A formulaic, if impassioned, Rx by the executive director of the Association of American Physicians and Surgeons, whose answer to runaway medical costs and uneven care is to put patients, not health care managers, back in the driver's seat. Jane M. Orient is an LMD, a local medical doctor, who practices internal medicine in Tucson, Ariz. Her irreverence towards the establishment is implicit in her definition of an LMD, ``a term of derision used by significant persons such as full professors to refer to doctors in the world outside the academy. The term connotes a bumbler or hick who somehow got an M.D. degree.'' Orient takes money only from patients, not from third- party payers. Because she's chosen to be independent from managed care networks, she is increasingly a ``superfluous woman,'' i.e. her medical opinion doesn't count. Orient compares the state of American medicine to that of an overmedicated patient, one suffering toxic effects from drugs prescribed to regulate conditions that were best left alone. Her answer is decentralization. ``Medicine,'' she argues, ``is based on the doctor-patient relationship founded on the Hippocratic Oath—not on an administrative flowchart. Remember, you can fire your doctor if you like. You can't fire your bureaucrat.'' Orient reviews the pros and cons of the British, Canadian, and German health care systems, as well as the AMA's practice guidelines, and concludes that a free market is the best alternative and the one that does the least harm. In a final chapter called ``Getting It Right,'' she issues her own plan: (1) restore insurance, as opposed to a system of managed care, (2) decrease government regulation, and (3) encourage charity to the poor. A conservative argument against increasing government regulation and bureaucratization of American medicine in the tradition of such free-market thinkers as Milton Friedman.
Pub Date: May 22, 1994
ISBN: 0-517-59011-5
Page Count: 288
Publisher: Crown
Review Posted Online: May 19, 2010
Kirkus Reviews Issue: March 15, 1994
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular...
A neurosurgeon with a passion for literature tragically finds his perfect subject after his diagnosis of terminal lung cancer.
Writing isn’t brain surgery, but it’s rare when someone adept at the latter is also so accomplished at the former. Searching for meaning and purpose in his life, Kalanithi pursued a doctorate in literature and had felt certain that he wouldn’t enter the field of medicine, in which his father and other members of his family excelled. “But I couldn’t let go of the question,” he writes, after realizing that his goals “didn’t quite fit in an English department.” “Where did biology, morality, literature and philosophy intersect?” So he decided to set aside his doctoral dissertation and belatedly prepare for medical school, which “would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” The author’s empathy undoubtedly made him an exceptional doctor, and the precision of his prose—as well as the moral purpose underscoring it—suggests that he could have written a good book on any subject he chose. Part of what makes this book so essential is the fact that it was written under a death sentence following the diagnosis that upended his life, just as he was preparing to end his residency and attract offers at the top of his profession. Kalanithi learned he might have 10 years to live or perhaps five. Should he return to neurosurgery (he could and did), or should he write (he also did)? Should he and his wife have a baby? They did, eight months before he died, which was less than two years after the original diagnosis. “The fact of death is unsettling,” he understates. “Yet there is no other way to live.”
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular clarity.Pub Date: Jan. 19, 2016
ISBN: 978-0-8129-8840-6
Page Count: 248
Publisher: Random House
Review Posted Online: Sept. 29, 2015
Kirkus Reviews Issue: Oct. 15, 2015
PERSPECTIVES
For Howard Zinn, long-time civil rights and anti-war activist, history and ideology have a lot in common. Since he thinks that everything is in someone's interest, the historian—Zinn posits—has to figure out whose interests he or she is defining/defending/reconstructing (hence one of his previous books, The Politics of History). Zinn has no doubts about where he stands in this "people's history": "it is a history disrespectful of governments and respectful of people's movements of resistance." So what we get here, instead of the usual survey of wars, presidents, and institutions, is a survey of the usual rebellions, strikes, and protest movements. Zinn starts out by depicting the arrival of Columbus in North America from the standpoint of the Indians (which amounts to their standpoint as constructed from the observations of the Europeans); and, after easily establishing the cultural disharmony that ensued, he goes on to the importation of slaves into the colonies. Add the laborers and indentured servants that followed, plus women and later immigrants, and you have Zinn's amorphous constituency. To hear Zinn tell it, all anyone did in America at any time was to oppress or be oppressed; and so he obscures as much as his hated mainstream historical foes do—only in Zinn's case there is that absurd presumption that virtually everything that came to pass was the work of ruling-class planning: this amounts to one great indictment for conspiracy. Despite surface similarities, this is not a social history, since we get no sense of the fabric of life. Instead of negating the one-sided histories he detests, Zinn has merely reversed the image; the distortion remains.
Pub Date: Jan. 1, 1979
ISBN: 0061965588
Page Count: 772
Publisher: Harper & Row
Review Posted Online: May 26, 2012
Kirkus Reviews Issue: Jan. 1, 1979
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