Culture and Politics of Health Care Work
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Out of Practice
Fighting for Primary Care Medicine in America
by Frederick M. Barken
Part 3 of the Culture and Politics of Health Care Work series
Primary care medicine, as we know and remember it, is in crisis. While policymakers, government administrators, and the health insurance industry pay lip service to the personal relationship between physician and patient, dissatisfaction and disaffection run rampant among primary care doctors, and medical students steer clear in order to pursue more lucrative specialties. Patients feel helpless, well aware that they are losing a valued close connection as health care steadily becomes more transactional than relational. The thin-margin efficiency, rapid pace, and high volume demanded by the new health care economics do not work for primary care, an inherently slower, more personal, and uniquely tailored service. In Out of Practice, Dr. Frederick Barken juxtaposes his personal experience with the latest research on the transformations in the medical field. He offers a cool critique of the "market model of medicine" while vividly illustrating how the seemingly inexorable trend toward specialization in the last few decades has shifted emphasis away from what was once the foundation of medical practice. Dr. Barken addresses the complexities of modern practice-overuse of diagnostic studies, fragmentation of care, increasing reliance on an array of prescription drugs, and the practice of defensive medicine. He shows how changes in medicine, the family, and society have left physicians to deal with a wide range of geriatric issues, from limited mobility to dementia, that are not addressed by health care policy and are not entirely amenable to a physician's prescription. Indeed, Dr. Barken contends, the very survival of primary care is in jeopardy at a time when its practitioners are needed more than ever. Illustrated with case studies gleaned from more than twenty years in private practice and data from a wide range of sources, Out of Practice is more than a jeremiad about a broken system. Throughout, Dr. Barken offers cogent suggestions for policymakers and practitioners alike, making clear that as valuable as the latest drug or medical device may be, a successful health care system depends just as much on the doctor-patient relationship embodied by primary care medicine.
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Robots Won't Save Japan
An Ethnography of Eldercare Automation
by James Adrian Wright
Part of the Culture and Politics of Health Care Work series
“Robots Won't Save Japan” addresses the Japanese government's efforts to develop care robots in response to the challenges of an aging population, rising demand for eldercare, and a critical shortage of care workers. Drawing on ethnographic research at key sites of Japanese robot development and implementation, James Wright reveals how such devices are likely to transform the practices, organization, meanings, and ethics of caregiving if implemented at scale.
This new form of techno-welfare state that Japan is prototyping involves a reconfiguration of care that deskills and devalues care work and reduces opportunities for human social interaction and relationship building. Moreover, contrary to expectations that care robots will save labor and reduce health care expenditures, robots cost more money and require additional human labor to tend to the machines. As Wright shows, robots alone will not rescue Japan from its care crisis. The attempts to implement robot care instead point to the importance of looking beyond such techno-fixes to consider how to support rather than undermine the human times, spaces, and relationships necessary for sustainably cultivating good care.
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Wounds of War
How the VA Delivers Health, Healing, and Hope to the Nation's Veterans
by Suzanne Gordon
Part of the Culture and Politics of Health Care Work series
U.S. military conflicts abroad have left nine million Americans dependent on the Veterans Health Administration (VHA) for medical care. Their "wounds of war" are treated by the largest hospital system in the country-one that has come under fire from critics in the White House, on Capitol Hill, and in the nation's media. The resulting public debate about the future of veterans' health care has pitted VHA patients and their care-givers against politicians and policy-makers who believe that former military personnel would be better served by private health care providers.
This high stakes controversy led Suzanne Gordon, award-winning health care journalist and author, to seek insight from veterans and their families, VHA staff and administrators, advocates for veterans, and proponents of privatization. Gordon spent five years closely observing the VHA's treatment of patients suffering from service related injuries, physical and mental.
In Wounds of War, Gordon describes how the VHA-tasked with a challenging patient population- does a better job than private sector institutions offering primary and geriatric care, mental health and home care services, and support for patients nearing the end of life. The VHA, Gordon argues, is an integrated health care system worthy of wider emulation, rather than piece-meal dismantling for the benefit of private contractors. In the unusual culture of solidarity between patients and providers that the VHA has fostered, the author finds a working model for higher quality health care and a much-needed alternative to the practice of for-profit medicine.
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Healing Together
The Labor-Management Partnership at Kaiser Permanente
by Thomas A. Kochan
Part of the Culture and Politics of Health Care Work series
Kaiser Permanente is the largest managed care organization in the country. It also happens to have the largest and most complex labor-management partnership ever created in the United States. This book tells the story of that partnership-how it started, how it grew, who made it happen, and the lessons to be learned from its successes and complications. With twenty-seven unions and an organization as complex as 8.6-million-member Kaiser Permanente, establishing the partnership was not a simple task and maintaining it has proven to be extraordinarily challenging.
Thomas A. Kochan, Adrienne E. Eaton, Robert B. McKersie, and Paul S. Adler are among a team of researchers who have been tracking the evolution of the partnership between Kaiser Permanente and the Coalition of Kaiser Permanente Unions ever since 2001. They review the history of health care labor relations and present a profile of Kaiser Permanente as it has developed over the years. They then delve into the partnership, discussing its achievements and struggles, including the negotiation of the most innovative collective bargaining agreements in the history of American labor relations. They conclude with an assessment of the Kaiser partnership's effect on the larger health care system and its implications for labor-management relations in other industries.
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Life Support
Three Nurses on the Front Lines
by Suzanne Gordon
Part of the Culture and Politics of Health Care Work series
In this book, Suzanne Gordon describes the everyday work of three RNs in Boston-a nurse practitioner, an oncology nurse, and a clinical nurse specialist on a medical unit. At a time when nursing is often undervalued and nurses themselves in short supply, Life Support provides a vivid, engaging, and intimate portrait of health care's largest profession and the important role it plays in patients' lives. Life Support is essential reading for working nurses, nursing students, and anyone considering a career in nursing as well as for physicians and health policy makers seeking a better understanding of what nurses do and why we need them. For the Cornell edition of this landmark work, Gordon has written a new introduction that describes the current nursing crisis and its impact on bedside nurses like those she profiled in the book.
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The Informed Patient
A Complete Guide to a Hospital Stay
by Karen A. Friedman
Part of the Culture and Politics of Health Care Work series
Even the most capable individuals are challenged when confronted with the complexity of the modern hospital experience. The Informed Patient is a guide and a workbook, divided into topical, focused sections with step-by-step instructions, insights, and tips to illustrate what patients and their families can expect during a hospital stay. Anyone who will experience a hospital stay-or friends or family who may be in charge of a patient's care-will find all the help and advice they could need in the detailed sections that cover every aspect of what they can expect.
Karen A. Friedman, MD, and Sara L. Merwin, MPH, offer hands-on advice about how patients, health care providers, and medical staff can work together to achieve good outcomes. Through anecdotes, tips, sidebars, and clinical scenario vignettes, The Informed Patient presents ways to enhance and optimize a hospital stay, from practical advice on obtaining the best care to dealing with the emotional experience of being in the hospital.
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From Silence to Voice
What Nurses Know and Must Communicate to the Public
by Bernice Buresh
Part of the Culture and Politics of Health Care Work series
To get the resources and respect they need, nurses have long had to be advocates for themselves and their profession, not just for their patients. For a decade, From Silence to Voice has provided nurses with the tools they need to explain the breath and complexity of nursing work. Bernice Buresh and Suzanne Gordon have helped nurses around the world speak up and convey to the public that nursing is more than dedication and caring-it demands specialized knowledge, expertise across a range of medical technologies, and decision-making about life-and-death issues. "Nurses and nursing organizations," they write, "must go out and tell the public what nurses really do so that patients can actually get the benefit of their expert care."
The comprehensively revised and updated third edition of From Silence to Voice will help nurses construct messages using a range of traditional and new social media that accurately describe the true nature of their work. Because nurses are busy, the communication techniques in this book are designed to integrate naturally into nurses' everyday lives and to complement nurses' work with patients and families.
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Watch Your Back!
How the Back Pain Industry Is Costing Us More and Giving Us Less-and What You Can Do to Inform and E
by Richard A. Deyo
Part of the Culture and Politics of Health Care Work series
Over the past twenty years, treatment of back pain has become ever more expensive and intensive. Use of MRI scans, narcotic painkillers, injections, and invasive spine surgery have all grown by several hundred percent. In some areas of medicine, newer treatments have improved quality and duration of life, but as back pain is treated more aggressively, annual surveys of people with back pain report steadily worse impairments. In Watch Your Back!, Richard A. Deyo, MD, proposes an approach to managing back pain, which most adults in the United States experience at some point, that empowers the individual and leads more directly to effective care. Though it may seem counterintuitive, fewer medical interventions may produce better results. Expecting a probe, a pill, or a procedure to cure back pain is usually unrealistic, yet entire industries promote the notion that someone else will "fix" you. Watch Your Back! exposes these flaws in the current approach to back pain, along with the profit motives and conflicts of interest behind many of them. The book dramatizes the problems with stories of prominent individuals who encountered high-tech pitfalls, then found low-tech solutions suited to their lifestyles and the nature of their back pain. Watch Your Back! will be useful not only for people with back pain but also for doctors and policy makers. Our health care system has a growing interest in reducing waste, overuse, and unnecessary care. There's a consensus that health care is too expensive and that we get too little for the money. Back pain exemplifies a problem for which we can simultaneously improve quality of care and reduce costs.
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Achieving Access
Professional Movements and the Politics of Health Universalism
by Joseph Harris
Part of the Culture and Politics of Health Care Work series
At a time when the world's wealthiest nations struggle to make health care and medicine available to everyone, why do resource-constrained countries make costly commitments to universal health coverage and AIDS treatment after transitioning to democracy? Joseph Harris explores the dynamics that made landmark policies possible in Thailand and Brazil but which have led to prolonged struggle and contestation in South Africa. Drawing on firsthand accounts of the people wrestling with these issues, Achieving Access documents efforts to institutionalize universal healthcare and expand access to life-saving medicines in three major industrializing countries. In comparing two separate but related policy areas, Harris finds that democratization empowers elite professionals, such as doctors and lawyers, to advocate for universal health care and treatment for AIDS. Harris's analysis is situated at the intersection of sociology, political science, and public health and will speak to scholars with interests in health policy, comparative politics, social policy, and democracy in the developing world. In light of the growing interest in health insurance generated by implementation of the Affordable Care Act (as well as the coming changes poised to be made to it), Achieving Access will also be useful to policymakers in developing countries and officials working on health policy in the United States.
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The Caring Self
The Work Experiences of Home Care Aides
by Clare L. Stacey
Part of the Culture and Politics of Health Care Work series
According to the Bureau of Labor Statistics, there were approximately 1.7 million home health aides and personal and home care aides in the United States as of 2008. These home care aides are rapidly becoming the backbone of America's system of long-term care, and their numbers continue to grow. Often referred to as frontline care providers or direct care workers, home care aides-disproportionately women of color-bathe, feed, and offer companionship to the elderly and disabled in the context of the home. In The Caring Self, Clare L. Stacey draws on observations of and interviews with aides working in Ohio and California to explore the physical and emotional labor associated with the care of others. Aides experience material hardships-most work for minimum wage, and the services they provide are denigrated as unskilled labor-and find themselves negotiating social norms and affective rules associated with both family and work. This has negative implications for workers who struggle to establish clear limits on their emotional labor in the intimate space of the home. Aides often find themselves giving more, staying longer, even paying out of pocket for patient medications or incidentals; in other words, they feel emotional obligations expected more often of family members than of employees. However, there are also positive outcomes: some aides form meaningful ties to elderly and disabled patients. This sense of connection allows them to establish a sense of dignity and social worth in a socially devalued job. The case of home care allows us to see the ways in which emotional labor can simultaneously have deleterious and empowering consequences for workers.
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Code Green
Money-Driven Hospitals and the Dismantling of Nursing
by Dana Beth Weinberg
Part of the Culture and Politics of Health Care Work series
We are on the verge of the nation's worst nursing shortage in history. Dedicated nurses are leaving hospitals in droves, and there are not enough new recruits to the profession to meet demand. Even hospitals that were once very highly regarded for the quality of their nursing care, such as Boston's Beth Israel Deaconess Medical Center, now struggle to fill vacant positions. What happened? Dana Beth Weinberg argues that hospital restructuring in the 1990s is to blame.
In their attempts to retain profit margins or even just to stay afloat, hospitals adopted a common set of practices to cut costs and increase revenues. Many strategies squeezed greater productivity out of nurses and other hospital workers. Nurses' workloads increased to the point that even the most skilled nurses questioned whether they could provide minimal, safe care to patients. As hospitals hemorrhaged money, it seemed that no one-not hospital administrators, not doctors-felt they could afford to listen to nurses.
Through a careful look at the effects of the restructuring strategies chosen and implemented by Beth Israel Deaconess Medical Center, the author examines management's efforts to balance service and survival. By showing the effects of hospital restructuring on nurses' ability to plan, evaluate, and deliver excellent care, Weinberg provides a stinging indictment of standard industry practices that underestimate the contribution nurses make both to hospitals and to patient care.
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Bedside Manners
Play and Workbook
by Suzanne Gordon
Part of the Culture and Politics of Health Care Work series
In recent years, there has been growing awareness of the need for interprofessional cooperation in healthcare. Countless studies have shown that genuine teamwork and team intelligence are critical to patient safety. Poor communication among health care personnel is a major factor in hospital errors, even more so than the level of staff competence and experience. This is why many schools for health professionals and major health care employers now promote interprofessional education and cooperation. Bedside Manners is a play about workplace relations among physicians, nurses, others who work in health care, and patients-and how their interaction affects the quality of patient care, for better or worse. The accompanying workbook helps educators, managers, patient safety advocates, administrators, and union representatives to analyze and discuss the issues raised in the play. When presented in hospitals, universities, and health care conferences all over the United States, Bedside Manners invariably sparks a vibrant conversation about patient safety problems and how to solve them, job satisfaction and stress, and the importance of information sharing and mutual respect. As text or script, this play is a unique teaching tool for medical and nursing schools, and other health professional schools and continuing education programs involving health care clinicians and staff of all kinds.
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The Question of Competence
Reconsidering Medical Education in the Twenty-First Century
by Various Authors
Part of the Culture and Politics of Health Care Work series
Medical competence is a hot topic surrounded by much controversy about how to define competency, how to teach it, and how to measure it. While some debate the pros and cons of competence-based medical education and others explain how to achieve various competencies, the authors of the seven chapters in The Question of Competence offer something very different. They critique the very notion of competence itself and attend to how it has shaped what we pay attention to-and what we ignore-in the education and assessment of medical trainees. Two leading figures in the field of medical education, Brian D. Hodges and Lorelei Lingard, drew together colleagues from the United States, Canada, and the Netherlands to explore competency from different perspectives, in order to spark thoughtful discussion and debate on the subject. The critical analyses included in the book's chapters cover the role of emotion, the implications of teamwork, interprofessional frameworks, the construction of expertise, new directions for assessment, models of self-regulation, and the concept of mindful practice. The authors juxtapose the idea of competence with other highly valued ideas in medical education such as emotion, cognition and teamwork, drawing new insights about their intersections and implications for one another.
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Beyond the Checklist
What Else Health Care Can Learn from Aviation Teamwork and Safety
by Suzanne Gordon
Part of the Culture and Politics of Health Care Work series
The U.S. healthcare system is now spending many millions of dollars to improve "patient safety" and "inter-professional practice." Nevertheless, an estimated 100,000 patients still succumb to preventable medical errors or infections every year. How can health care providers reduce the terrible financial and human toll of medical errors and injuries that harm rather than heal? Beyond the Checklist argues that lives could be saved and patient care enhanced by adapting the relevant lessons of aviation safety and teamwork. In response to a series of human-error caused crashes, the airline industry developed the system of job training and information sharing known as Crew Resource Management (CRM). Under the new industry-wide system of CRM, pilots, flight attendants, and ground crews now communicate and cooperate in ways that have greatly reduced the hazards of commercial air travel.
The coauthors of this book sought out the aviation professionals who made this transformation possible. Beyond the Checklist gives us an inside look at CRM training and shows how airline staff interaction that once suffered from the same dysfunction that too often undermines real teamwork in health care today has dramatically improved. Drawing on the experience of doctors, nurses, medical educators, and administrators, Beyond the Checklist demonstrates how CRM can be adapted, more widely and effectively, to health care delivery. The authors provide case studies of three institutions that have successfully incorporated CRM-like principles into the fabric of their clinical culture by embracing practices that promote common patient safety knowledge and skills.
The coauthors infuse this study with their own diverse experience and collaborative spirit: Patrick Mendenhall is a commercial airline pilot who teaches CRM; Suzanne Gordon is a nationally known health care journalist, training consultant, and speaker on issues related to nursing; and Bonnie Blair O'Connor is an ethnographer and medical educator who has spent more than two decades observing medical training and teamwork from the inside.
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Where Night Is Day
The World of the ICU
by James Kelly
Part of the Culture and Politics of Health Care Work series
Where Night Is Day is a nonfiction narrative grounded in the day-by-day, hour-by-hour rhythms of an ICU in a teaching hospital in the heart of New Mexico. It takes place over a thirteen-week period, the time of the average rotation of residents through the ICU. It begins in September and ends at Christmas. It is the story of patients and families, suddenly faced with critical illness, who find themselves in the ICU. It describes how they navigate through it and find their way. James Kelly is a sensitive witness to the quiet courage and resourcefulness of ordinary people.
Kelly leads the reader into a parallel world: the world of illness. This world, invisible but not hidden, not articulated by but known by the ill, does not readily offer itself to our understanding. In this context, Kelly reflects on the nature of medicine and nursing, on how doctors and nurses see themselves and how they see each other. Drawing on the words of medical historians, doctor-writers, and nursing scholars, Kelly examines the relationship of professional and lay observers to the meaning of illness, empathy, caring, and the silence of suffering. Kelly offers up an intimate portrait of the ICU and its inhabitants.
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Creating the Health Care Team of the Future
The Toronto Model for Interprofessional Education and Practice
by Sioban Nelson
Part of the Culture and Politics of Health Care Work series
One way to significantly improve the delivery of health care is to teach the health professionals who provide care to work together, to communicate with each other across professional boundaries, and to start to think and act like a team that has the patient at its center. The team-based care movement is at the heart of major changes in medical education and will become an element in the new accreditation standards. Through its Centre for Interprofessional Education, the pioneering approach in this area taken by the University of Toronto has attracted international attention. The role of the Centre for IPE, a formal partnership between the University of Toronto and the Toronto Academic Health Sciences Network, is to create a hub for the university and the many teaching hospitals where all core parties can be actively engaged in redesigning this new model of health care. In Creating the Health Care Team of the Future, Sioban Nelson, Maria Tassone, and Brian D. Hodges give a brief background of the Toronto Model and provide a step-by-step guide to developing an IPE program.
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The Changing Face of Medicine
Women Doctors and the Evolution of Health Care in America
by Ann K. Boulis
Part of the Culture and Politics of Health Care Work series
The number of women practicing medicine in the United States has grown steadily since the late 1960s, with women now roughly at parity with men among entering medical students. Why did so many women enter American medicine? How are women faring, professionally and personally, once they become physicians? Are women transforming the way medicine is practiced? To answer these questions, The Changing Face of Medicine draws on a wide array of sources, including interviews with women physicians and surveys of medical students and practitioners. The analysis is set in the twin contexts of a rapidly evolving medical system and profound shifts in gender roles in American society. Throughout the book, Ann K. Boulis and Jerry A. Jacobs critically examine common assumptions about women in medicine. For example, they find that women's entry into medicine has less to do with the decline in status of the profession and more to do with changes in women's roles in contemporary society. Women physicians' families are becoming more and more like those of other working women. Still, disparities in terms of specialty, practice ownership, academic rank, and leadership roles endure, and barriers to opportunity persist. Along the way, Boulis and Jacobs address a host of issues, among them dual-physician marriages, specialty choice, time spent with patients, altruism versus materialism, and how physicians combine work and family. Women's presence in American medicine will continue to grow beyond the 50 percent mark, but the authors question whether this change by itself will make American medicine more caring and more patient centered. The future direction of the profession will depend on whether women doctors will lead the effort to chart a new course for health care delivery in the United States.
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Nursing against the Odds
How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Car
by Suzanne Gordon
Part of the Culture and Politics of Health Care Work series
In the United States and throughout the industrialized world, just as the population of older and sicker patients is about to explode, we have a major shortage of nurses. Why are so many RNs dropping out of health care's largest profession? How will the lack of skilled, experienced caregivers affect patients? These are some of the questions addressed by Suzanne Gordon's definitive account of the world's nursing crisis. In Nursing against the Odds, one of North America's leading health care journalists draws on in-depth interviews, research studies, and extensive firsthand reporting to help readers better understand the myriad causes of and possible solutions to the current crisis. Gordon examines how health care cost cutting and hospital restructuring undermine the working conditions necessary for quality care. She shows how the historically troubled workplace relationships between RNs and physicians become even more dysfunctional in modern hospitals. In Gordon's view, the public image of nurses continues to suffer from negative media stereotyping in medical shows on television and from shoddy press coverage of the important role RNs play in the delivery of health care. Gordon also identifies the class and status divisions within the profession that hinder a much-needed defense of bedside nursing. She explains why some policy panaceas-hiring more temporary workers, importing RNs from less-developed countries-fail to address the forces that drive nurses out of their workplaces. To promote better care, Gordon calls for a broad agenda that includes safer staffing, improved scheduling, and other policy changes that would give nurses a greater voice at work. She explores how doctors and nurses can collaborate more effectively and what medical and nursing education must do to foster such cooperation. Finally, Gordon outlines ways in which RNs can successfully take their case to the public while campaigning for health care system reform that actually funds necessary nursing care.
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Fields of Combat
Understanding PTSD among Veterans of Iraq and Afghanistan
by Erin P. Finley
Part of the Culture and Politics of Health Care Work series
For many of the 1.6 million U.S. service members who have served in Iraq and Afghanistan since 2001, the trip home is only the beginning of a longer journey. Many undergo an awkward period of readjustment to civilian life after long deployments. Some veterans may find themselves drinking too much, unable to sleep or waking from unspeakable dreams, lashing out at friends and loved ones. Over time, some will struggle so profoundly that they eventually are diagnosed with post-traumatic stress Disorder (PTSD).Both heartbreaking and hopeful; Fields of Combat tells the story of how American veterans and their families navigate the return home. Following a group of veterans and their personal stories of war, trauma, and recovery, Erin P. Finley illustrates the devastating impact PTSD can have on veterans and their families. Finley sensitively explores issues of substance abuse, failed relationships, domestic violence, and even suicide and also challenges popular ideas of PTSD as incurable and permanently debilitating. Drawing on rich, often-searing ethnographic material, Finley examines the cultural, political, and historical influences that shape individual experiences of PTSD and how its sufferers are perceived by the military, medical personnel, and society at large. Despite widespread media coverage and public controversy over the military's response to wounded and traumatized service members, debate continues over how best to provide treatment and compensation for service-related disabilities. Meanwhile, new and highly effective treatments are revolutionizing how the Department of Veterans Affairs (VA) provides trauma care, redefining the way PTSD itself is understood in the process. Carefully and compassionately untangling each of these conflicts, Fields of Combat reveals the very real implications they have for veterans living with PTSD and offers recommendations to improve how we care for this vulnerable but resilient population.
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Collaborative Caring
Stories and Reflections on Teamwork in Health Care
by Various Authors
Part of the Culture and Politics of Health Care Work series
Teamwork is essential to improving the quality of patient care and reducing medical errors and injuries. But how does teamwork really function? And what are the barriers that sometimes prevent smart, well-intentioned people from building and sustaining effective teams? Collaborative Caring takes an unusual approach to the topic of teamwork. Editors Suzanne Gordon, David L. Feldman, MD, and Michael Leonard, MD, have gathered fifty engaging first-person narratives provided by people from various health care professions. Each story vividly portrays a different dimension of teamwork, capturing the complexity-and sometimes messiness-of moving from theory to practice when it comes to creating genuine teams in health care. The stories help us understand what it means to be a team leader and an assertive team member. They vividly depict how patients are left out of or included on the team and what it means to bring teamwork training into a particular workplace. Exploring issues like psychological safety, patient advocacy, barriers to teamwork, and the kinds of institutional and organizational efforts that remove such barriers, the health care professionals who speak in this book ultimately have one consistent message: teamwork makes patient care safer and health care careers more satisfying. These stories are an invaluable tool for those moving toward genuine interprofessional and intraprofessional teamwork.
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First, Do Less Harm
Confronting the Inconvenient Problems of Patient Safety
by Various Authors
Part of the Culture and Politics of Health Care Work series
Each year, hospital-acquired infections, prescribing and treatment errors, lost documents and test reports, communication failures, and other problems have caused thousands of deaths in the United States, added millions of days to patients' hospital stays, and cost Americans tens of billions of dollars. Despite (and sometimes because of) new medical information technology and numerous well-intentioned initiatives to address these problems, threats to patient safety remain and in some areas are on the rise. In First, Do Less Harm, twelve health care professionals and researchers plus two former patients look at patient safety from a variety of perspectives, finding many of the proposed solutions to be inadequate or impractical. Several contributors to this book attribute the failure to confront patient safety concerns to the influence of the "market model" on medicine and emphasize the need for hospital-wide teamwork and greater involvement from frontline workers (from janitors and aides to nurses and physicians) in planning, implementing, and evaluating effective safety initiatives. Several chapters in First, Do Less Harm focus on the critical role of interprofessional and occupational practice in patient safety. Rather than focusing on the usual suspects-physicians, safety champions, or high level management-these chapters expand the list of "stakeholders" and patient safety advocates to include nurses, patient care assistants, and other staff, as well as the health care unions that may represent them. First, Do Less Harm also highlights workplace issues that negatively affect safety: including sleeplessness, excessive workloads, outsourcing of hospital cleaning, and lack of teamwork between physicians and other health care staff. In two chapters, experts explain why the promise of health care information technology to fix safety problems remains unrealized, with examples that are at once humorous and frightening. A book that will be required reading for physicians, nurses, hospital administrators, public health officers, quality and risk managers, healthcare educators, economists, and policymakers, First, Do Less Harm concludes with a list of twenty-seven paradoxes and challenges facing everyone interested in making care safe for both patients and those who care for them.
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When Chicken Soup Isn't Enough
Stories of Nurses Standing Up for Themselves, Their Patients, and Their Profession
by Suzanne Gordon
Part of the Culture and Politics of Health Care Work series
The reassuring bromides of "chicken soup for the soul" provide little solace for nurses-and the people they serve-in real-life hospitals, nursing homes, schools of nursing, and other settings. In the minefield of modern health care, there are myriad obstacles to quality patient care-including work overload, inadequate funds for nursing education and research, and poor communication between and within the professions, to name only a few. The seventy RNs whose stories are collected here by the award-winning journalist Suzanne Gordon know that effective advocacy isn't easy. It takes nurses willing to stand up for themselves, their coworkers, their patients, and the public. When Chicken Soup Isn't Enough brings together compelling personal narratives from a wide range of nurses from across the globe. The assembled profiles in professional courage provide new insight into the daily challenges that RNs face in North America and abroad-and how they overcome them with skill, ingenuity, persistence, and individual and collective advocacy at work and in the community. In this collection, we meet RNs working at the bedside, providing home care, managing hospital departments, teaching and doing research, lobbying for quality patient care, and campaigning for health care reform. Their stories are funny, sad, deeply moving, inspiring, and always revealing of the different ways that nurses make their voices heard in the service of their profession. The risks and rewards, joys and sorrows, of nursing have rarely been captured in such vivid first-person accounts. Gordon and the authors of the essays contained in this book have much to say about the strengths and shortcomings of health care today-and the role that nurses play as irreplaceable agents of change.
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My Imaginary Illness
A Journey into Uncertainty and Prejudice in Medical Diagnosis
by Chloe Atkins
Part of the Culture and Politics of Health Care Work series
How Patients Think. At age twenty-one, Chloë Atkins began suffering from a mysterious illness, the symptoms of which rapidly worsened. Paralyzed for months at a time, she frequently required intubation and life support. She eventually became quadriplegic, dependent both on a wheelchair and on health professionals who refused to believe there was anything physically wrong with her. When test after test returned inconclusive results, Atkins's doctors pronounced her symptoms psychosomatic. Atkins was told not only that she was going to die but also that this was her own fault; they concluded she was so emotionally deranged that she was willing her own death. My Imaginary Illness is the compelling story of Atkins's decades-long battle with a disease deemed imaginary, her frustration with a succession of doctors and diagnoses, her immersion in the world of psychotherapy, and her excruciating physical and emotional journey back to wellness. As both a political theorist and patient, Atkins provides a narrative critique of contemporary medicine and its problematic handling of uncertainty and of symptoms that are not easily diagnosed or known. She convincingly illustrates that medicine's belief in evidence-based practice does not mean that individual doctors are capable of objectivity, nor that the presence of biomedical ethics invokes ethical practices in hospitals and clinics. A foreword by Bonnie Blair O'Connor, who teaches medical students how to listen to patients, and a clinical commentary by Dr. Brian David Hodges, a professor of psychiatry, enrich the book's narrative with practical guidance for medical practitioners and patients alike.
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Doctors at War
Life and Death in a Field Hospital
by Mark Rond
Part of the Culture and Politics of Health Care Work series
Doctors at War is a candid account of a trauma surgical team based, for a tour of duty, at a field hospital in Helmand, Afghanistan. Mark de Rond tells of the highs and lows of surgical life in hard-hitting detail, bringing to life a morally ambiguous world in which good people face impossible choices and in which routines designed to normalize experience have the unintended effect of highlighting war's absurdity. With stories that are at once comical and tragic, de Rond captures the surreal experience of being a doctor at war. He lifts the cover on a world rarely ever seen, let alone written about, and provides a poignant counterpoint to the archetypical, adrenaline-packed, macho tale of what it is like to go to war. Here the crude and visceral coexist with the tender and affectionate. The author tells of well-meaning soldiers at hospital reception, there to deliver a pair of legs in the belief that these can be reattached to their comrade, now in mid-surgery; of midsummer Christmas parties and pancake breakfasts and late-night sauna sessions; of interpersonal rivalries and banter; of caring too little or too much; of tenderness and compassion fatigue; of hell and redemption; of heroism and of playing God. While many good firsthand accounts of war by frontline soldiers exist, this is one of the first books ever to bring to life the experience of the surgical teams tasked with mending what war destroys.
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The Big Squeeze
A Social and Political History of the Controversial Mammogram
by Handel E. Reynolds
Part of the Culture and Politics of Health Care Work series
In 2009, an influential panel of medical experts ignited a controversy when they recommended that most women should not begin routine mammograms to screen for breast cancer until the age of fifty, reversing guidelines they had issued just seven years before when they recommended forty as the optimal age to start getting mammograms. While some praised the new recommendation as sensible given the smaller benefit women under fifty derive from mammography, many women's groups, health care advocates, and individual women saw the guidelines as privileging financial considerations over women's health and a setback to decades-long efforts to reduce the mortality rate of breast cancer. In The Big Squeeze, Dr. Handel Reynolds, a practicing radiologist, notes that this episode was only the most recent controversy in the turbulent history of mammography since its introduction in the early 1970s. In a book written for the millions of women who face the decision about whether to get a mammogram, health professionals interested in cancer screening, and public health policymakers, Reynolds shows how pivotal decisions made during mammography's initial launch made it all but inevitable that the test would be contentious. He describes how, at several key points in its history, the emphasis on mammography screening as a fundamental aspect of women's preventive health care coincided with social and political developments, from the women's movement in the early 1970s to breast cancer activism in the 1980s and '90s. At the same time, aggressive promotion of mammography made the screening tool the cornerstone of a huge new industry. Taking a balanced approach to this much-disputed issue, Reynolds addresses both the benefits and risks of mammography, charting debates, for example, that have weighed the early detection of aggressively malignant tumors against unnecessary treatments resulting from the identification of slow-growing and non-life-threatening cancers. The Big Squeeze, ultimately, helps to evaluate the ongoing public health controversies surrounding mammography and provides a clear understanding of how mammography achieved its current primacy in cancer screening.
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Differential Diagnoses
A Comparative History of Health Care Problems and Solutions in the United States and France
by Paul V. Dutton
Part of the Culture and Politics of Health Care Work series
Although the United States spends 16 percent of its gross domestic product on health care, more than 46 million people have no insurance coverage, while one in four Americans report difficulty paying for medical care. Indeed, the U.S. health care system, despite being the most expensive health care system in the world, ranked thirty-seventh in a comprehensive World Health Organization report. With health care spending only expected to increase, Americans are again debating new ideas for expanding coverage and cutting costs. According to the historian Paul V. Dutton, Americans should look to France, whose health care system captured the World Health Organization's number-one spot.
In Differential Diagnoses, Dutton debunks a common misconception among Americans that European health care systems are essentially similar to each other and vastly different from U.S. health care. In fact, the Americans and the French both distrust "socialized medicine." Both peoples cherish patient choice, independent physicians, medical practice freedoms, and private insurers in a qualitatively different way than the Canadians, the British, and many others.
The United States and France have struggled with the same ideals of liberty and equality, but one country followed a path that led to universal health insurance; the other embraced private insurers and has only guaranteed coverage for the elderly and the very poor. How has France reconciled the competing ideals of individual liberty and social equality to assure universal coverage while protecting patient and practitioner freedoms? What can Americans learn from the French experience, and what can the French learn from the U.S. example? Differential Diagnoses answers these questions by comparing how employers, labor unions, insurers, political groups, the state, and medical professionals have shaped their nations' health care systems from the early years of the twentieth century to the present day.
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Helping Soldiers Heal
How the US Army Created a Learning Mental Health Care System
by Jayakanth Srinivasan
Part of the Culture and Politics of Health Care Work series
Helping Soldiers Heal tells the story of the US Army's transformation from a disparate collection of poorly standardized, largely disconnected clinics into one of the nation's leading mental health care systems. It is a step-by-step guidebook for military and civilian health care systems alike. Jayakanth Srinivasan and Christopher Ivany provide a unique insider-outsider perspective as key participants in the process, sharing how they confronted the challenges firsthand and helped craft and guide the unfolding change.
The Army's system was being overwhelmed with mental health problems among soldiers and their family members, impeding combat readiness. The key to the transformation was to apply the tenets of "learning" health care systems. Building a learning health care system is hard, building a learning mental health care system is even harder. As Helping Soldiers Heal recounts, the Army overcame the barriers to success, and its experience is full of lessons for any health care system seeking to transform.
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We Walk
Life with Severe Autism
by Amy S. F. Lutz
Part of the Culture and Politics of Health Care Work series
In this collection of beautiful and raw essays, Amy S. F. Lutz writes openly about her experience―the positive and the negative―as the mother of a son with severe autism. Lutz's human emotion drives through each page and challenges commonly held ideas that define autism either as a disease or as neurodiversity. We Walk is inspired by questions raised by Lutz as a parent of a severely autistic, now twenty-one-year-old son: What is the place of the intellectually and developmentally disabled in society? What responsibilities do we, as citizens and human beings, owe one another? Who should decide for those who can't decide for themselves? What is the meaning of religion to someone with no abstract language? In exploring these questions, We Walk directly, but humanly examines social issues such as inclusion, religion, therapeutics, and friendship through the lens of severe autism.
In a world where the public perception of autism is largely shaped by the "quirky geniuses" featured on television shows like The Big Bang Theory and The Good Doctor, We Walk demands that we center our debates about this disorder on those who are most impacted by it.
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Taking Care of Our Own
When Family Caregivers Do Medical Work
by Sherry N. Mong
Part of the Culture and Politics of Health Care Work series
Mixing personal history, interviewee voices, and academic theory from the fields of care work, the sociology of work, medical sociology, and nursing, Taking Care of Our Own introduces us to the hidden world of family caregivers. Using a multidimensional approach, Sherry N. Mong seeks to understand and analyze the types of skilled work that family caregivers do, the processes through which they learn and negotiate new skills, and the meanings that both caregivers and nurses attach to their care work.
Taking Care of Our Own is based on sixty-two in-depth interviews with family caregivers, home and community health care nurses, and other expert observers to provide a lens through which in-home care processes are analyzed, while also exploring how caregivers learn necessary procedures. Further, Mong examines the emotional labor of caregiving, as well as the identities of caregivers and nurses who are key players in the labor process, and gives attention to the ways in which the labor is transferred from medical professionals to family caregivers.
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Cleaning Up
How Hospital Outsourcing Is Hurting Workers and Endangering Patients
by Dan Zuberi
Part of the Culture and Politics of Health Care Work series
To cut costs and maximize profits, hospitals in the United States and many other countries are outsourcing such tasks as cleaning and food preparation to private contractors. In Cleaning Up, the first book to examine this transformation in the healthcare industry, Dan Zuberi looks at the consequences of outsourcing from two perspectives: its impact on patient safety and its role in increasing socioeconomic inequality. Drawing on years of field research in Vancouver, Canada as well as data from hospitals in the U.S. and Europe, he argues that outsourcing has been disastrous for the cleanliness of hospitals-leading to an increased risk of hospital-acquired infections, a leading cause of severe illness and death-as well as for the effective delivery of other hospital services and the workers themselves. Zuberi's interviews with the low-wage workers who keep hospitals running uncover claims of exposure to near-constant risk of injury and illness. Many report serious concerns about the quality of the work due to understaffing, high turnover, poor training and experience, inadequate cleaning supplies, and on-the-job injuries. Zuberi also presents policy recommendations for improving patient safety by reducing the risk of hospital-acquired infection and ameliorating the work conditions and quality of life of hospital support workers. He makes the case that hospital outsourcing exemplifies the trend towards "low-road" service-sector jobs that threatens to undermine society's social health, as well as the physical health and well-being of patients in health care settings globally.
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Home Care Fault Lines
Understanding Tensions and Creating Alliances
by Cynthia J. Cranford
Part of the Culture and Politics of Health Care Work series
In this revealing look at home care, Cynthia J. Cranford illustrates how elderly and disabled people and the immigrant women workers who assist them in daily activities develop meaningful relationships even when their different ages, abilities, races, nationalities, and socio-economic backgrounds generate tension in the intimate encounter that is home help. As Cranford shows, workers experience devaluation within racialized and gendered class hierarchies, which shapes their pursuit of security.
Home Care Fault Lines analyzes the tensions, alliances, and compromises between security for workers and flexibility for elderly and disabled people, and Cranford argues that workers and recipients negotiate flexibility and security within intersecting inequalities in varying ways depending on multiple interacting dynamics.
What comes through from Cranford's analysis is the need for a new unionism that builds deeply democratic alliances across multiple axes of inequality. She argues for an intimate community unionism that advocates for universal state funding, designs worker-recipient run, culturally sensitive labor market intermediaries to help people find workers and jobs, and addresses everyday tensions in the home-workplaces in order to support both flexible care and secure work.
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More Than Medicine
Nurse Practitioners and the Problems They Solve for Patients, Health Care Organizations, and the Sta
by LaTonya J. Trotter
Part of the Culture and Politics of Health Care Work series
In More Than Medicine, LaTonya J. Trotter chronicles the everyday work of a group of nurse practitioners (NPs) working on the front lines of the American health care crisis as they cared for four hundred African-American older adults living with poor health and limited means. Trotter describes how these NPs practiced an inclusive form of care work that addressed medical, social, and organizational problems that often accompany poverty. In solving this expanded terrain of problems from inside the clinic, these NPs were not only solving a broader set of concerns for their patients; they became a professional solution for managing "difficult people" for both their employer and the state. Through More Than Medicine, we discover that the problems found in the NP's exam room are as much a product of our nation's disinvestment in social problems as of physician scarcity or rising costs.
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Beyond Medicine
Why European Social Democracies Enjoy Better Health Outcomes Than the United States
by Paul V. Dutton
Part of the Culture and Politics of Health Care Work series
In Beyond Medicine, Paul V. Dutton provides a penetrating historical analysis of why countless studies show that Americans are far less healthy than their European counterparts.
Dutton argues that Europeans are healthier than Americans because beginning in the late nineteenth century European nations began construction of health systems that focused not only on medical care but the broad social determinants of health: where and how we live, work, play, and age. European leaders also created social safety nets that became integral to national economic policy. In contrast, US leaders often viewed investments to improve the social determinants of health and safety-net programs as a competing priority to economic growth.
Beyond Medicine compares the US to three European social democracies-France, Germany, and Sweden-in order to explain how, in differing ways, each protects the health of infants and children, working-age adults, and the elderly. Unlike most comparative health system analyses, Dutton draws on history to find answers to our most nettlesome health policy questions.
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Health Insurance Politics in Japan
Policy Development, Government, and the Japan Medical Association
by Takakazu Yamagishi
Part of the Culture and Politics of Health Care Work series
Japan is the fastest aging country, with the largest super-aged society in the world and growing larger by the day, yet its universal health care costs are relatively low. In Health Insurance Politics in Japan, Takakazu Yamagishi draws back the curtain for an international audience and investigates how Japan has been able to control health care costs through health insurance politics.
Covering the period from the Meiji Restoration to the Abe Administration, Yamagishi uses a historical institutionalist approach to examine the driving force behind the development of health insurance policies in Japan. Yamagishi pays special attention to the roles of government and medical professionals, the main actors of the policymaking and medical worlds, in this development. Health Insurance Politics in Japan pushes Japan into the spotlight of the international conversation about health care reform.
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The Caring Class
Home Health Aides in Crisis
by Richard Schweid
Part of the Culture and Politics of Health Care Work series
The number of elderly and disabled Americans in need of home health care is increasing annually, even as the pool of people-almost always women-willing to do this job gets smaller and smaller. The Caring Class takes readers inside the reality of home health care by following the lives of women training and working as home health aides in the South Bronx.
Richard Schweid examines home health care in detail, focusing on the women who tend to our elderly and disabled loved ones and how we fail to value their work. They are paid minimum wage so that we might be absent, getting on with our own lives. The book calls for a rethinking of home health care and explains why changes are urgent: the current system offers neither a good way to live nor a good way to die. By improving the job of home health aide, Schweid shows, we can reduce income inequality and create a pool of qualified, competent home health care providers who would contribute to the well-being of us all.
The Caring Class also serves as a guide into the world of our home health care system. Nearly 50 million US families look after an elderly or disabled loved one. This book explains the issues and choices they face. Schweid explores the narratives, histories, and people behind home health care in the United States, examining how we might improve the lives of both those who receive care and those who provide it.
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Anti/Vax
Reframing the Vaccination Controversy
by Bernice L. Hausman
Part of the Culture and Politics of Health Care Work series
Antivaxxers are crazy. That is the perception we all gain from the media, the internet, celebrities, and beyond, writes Bernice Hausman in Anti/Vax, but we need to open our eyes and ears so that we can all have a better conversation about vaccine skepticism and its implications.
Hausman argues that the heated debate about vaccinations and whether to get them or not is most often fueled by accusations and vilifications rather than careful attention to the real concerns of many Americans. She wants to set the record straight about vaccine skepticism and show how the issues and ideas that motivate it-like suspicion of pharmaceutical companies or the belief that some illness is necessary to good health-are commonplace in our society.
Through Anti/Vax, Hausman wants to engage public health officials, the media, and each of us in a public dialogue about the relation of individual bodily autonomy to the state's responsibility to safeguard citizens' health. We need to know more about the position of each side in this important stand-off so that public decisions are made through understanding rather than stereotyped perceptions of scientifically illiterate antivaxxers or faceless bureaucrats. Hausman reveals that vaccine skepticism is, in part, a critique of medicalization and a warning about the dangers of modern medicine rather than a glib and gullible reaction to scaremongering and misunderstanding.
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Kidney to Share
by Martha Gershun
Part of the Culture and Politics of Health Care Work series
In Kidney to Share, Martha Gershun tells the story of her decision to donate a kidney to a stranger. She takes readers through the complex process by which such donors are vetted to ensure that they are physically and psychologically fit to take the risk of a major operation. John D. Lantos, a physician and bioethicist, places Gershun's story in the larger context of the history of kidney transplantation and the ethical controversies that surround living donors. Together, they help readers understand the discoveries that made transplantation relatively safe and effective as well as the legal, ethical, and economic policies that make it feasible.
Gershun and Lantos explore the steps involved in recovering and allocating organs. They analyze the differences that arise depending on whether the organ comes from a living donor or one who has died. They observe the expertise-and the shortcomings-of doctors, nurses, and other professionals and describe the burdens that we place on people who are willing to donate. In this raw and vivid book, Gershun and Lantos ask us to consider just how far society should go in using one person's healthy body parts in order to save another person.
Kidney to Share provides an account of organ donation that is both personal and analytical. The combination of perspectives leads to a profound and compelling exploration of a largely opaque practice. Gershun and Lantos pull back the curtain to offer readers a more transparent view of the fascinating world of organ donation.
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Hoping to Help
The Promises and Pitfalls of Global Health Volunteering
by Judith N. Lasker
Part of the Culture and Politics of Health Care Work series
Overseas volunteering has exploded in numbers and interest in the last couple of decades. Every year, hundreds of thousands of people travel from wealthier to poorer countries to participate in short-term volunteer programs focused on health services. Churches, universities, nonprofit service organizations, profit-making "voluntourism" companies, hospitals, and large corporations all sponsor brief missions. Hoping to Help is the first book to offer a comprehensive assessment of global health volunteering, based on research into how it currently operates, its benefits and drawbacks, and how it might be organized to contribute most effectively. Given the enormous human and economic investment in these activities, it is essential to know more about them and to understand the advantages and disadvantages for host communities. Most people assume that poor communities benefit from the goodwill and skills of the volunteers. Volunteer trips are widely advertised as a means to "give back" and "make a difference." In contrast, some claim that health volunteering is a new form of colonialism, designed to benefit the volunteers more than the host communities. Others focus on unethical practices and potential harm to the presumed "beneficiaries." Judith N. Lasker evaluates these opposing positions and relies on extensive research-interviews with host country staff members, sponsor organization leaders, and volunteers, a national survey of sponsors, and participant observation-to identify best and worst practices. She adds to the debate a focus on the benefits to the sponsoring organizations, benefits that can contribute to practices that are inconsistent with what host country staff identify as most likely to be useful for them and even with what may enhance the experience for volunteers. Hoping to Help illuminates the activities and goals of sponsoring organizations and compares dominant practices to the preferences of host country staff and to nine principles for most effective volunteer trips.
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Deadly River
Cholera and Cover-Up in Post-Earthquake Haiti
by Ralph R. Frerichs
Part of the Culture and Politics of Health Care Work series
In October 2010, nine months after the massive earthquake that devastated Haiti, a second disaster began to unfold-soon to become the world's largest cholera epidemic in modern times. In a country that had never before reported cholera, the epidemic mysteriously and simultaneously appeared in river communities of central Haiti, eventually triggering nearly 800,000 cases and 9,000 deaths. What had caused the first cases of cholera in Haiti in recorded history? Who or what was the deadly agent of origin? Why did it explode in the agricultural-rich delta of the Artibonite River? When answers were few, rumors spread, causing social and political consequences of their own. Wanting insight, the Haitian government and French embassy requested epidemiological assistance from France. A few weeks into the epidemic, physician and infectious disease specialist Renaud Piarroux arrived in Haiti. In Deadly River, Ralph R. Frerichs tells the story of the epidemic, of a French disease detective determined to trace its origins so that he could help contain the spread and possibly eliminate the disease, and the political intrigue that has made that effort so difficult. The story involves political maneuvering by powerful organizations such as the United Nations and its peacekeeping troops in Haiti, as well as by the World Health Organization and the U.S. Centers for Disease Control. Frerichs explores a quest for scientific truth and dissects a scientific disagreement involving world-renowned cholera experts who find themselves embroiled in intellectual and political turmoil in a poverty-stricken country. Frerichs's narrative highlights how the world's wealthy nations, nongovernmental agencies, and international institutions respond when their interests clash with the needs of the world's most vulnerable people. The story poses big social questions and offers insights not only on how to eliminate cholera in Haiti but also how nations, NGOs, and international organizations such as the UN and CDC deal with catastrophic infectious disease epidemics.
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