Guarded Prognosis

Publishers Weekly - Publisher's Weekly

With 35 years' experience as a physician, Lockshin remembers the days before Medicare, Medicaid and HMOs. Working particularly with lupus patients, he has accrued vast knowledge of chronic illness, insurance and hospital administration. Here, in the voice of a caring doctor whose primary concern is always the welfare of his patients, Lockshin provides moving human case histories that illustrate current issues and dilemmas in American medicine. His prognosis is bleak, as he details how the personal welfare of individuals and their families is often ignored by a system obsessed with numbers and, ultimately, "comfortable profits." Lockshin finds that, in particular, the elderly, the poor and those with chronic illnesses are not well served by the number-crunching approach of insurance companies and hospital administrations. He observes that limiting the number and kinds of tests and procedures, the length of hospital stays and access to specialists keeps costs down in the short term, but drastically reduces the quality of care and often ends up costing more later. In this enlightening and frightening book, Lockshin carefully considers all sides to his arguments and, finally, offers hope that beneficial compromise is still possible. (Sept.)

Booknews

Descrying the survival of the fittest mentality of Health Maintenance Organizations (HMOs), this New York specialist in rheumatic diseases (e.g. rheumatoid arthritis and lupus) and onetime director of National Institute of Health programs makes a cogent plea using case histories and analysis for ensuring a health care safety net and healthy doctor-patient partnership for all<--> including the elderly and those with costly chronic conditions. Annotation c. by Book News, Inc., Portland, Or.

Kirkus Reviews

Using his patients' personal stories to illustrate dramatically how medical care once worked and how it works today, a concerned and caring physician makes clear just why he fears the current system has a very poor prognosis. Director of the Center for Women and Rheumatic Disease at the Hospital for Special Surgery in New York, Lockshin specializes in lupus, a chronic disease that affects every organ in the body and brings its patients into contact with all segments of the medical-care system. Drawing on some 35 years of medical experience, he writes knowingly and sympathetically of patients who need long-term, expensive care, whose problems may require speedy treatment by specialists. In doing so, he questions how well such individuals would fare in a system where primary-care doctors act not as their patients' advocates but as gatekeepers, deciding who will have access to what kind of care. He acknowledges that cost is at the heart of the medical-care crisis, but points out that this cost comes largely from common, chronic, and crippling diseases. Lockshin outlines what he perceives as the elements of an ideal system and calls for a vigorous public debate over the issues, which, he notes, seem medical but are social and political as well. He argues that decision-making criteria concerning health-care resources and spending must include compassion as well as cost-benefit. The questions he raises about cost cutting, rationing of care, doctor-patient privacy, and individual needs and rights are ones that deserve careful consideration. An able spokesman for the poor and chronically ill, those whose voices he believes are seldom heard in the debate over health policy in this country, hehas given us stories to remind us that abstract policies affect individuals who could be us or those we love.