Very good book, written by a journalist who spent a year with the staff and patients of Maimonides Hospital in Brooklyn. She tells the hospital story through the eyes of several patients, nurses, physicians, different admin jobs and the community. The hospital is really a melting pot for quite a few races and ethnic groups, and being a public hospital, takes everyone, creating quite an interesting, overburdened, underfunded mix ( )

Interesting story of "a year in the life" of Maimonides Hospital in Brooklyn. Although it is a little dated due to the ever-changing picture of healthcare in the U.S., I found it to be a fascinating glimpse into the complexities of running a hospital. I work in a hospital myself (although I do not have direct patient contact) and many of the episodes described in the book ring true. Maimonides, however, is different from my hospital by the sheer volume of patients and variety of cultures that intersect in their facilities. It really is "diversity on steroids," as the title says. A few passages that stood out for me:

New medicine demanded cultural competency, clinical excellence, and psychological awareness, but not at the expense of efficiency, coordination, and speed (none of which conformed to the vagaries of illness, insurance compensation, and the availability of aftercare for the elderly and the infirm).

[Referring to 9/11/01] Not just the twin towers of the World Trade Center had been destroyed. The surprise invasion had shaken the sense of American invincibility that was the underpinning of its arrogance as well as its tolerance. Suddenly the large and growing Muslim population was no longer the latest colorful addition to New York's protean populace, but rather a potential menace.

[Quoting Abraham Joshua Hershel's essay "The Patient as a Person"] "The truth of being human is gratitude, the secret of existence is appreciation, its significance is revealed in reciprocity. Mankind will not die for lack of information; it may perish for lack of appreciation."

"I had to assimilate to this country," he told me. "I had to assimilate to Switzerland. I had to assimilate to France. Wherever I went. This disrespect for our country is what I hate. And this is my country now. We cater to this disrespect. Our health-care system completely embraces this kind of stuff. We can't expect these people to change because we do nothing to change them. When I was in France, they didn't bend in any way. You either learned French or else. Nothing. They can speak English, but they won't. Even if you go to a hospital, they expect you to speak French. Here you get translators. That kind of catering is why people have this attitude they can do anything they want."

"Some things are easy to measure. Death. That's easy to measure. Readmissions. You have an electronic way of counting something and assume it's a proxy for the real thing. But how much happiness are you producing? Who the bleep knows? Think about it. It is very, very hard to measure...Thank the Lord we are designed, however we got here, whether Lord Darwin or the Creator, that most things tend to fix themselves, and it takes a lot to really fuck someone up. Most things do get better."

The hospital, however, was populated by humans, imperfect men and women, existing in an imperfect world. Politicians started out believing in the social contract and then forgot their duty to fight for the people they represented. Drug and insurance executives said that their desire was to improve and protect health care, but their jobs and fortunes depended on profitability, not making medicine available to everyone. Technocrats worshipped faster and more efficient machines that helped prolong health and life, but they neglected empathy, understanding, and the probing that requires genuine conversation and time. Doctors planned to devote their lives to healing and then spent too much time analyzing their bank accounts or nursing bruised egos instead of making sure the system provided for their patients. Patients agreed with all of the above but failed to accept responsibility for the abuses they inflicted on themselves by working too hard, exercising too little, and smoking, drinking, and eating too much...Depending on the day or night, life in the hospital could seem full of exquisite promise or pointless despair.

"The solutions are not national. You can't wait and hope that model will change. The solutions are local. You have to look at your own hospital. What is its mission, what is its community, who does it serve--and scale it for that mission. Get it well managed and you can survive."

I'm going to recommend this book to several other folks at my workplace. I enjoyed it immensely and found it informative. ( )

This book was about the administration of Maimonides Hospital in New York and just about as thrilling as that sounds! It was a long, hard slog but in the same way as hill-walking is pretty hard step by step, but worth it for the view, the interesting things you see along the way and the accomplishment, quite enjoyable.

It was a real eye-opener for me, a hospital which is a business first, the chosen product being health care, coming as I do from the UK where private insurance for health care is an option, not the default standard.

People say that you get what you pay for, that it is worth purchasing health insurance because you will be assured of a better standard of diagnosis, treatment and care. It isn't actually true. A year and a half ago my (late) mother underwent a couple of non-invasive tests in a National Health hospital that wasn't luxurious and made her wait but it was free. She waited a week for the results. She didn't want to believe the results so she went to a very high-ranking, very luxurious private hospital where endless tests were done over a three week period, some of the tests being extremely painful and $20,000 later they came up with exactly the same result as the 'free' hospital. Neither could offer her any treatment.

So this book was, as I said, a real eye-opener to medicine where the money you have does make a difference and where the chief executive earns well over a $1M a year (now), as do quite a few of the medical staff and other administrators approach that figure, and they bemoan the fact that their cancer centre is losing money at the rate of $8M a year because they are failing to attract the type of patient with good insurance.

No sympathy! If they cared that much, hey a small paycut for a dozen or so of them for a year or two would put the cancer centre back on its feet as the community cancer centre for Brooklynites. Community my arse, caring, my arse. Community and caring after pay. The doctors and administrators were efficient and often very empathetic but all of it was subservient to money and hospital politics. Who could jostle for the best position, who could get the most fame, who was recognised by the media as 'sexy' and charismatic and its rewards: the most money. A good career for a young person seeking to become rich, brains and manual dexterity necessary, compassion optional.

So it was interesting. But hell, I do feel for those who are poor and those who aren't quite poor enough for aid but not well-off enough for insurance.

I did learn one very interesting fact, that an emergency department is obliged to treat you no matter what your financial status. Like the Arab who flew all the way from the middle East, got a cab to Maimonides and went to the Emergency department knowing that his heart surgery would then be free. There's always someone, always a way to game the players!

4 May 2011 ( )

Engrossing report of a year at a big city American hospital, focussing on the conflicting pressures and interests within it. An interesting real-life complement to more abstract discussions about America's health care problem(s). ( )

An insiders view of the running of a major hospital in Brooklyn. ( )