Guarded Prognosis: A Doctor and His Patients Talk About Chronic Disease and How to Cope With It   When individual and broad social values clash, who should determine the course of action? An important new voice, Michael Lockshin, M.D., speaks out on health care in America today. A noted physician with broad experience in treating long-term, incurable patients, Lockshin shows exactly how our health-care system could be more efficient, less costly, and more humane.

Kirkus Reviews

Guarded Prognosis: A Doctor and his Patients Talk about Chronic Disease and How to Cope With It  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, he has given us stories to remind us that abstract policies affect individuals who could be us or those we love. — Copyright ©1998, Kirkus Associates, LP. All rights reserved.

Publishers Weekly

 Guarded Prognosis: A Doctor and his Patients Talk about Chronic Disease and How to Cope With It  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. Copyright 1998 Reed Business Information, Inc.

Booklist

Guarded Prognosis: A Doctor and his Patients Talk about Chronic Disease and How to Cope With It  The subtitle tells much more about this book than the title. For doctors do not treat aggregates of patients, they treat individual humans. Lockshin argues that governments, insurance companies, hospitals, and HMOs should listen to individuals rather than the impersonal figures aggregates produce. Many of Lockshin’s patients have lupus, arthritis, or scleroderma. Since those diseases affect different patients in different ways, Lockshin’s emphasis on the individual makes sense; each person’s sense of health priorities, he says, should be carefully considered when choosing a treatment program. Lockshin draws a clearcut distinction between medicine and science: the former deals primarily with individuals, the latter with theories and groups. Since HMOs have come into the picture, many doctors are being forced to think of each potential patient in terms of whether this treating of this person is going to be an occasion of profit or of loss, and he asks, “Are you sure that you know for whom your doctor works?” William Beatty

chapters.indigo.ca

Guarded Prognosis: A Doctor and his Patients Talk about Chronic Disease and How to Cope With It  From Our Editors Like James Herriott, Oliver Sacks and Lewis Thomas, Michael Lockshin teaches us about illness and health by telling stories about medicine. His stories focus not on disease, but the risks of the health care system. He demonstrates the heartbreaking, horrifying and hilarious situations patients and doctors must deal with – the kind not found in insurance company formulas. Not only does Guarded Prognosis honour the ill and those who care for them, it shows exactly how health care could be more efficient, less costly and more humane. From http://www.chapters.indigo.ca/