The Present Illness

Beyond political posturing and industry quick-fixes, why is the American health care system so difficult to reform? Health care reform efforts are difficult to achieve and have been historically undermined by their narrow scope. In The Present Illness, Martin F. Shapiro, MD, PhD, MPH, weaves together history, sociology, extensive research, and his own experiences as a physician to explore the broad range of afflictions impairing US health care and explains why we won't be able to fix the system without making significant changes across society. With a sharp eye and ready humor, Shapiro dissects the ways all groups participating—clinicians and their organizations, medical schools and their faculty, hospitals and clinical corporations, scientists and the National Institutes of Health, insurers and manufacturers, governments and their policies, and also patients and the public—shape and reinforce a dysfunctional system. Shapiro identifies three major problems stymieing reform: commodification of care; values, expectations, unmet needs, attitudes, and personal limitations of participants; and toxic relationships and communication among these groups. Shapiro lays out a sweeping agenda of concrete actions to address the many factors contributing to the system's failings. Highlighting the interconnectedness of both the problems and potential solutions, he warns that piecemeal reform efforts will continue to be undermined by those who believe they have something to gain from the status quo. Although overhauling our health care system is daunting, Shapiro nonetheless concludes that we must push forward with a far more comprehensive effort in all sectors of health care and throughout society to create a system that is humane, effective, and just.

This “brutal and brave” (Booklist) novel transmutes the practice of medicine into a larger exploration of humanity, the meaning of care, and the nature of annihilation—physical, spiritual, or both. A young woman puts on a white coat for her first day as a student doctor. So begins this powerful debut, which follows our unnamed narrator through cadaver dissection, surgical rotation, difficult births, sudden deaths, and a budding relationship with a seminarian. In the troubled world of the hospital, where the language of blood tests and organ systems so often hides the heart of the matter, she works her way from one bed to another, from a man dying of substance use and tuberculosis, to a child in pain crisis, to a young woman, fading from confusion to aphasia to death. The long hours and heartrending work begin to blur the lines between her new life as a physician and the lifelong traumas she has fled. In brilliant, wry, and biting prose, A History of Present Illness is a boldly honest meditation on the body, the hope of healing in the face of total loss, and what it means to be alive. 2023 Rosenthal Family Foundation Award, American Academy of Arts and Letters • A Lit Hub Most Anticipated Book of 2022 • A Publishers Weekly “Writer to Watch” “A revelation.” –The New York Times

Sixteen “lovely, nuanced” (The New York Times) linked stories from a potent new voice-a doctor with an M.D. from Harvard and an M.F.A. in fiction. A History of the Present Illness takes readers into overlooked lives in the neighborhoods, hospitals, and nursing homes of San Francisco, offering a deeply humane and incisive portrait of health and illness in America today. An elderly Chinese immigrant sacrifices his demented wife's well-being to his son's authority. A busy Latina physician's eldest daughter's need for more attention has disastrous consequences. A young veteran's injuries become a metaphor for the rest of his life. A gay doctor learns very different lessons about family from his life and his work. And a psychiatrist who advocates for the underserved may herself be crazy. Together, these honest and compassionate stories introduce a striking new literary voice and provide a view of what it means to be a doctor and a patient unlike anything we've read before. In the tradition of Oliver Sacks and Abraham Verghese, Aronson's writing is based on personal experience and addresses topics of current social relevance. Masterfully told, A History of the Present Illness explores the role of stories in medicine and creates a world pulsating with life, speaking truths about what makes us human.

A young woman puts on a white coat for her first day as a student doctor. So begins this powerful debut, which follows our unnamed narrator through cadaver dissection, surgical rotation, difficult births, sudden deaths, and a budding relationship with a seminarian. In the troubled world of the hospital, where the language of blood tests and organ systems so often hides the heart of the matter, she works her way from one bed to another, from a man dying of substance use and tuberculosis, to a child in pain crisis, to a young woman, fading from confusion to aphasia to death. The long hours and heartrending work begin to blur the lines between her new life as a physician and the lifelong traumas she has fled. In brilliant, wry, and biting prose, A History of Present Illness is a boldly honest meditation on the body, the hope of healing in the face of total loss, and what it means to be alive.

A New York Times bestseller/Washington Post Notable Book of 2017/NPR Best Books of 2017/Wall Street Journal Best Books of 2017 "This book will serve as the definitive guide to the past and future of health care in America.”—Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies and The Gene At a moment of drastic political upheaval, An American Sickness is a shocking investigation into our dysfunctional healthcare system - and offers practical solutions to its myriad problems. In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in their healthcare. Our politicians have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life; fatalism has set in. Very quickly Americans have been made to accept paying more for less. How did things get so bad so fast? Breaking down this monolithic business into the individual industries—the hospitals, doctors, insurance companies, and drug manufacturers—that together constitute our healthcare system, Rosenthal exposes the recent evolution of American medicine as never before. How did healthcare, the caring endeavor, become healthcare, the highly profitable industry? Hospital systems, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Patients receive bills in code, from entrepreneurial doctors they never even saw. The system is in tatters, but we can fight back. Dr. Elisabeth Rosenthal doesn't just explain the symptoms, she diagnoses and treats the disease itself. In clear and practical terms, she spells out exactly how to decode medical doublespeak, avoid the pitfalls of the pharmaceuticals racket, and get the care you and your family deserve. She takes you inside the doctor-patient relationship and to hospital C-suites, explaining step-by-step the workings of a system badly lacking transparency. This is about what we can do, as individual patients, both to navigate the maze that is American healthcare and also to demand far-reaching reform. An American Sickness is the frontline defense against a healthcare system that no longer has our well-being at heart.

Challenges popular conceptions to outline new methods for promoting wellness and longevity, arguing that traditional medicine has not been successful in treating serious illness while urging readers to embrace a systemic understanding of the body that incorporates the use of revolutionary technologies.

Table of Contents Table of Boxes Preface Explanatory Notes Chapter 1 Diagnosis of Neurological Diseases (General Principle) Chapter 2 History Taking Chapter 3 Physical Examination Chapter 4 Evaluation of Consciousness Chapter 5 Brainstem and Cranial Nerve Territories Chapter 6 Olfactory Sensation Chapter 7 Visual Functions Chapter 8 Pupils and Accommodation Chapter 9 Extraocular Muscles, Gaze, and Eye Movements Chapter 10 Trigeminal Nerve Chapter 11 Facial Nerve Chapter 12 Auditory Function Chapter 13 Sense of Equilibrium Chapter 14 Swallowing, Phonation, and Articulation Chapter 15 Neck and Trunk Chapter 16 Motor Functions Chapter 17 Tendon Reflexes and Pathologic Reflexes Chapter 18 Involuntary Movements Chapter 19 Somatosensory Function Chapter 20 Autonomic Nervous System Chapter 21 Posture and Gait Chapter 22 Mental and Cognitive Functions Chapter 23 Aphasia, Apraxia, and Agnosia Chapter 24 Paroxysmal and Functional Disorders Chapter 25 Ion Channel Disorders Chapter 26 Psychogenic Neurological Diseases Chapter 27 Thalamus Chapter 28 Hypothalamus and Neuroendocrinology Chapter 29 Neurological Emergency Chapter 30 Disability, Functional Recovery, and Prognosis Chapter 31 How to Plan Laboratory Tests Afterword: For Those Who Wish to Study Neurology.

Drawing on the work of the Roundtable on Evidence-Based Medicine, the 2007 IOM Annual Meeting assessed some of the rapidly occurring changes in health care related to new diagnostic and treatment tools, emerging genetic insights, the developments in information technology, and healthcare costs, and discussed the need for a stronger focus on evidence to ensure that the promise of scientific discovery and technological innovation is efficiently captured to provide the right care for the right patient at the right time. As new discoveries continue to expand the universe of medical interventions, treatments, and methods of care, the need for a more systematic approach to evidence development and application becomes increasingly critical. Without better information about the effectiveness of different treatment options, the resulting uncertainty can lead to the delivery of services that may be unnecessary, unproven, or even harmful. Improving the evidence-base for medicine holds great potential to increase the quality and efficiency of medical care. The Annual Meeting, held on October 8, 2007, brought together many of the nation's leading authorities on various aspects of the issues - both challenges and opportunities - to present their perspectives and engage in discussion with the IOM membership.