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Sick To Death and Not Going to Take It Anymore!: Reforming Health Care for the Last Years of Life

Joanne Lynn
Copyright Date: 2004
Edition: 1
Pages: 217
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  • Book Info
    Sick To Death and Not Going to Take It Anymore!
    Book Description:

    Just a few generations ago, serious illness, like hazardous weather, arrived with little warning, and people either lived through it or died. In this important, convincing, and long-overdue call for health care reform, Joanne Lynn demonstrates that our current health system, like our concepts of health and disease, developed at a time when life was mostly short, serious illnesses and disabilities were common at every age, and dying was quick. Today, most Americans live a long life, with the disabilities and discomforts of progressive chronic illness appearing only during the final chapters of their life stories.Sick to Death and Not Going to Take It Anymore!maintains that health care and community services are not set up to meet the needs of the large number of people who face a prolonged period of progressive illness and disability before death. Lynn offers what she calls an "owner's manual for the health care system," which lays out facts, concepts, strategies, and action plans for genuine reform and gives the reader new ways to interpret information creatively, imagine innovative possibilities, and take steps to implement them.

    eISBN: 978-0-520-93142-8
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. List of Illustrations and Tables
    (pp. vii-viii)
  4. Foreword
    (pp. ix-x)
    Daniel M. Fox and Samuel L. Milbank

    The Milbank Memorial Fund is an endowed operating foundation that engages in nonpartisan analysis, study, research, and communication on significant issues in health policy. Since 1905 the Fund has worked to improve and maintain health by encouraging persons who make and implement health policy to use the best available evidence. The Fund convenes meetings of leaders in the public and private sectors and publishes reports, articles, and books.

    This is the tenth of the California/Milbank Books on Health and the Public. The publishing partnership between the Fund and the University of California Press seeks to encourage the synthesis and communication...

  5. Acknowledgments
    (pp. xi-xii)
    (pp. 1-3)

    The life stories of most Americans nowadays are long and remarkably free from serious disability or disease. When serious disability, progressive chronic illness, or frailty arrives, it is usually only in the last chapters of our life stories. Growing old before becoming seriously ill and dying is a remarkable accomplishment. Just a century ago, serious illnesses and disabilities were common at every age, and dying was usually quick.

    Yet long life poses its own challenges. Health care and community services simply do not meet the needs of the large number of people facing a prolonged period of progressive illness and...

  7. 1 JUST THE FACTS Serious Chronic Disease in the Last Phase of Life
    (pp. 4-34)
    Carol Levine

    Just a few generations ago, serious illness, like hazardous weather, arrived with little warning, and people either recovered or worsened and died within days or weeks. People had a great deal of trouble from illnesses that are now nearly eradicated—such things as childbirth complications, improperly healed fractures, broken teeth, and parasites. Nevertheless, the calamity that caused death was rarely apparent even a week or two ahead of death. Had they not encountered the specific illness or injury that overtook them, most of those who died could have lived for many years. A working man would die of his first...

  8. 2 SEEING THE WORLD DIFFERENTLY Ideas to Shape Reform
    (pp. 35-65)
    Donald M. Berwick

    Facts are like geography—they shape the possibilities. Interpretations are like politics—they create the human structures and meanings. The facts of the last chapter shape the terrain and give rise to a number of possible interpretations and perspectives. This chapter will offer the interpretations that I have come to see as the most important in order to generate a reliable, sustainable set of social arrangements to support the last phase of life.

    A remarkable proportion of overall health-care needs and costs is now concentrated in the last few years of the life span. Most of the costs—and the...

    (pp. 66-90)
    Joanne Lynn

    Reformers have already tried out some important innovations, including projects showing that patients with serious chronic illness regularly benefit from continuity and coordinated care in which each provider in each setting knows the patient’s diagnosis, treatment plan, and preferences. These innovations and reforms are useful not only for what they have achieved for small numbers of people or short periods of time but also for what they can teach about organizing reliable, high-quality care (National Coalition for Health Care and Institute for Healthcare Improvement 2000; Romer et al. 2002; Lynn, Schuster, and Kabcenell 2000). Professional education, health-care provider regulation and...

  10. 4 SURVEYING THE TERRAIN Opportunities and Challenges
    (pp. 91-120)
    Committee on Quality of Health Care in America, Institute of Medicine

    Eventually, good care will require major changes in our culture—the way we structure reality, what facts we take to be salient, and the language we use. Indeed, I judge that most of these cultural changes are largely inevitable—what well-considered strategy can do is to accelerate the pace of change and avoid inept care and suffering for many as we undertake reforms.

    This chapter lays out a number of approaches to the entrenched barriers I foreshadow above, as well as arguments for focusing upon caregivers and financing and high-leverage opportunities for change. Some of my claims will be controversial,...

  11. 5 GOOD CARE FOR US ALL Building the Care System to Count On
    (pp. 121-150)

    Very sick people should not have to be afraid of their care system. They and their families need care they can count on, with the services that matter to them readily available. Since patients coming to the end of life ordinarily get care in various settings and from various providers—home care, doctor’s office, hospice, hospital—the level of performance in each setting and from each provider must be high, and transfers among settings must be smooth. Only then can clinicians make promises of reliable services that cover all of the time from the onset of serious illness to the...

  12. APPENDIX: An Agenda for Action
    (pp. 151-166)
  13. References
    (pp. 167-190)
  14. Index
    (pp. 191-205)
  15. Back Matter
    (pp. 206-206)