees, aiming for no less than a "high-performance U.S. healthcare system... providing quality care at lower cost to all its citizens." An eye-opening, sausage-maker's perspective on contemporary medicine, Clifton's thorough text deserves the attention of policy makers, health professionals, and anyone regularly shuffled (or shoved) through the maze of U.S. health care.
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Review

"Dr. Guy Clifton lays out the problems in our health care system with extraordinary clarity and compassion, and he offers workable solutions. This book should be required reading for anybody who thinks health care needs fixing." ----Shannon Brownlee, Schwartz Senior Fellow, New America Foundation, and author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer

"Flatlined does a wonderful job of alerting readers to the causes of our health care crisis, while providing recommendations for reform. The true strength of this book comes from Clifton's presentation from the ground up as a practicing surgeon and physician who successfully blends his own experiences and observations with a serious examination of the existing literature."
David Mechanic, Ph.D., author of The Truth About Health Care

"Flatlined is a remarkable inside look at the embarrassingly flawed American health care delivery system. Dr. Clifton uses rich language to depicts in crisp, accurate detail the challenges and shortfalls of today’s system. He willingly talks about 'the dead elephant in the room'--the issues that are often skirted, ignored, or hidden behind pretty words--as he marches toward a proposed solution for the nation. A must-read for policy makers and health care leaders."
Nancy W. Dickey, president, Texas A&M Health Science Center and former president of the American Medical Association

"Dr. Clifton accurately diagnoses many of the substantive flaws in the American health care system while providing a heart-breaking set of anecdotes that illustrate its tragic consequences. A must-read for those who want remarkable insight into our eroding infrastructure, perverse payment incentives, and fragmented delivery system."
Karen Davis, president, The Commonwealth Fund

"Dr. Clifton tells a disturbing, too-often accurate story about our fragmented health care system and the realities Americans face as they struggle to work with a 1950s approach to providing medical services while living in a twenty-first century world. This disconnect creates serious problems for patients and providers alike. Flatlined offers smart solutions for the future of health care."
Wade Rose, vice president, External and Government Relations, Catholic Healthcare West

"Dr. Guy Clifton lays out the problems in our health care system with extraordinary clarity and compassion, and he offers workable solutions. This book should be required reading for anybody who thinks health care needs fixing."
Shannon Brownlee, Schwartz Senior Fellow, New America Foundation, and author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer

"Guy Clifton [is] a distinguished Texan neurosurgeon who spent a year as a Health Policy Fellow in the US Congress to develop the ideas he presents in this enlightening book, which I think is by far the best of its kind in recent memory. Clifton tells us that physicians need to have a financial incentive for practising efficient medicine. The new administration would do well to read this book, if it is, indeed, committed to intelligent health-care reform."
Noah Raizmann, The Lancet

"Guy Clifton is able to draw readers into his treatise on the health care conundrum. Clifton's solutions offer insight into the complexity of a system in urgent need of change. Clear, concise, well organized, and well researched, the book could be a quick read, but the statistics are so compelling and the issues are so complex that readers will be hard-pressed not to pause."
Journal of the American Medical Association

"In this important book, Dr. Guy Clifton, armed with facts and an extraordinary vision, accomplishes the impossible task of uniting medical and political territorial foes into a 'Save Our Emergency Rooms' action plan. If change is to take place on the national political level it will need someone like Clifton, a balanced voice in the partisan debates on health care reform."
Jerry McIntosh, co-founder of Administaff, Inc. and founder of Partners 5 West

"This well-researched volume offers well-argued suggestions, and is intentionally accessible to the general public who, the author believes, much be enlisted in the campaign for change. Clifton’s model is an interesting middle road between a nationalized and a privatized system. Recommended."
Choice

Dr. Guy Clifton lays out the problems in our health care system with extraordinary clarity and compassion, and he offers workable solutions. This book should be required reading for anybody who thinks health care needs fixing. --Shannon Brownlee, Schwartz Senior Fellow, New America Foundation, and author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer

Dr. Guy Clifton lays out the problems in our health care system with extraordinary clarity and compassion, and he offers workable solutions. This book should be required reading for anybody who thinks health care needs fixing. --Shannon Brownlee, Schwartz Senior Fellow, New America Foundation, and author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer<br /><br /><br /><br />Flatlined does a wonderful job of alerting readers to the causes of our health care crisis, while providing recommendations for reform. The true strength of this book comes from Clifton's presentation from the ground up as a practicing surgeon and physician who successfully blends his own experiences and observations with a serious examination of the existing literature. --David Mechanic, Ph.D., author of The Truth About Health Care

See all Editorial Reviews

Product Details

• Hardcover: 352 pages
• Publisher: Rutgers University Press (January 30, 2009)
• Language: English
• ISBN-10: 0813544289
• ISBN-13: 978-0813544281
• Product Dimensions: 9 x 6.3 x 1.1 inches
• Shipping Weight: 1.6 pounds (View shipping rates and policies)
• Average Customer Review: 5.0 out of 5 stars  See all reviews (9 customer reviews)
• Amazon.com Sales Rank: #60,381 in Books (See Bestsellers in Books)

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Customer Reviews

Most Helpful Customer Reviews

5 of 5 people found the following review helpful:

5.0 out of 5 stars The Healthcare Equivalent of "Kitchen Confidential", February 10, 2009

By	Arthur L. Kellermann "Art Kellermann, MD" (Atlanta, GA USA) - See all my reviews (REAL NAME)

Flatlined: Resuscitating American Medicine is the first book by Guy Clifton, MD. One of the nation's top academic neurosurgeons, Clifton chaired the Department of Neurosurgery at UT Houston for many years. As his preface indicates, he was at the pinnacle of his professional career when he left his practice and home to move to Washington and serve as a staff member in the U.S. Senate, focusing on healthcare issues.

Flatlined is the healthcare equivalent of Kitchen Confidential. Clifton provides a behind-the-scenes look at the many problems with America's healthcare system from the perspective of one of its master chefs. He explains, in plain English, why our healthcare costs so much and why it produces such mediocre results for so many.

In addition to a lot of practical wisdom about the perverse incentives that riddle our current system, his book is full of powerful stories. The following passage, from page 45, is my favorite:

"I did not see many uninsured patients in my clinic, though I cared for many when I was on emergency call. When I did see an uninsured patient in clinic who needed surgery, but was not an emergency case and could not afford it, we developed a set routine. I or my colleague of many years, a physician's assistant, would teach the patients in our clinic to come to the emergency room at an appointed time in the early morning when it was usually quiet. The patient was then instructed to lie to the emergency medicine doctor in a precise way, describing steadily worsening neurological symptoms consistent with the patient's primary problem. On a few occasions, we even taught the patients how to feign weakness when examined. The combination of contrived history and examination would guarantee the patient's emergency admission at the hospital's expense. We would also tell the patient not to eat after midnight the night before so he would be ready for the day of our scheduled emergency admission. I then operated on the patient that same day. I never lost sleep over this deception because I felt I was acting in the patient's best interest. It cannot be credibly argued that the uninsured in America receive acceptable health care, a problem that is inextricably linked to its high cost."

Clifton does more than document problems. He also offers solutions. A political independent, he isn't fond of the standard solutions offered by the left or the right. His practical, problem-solving approach is worth a careful read by any CEO or benefits director who is responsible for managing the healthcare costs of their employees. With millions of newly unemployed losing their coverage, Dr. Clifton's book is timely. Whether you are trying to understand our current system or have an interest in fixing it, Flatlined is a "must read."

Art Kellermann, MD, MPH
Atlanta, Georgia

3 of 3 people found the following review helpful:

5.0 out of 5 stars ACLS for Medical Care, February 10, 2009

By	David B. Cook, MD, MPH (Indianapolis, IN) - See all my reviews

There have been a number of recent books outlining the problems with medical care in the U.S. and proposing solutions. This effort appears to be the best of the lot, particularly for readers who are not health care insiders. One of the major barriers to managing our healthcare difficulties is that the medical "system" is both complicated and complex: there are lots of moving parts and they interact in ways that tend to produce feedback loops as well as responding to outside forces in very non-linear fashions - producing lots of surprises and unintended consequences. Many working and writing in this field, as in the parable of a group of blind men trying to describe an elephant, fail to consider all the parts and relationships. Dr. Clifton has been able to draw from his decades of experience as a practicing physician and clinical program manager to identify all the moving parts and to use those experiences to explain in a very understandable way our healthcare problems and their sources. The final section of the book will be of most interest to those who have lived inside a dysfunctional system long enough to know the problems firsthand. Here, Dr. Clifton draws on his work as a RWJ Foundation Health Policy Fellow and experience as a US Senate staff member to outline a realistic and effective set of potential solutions to the system's ills.

1 of 1 people found the following review helpful:

5.0 out of 5 stars Refreshing, March 30, 2009

By	Stanley Schultz - See all my reviews (REAL NAME)

This well written, engaging book sheds refreshing light on one of the pivitol issues confronting society. The author has spent his career in the "trenches" not in "think tanks", and his fist-hand experience, authenicity, and empathy are expressed with down-to-earth elegance.