Bad-delivery

I am a psychololgist. I read this book very carefully and outlined it, it was that good. It is very practical information on how to deliver difficult news. I found that I deliver more difficult news than I thought. I use the six steps outlined in the book now, and teach residents about the book. This is the best resouce I found for delivering bad news to patients.

This is a unique, delightful, and highly practical book. I recommend it very highly for all physicians and mental health professionals. The authors explain that, despite the American focus on informed consent, some patients who develop life threatening disease do NOT want to know all the details, or even the prognosis, of their condition. A wise and useful six-step protocol for breaking bad news is proffered, incorporating both readiness to fully inform and readiness to respect the patient's psychological vulnerabilities. Since bad news comes in many forms in this life, the skills and attitudes described have wide applicability in the helping professions. A TRULY OUTSTANDING videotape also exists as a companion to this book. I don't know if it is available through Amazon or not. PKC

How to Break Bad News is one of the best books on the subject I've found anywhere. I wrote a book called "Difficult Conversations" which deals with some of the same issues in a broader context, and I am impressed indeed by Buckman's book. I wish healthcare workers everywhere would read it.

As a practicing surgeon, I am always interested in reading about ways of improving the health system. Although the description of the problems in healthcare were defined as a result of a misguided approach being practiced by "free barons of the Medical guild," other factors need to be considered.

Patients in the United States feel entitled to all the innovation and health care resources available without consideration of cost. Once patients realize that they have to take responsibility for their health (to prevent illness) then the need for technologically advanced treatments will diminish. While doctors do have a say in the need for procedures, patients must take ultimate responsibility for their health.

We must also consider that the present legal environment adds to the cost of health care. When malpractice premiums for surgeons are $65,000 - $100,000 per year that will impact how physicians practice medicine. Secondly, when the best and the brightest are seeking admission into medical school presently, does anyone expect that trend to continue if medical school debts can amount to $150,000 and limitations will be placed on the autonomy of physician decision making? HMOs may be the answer, but legal and financial jobs will be filled with the best and the brightest leaving medical jobs for dabblers.

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.

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.

The author concludes that because Red Cross makes a LOT of money on blood and because a terrible thing - AIDS- happened to patients, therefore the Red Cross must have profited from these terrible things. Well, that may be true there are no facts to support the connection. There has been no investigative journalism done here. This approach will appeal to conspiracy theorists, but for a well-researched history and facts you'd be much better off with BLOOD: an epic history by Douglas Starr, ISBN 0688176496

A young man wanted to donate blood to a Palo Alto Blood Bank but they rejected him for having a super low t-cell count. His blood was later accepted by a Red Cross facility and his bad blood caused a recipient to get AIDs.
This book is filled with similar horror stories as well as details about this one. The American Red Cross cut corners every chance possible and then fought like pitt balls to avoid taking any responsibility.
The Ford Pinto and Dalkon Shield two famous product liability cases left a black mark on corporate America but the irresponsibilty of The American Red Cross is a black mark against all of Christianity.
A corporation that specializes in blood and relies on people's donations and uses the cross to engender peoples trust owes more then any car or iud maker.
They owe nothing short of their blood because the Christian cross symbolizes Christ's blood on the cross.
They sinned against God. The American Red Cross has been immortalized as one of the most greedy and ruthless corporations to ever exist!

This book tells the honest truth about blood transfusions that so many people overlook when they critcize someone for not taking one. The Blood industry is a multi-billion dollar industry and yes the Red Cross profitted incredibly! That is why it has wrongly educated doctors that people need blood transfusions. There are so many ways to use the skills physicians have to prevent and treat blood loss instead of blood transfusions but instead it is the easy way out. This book shows how many times blood is given when it is completely unnecessary. It shows the real dangers of blood transfusions and how many many people are suffering because of agreeing to receive blood. It's incredible how many diseases can be acquired through blood transfusions, even today. If anyone thinks that blood transfusions are safe today, they need to think again and read this book!