Old and Sick in America: The Journey through the Health Care System

By Muriel R. Gillick | Go to book overview

Acknowledgments

This book is my attempt to understand how the health care system that I have worked in as a geriatric and palliative care physician for over thirty years works, what it’s like for older patients to navigate this system when they become ill, and why it functions the way it does. It reflects my understanding of what happens to patients, for better and for worse, as well as what doesn’t happen that should. In addition to relying on my experiences taking care of patients, it rests on research in history, politics, economics, sociology, and other areas that don’t fit neatly into a single academic discipline. The result is both a very personal book, a synthesis of existing work in multiple fields, and, I hope, a manifesto on how to make the care of older people better in the future.

Old and Sick in America couldn’t have been written without my Swarthmore College undergraduate professors who taught me to write seminar papers. Those essays, which during the Honors Program at Swarthmore were cranked out every few weeks, required me to synthesize a host of disparate sources and come up with a way of tying all the strands together. At some level, I’ve been writing seminar papers ever since: my thought pieces in the New England Journal of Medicine, the Annals of Internal Medicine, and Health Affairs are all modeled on this format, and Old and Sick in America is in many ways made up of multiple seminar papers. I’m particularly indebted to Paul Beik in the History Department and Patrick Henry in the Religion Department for their mentorship and encouragement.

Many of the chapters in this book start with a vignette about my earliest reactions to the health care system, either as a medical student or a medical resident, at a time when every thing in medicine was new and fresh. For the perspective I developed during this crucial, formative period, I owe a debt of gratitude to my teachers at Harvard Medical School, particularly Charles Hatem and Robert Lawrence. They taught me much of what I know about the essentials of good doctoring. Other physicians I have gotten to know as colleagues, mentors, and role models have also contributed in sometimes subtle but always important ways to my understanding. Bob Buxbaum, a fine internist and pioneer in palliative care, died this past year—his wisdom and joy in doctoring are very much missed.

Thanks as well to those family members who agreed to share their relatives’ stories with me, and to editorialize on what the experience of the health care system was like for both patients and families. For reasons of confidentiality, the names and identifying characteristics of these patients have been modified, so I will not mention the names of their family members either, but you know who you are. Thank you, thank you, thank you.

This book is a synthesis of material from medical science, history, political science, and economics, and it rests on the scholarship and investigative journalism of many.

-245-

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Old and Sick in America: The Journey through the Health Care System
Table of contents

Table of contents

  • Title Page iii
  • Contents vii
  • Prelude ix
  • Abbreviations in the Text xxi
  • Part I - The Office 1
  • Chapter One - Going to the Doctor 3
  • Chapter Two - The Lay of the Land 23
  • Chapter Three - From the outside in 41
  • Chapter Four - The March of Time, 1965–2015 61
  • Part II - The Hospital 79
  • Chapter Five - Entering the Palace of Technology 81
  • Chapter Six - The Varieties of Hospital Experience 97
  • Chapter Seven - The Hospital through Other Eyes 113
  • Chapter Eight - The Transformation of the American Hospital, 1965–2015 133
  • Part III - The Skilled Nursing Facility 151
  • Chapter Nine - Going to Rehab 153
  • Chapter Ten - Different Snfs, Different Miffs 169
  • Chapter Eleven - Movers and Shapers 184
  • Chapter Twelve - Now and Then 202
  • Finale 223
  • Acknowledgments 245
  • Notes 247
  • Bibliography 267
  • Index 293
  • Studies in Social Medicine 301
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