The Surgeons: Life and Death in a Top Heart Center

published	October 29th 2007 by W. W. Norton
binding	Hardcover
isbn	0393065626 (isbn13: 9780393065626)
ebook
pages	256
description	An over-the-shoulder look at a major heart surgery center, with gripping accounts from the OR to the boardroom. Americans now spend mo...more [close] An over-the-shoulder look at a major heart surgery center, with gripping accounts from the OR to the boardroom. Americans now spend more money on hearts than on new passenger cars. To understand this remarkable trend, Charles R. Morris "embedded" himself with a surgical team at New York-Presbyterian Hospital in New York City, one of the world's premier cardiac surgery and transplant centers. Given unprecedented access, Morris witnessed sophisticated operations and observed the tense meetings where surgeons relentlessly criticize their own performance. In thrilling detail, Morris recounts a late-night against-the-clock "harvest run" to secure a precious transplantable organ; the heart-breaking story of a child's failed transplant; a trainee surgeon's brutal daily regimen; and much more. Along the way, Morris documents the fifty years of research and hundreds of millions of dollars that have been expended on creating a reliable mechanical heart, and he steps back to reflect on how doctors think and how they judge each other, what is really driving health care costs, and the future of health care policy in America. [close]
date added	10-11-07 edit book

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Ginnie rated it:

05/17/08

bookshelves: medical-health

I was surprised by how much I liked this book. It had seemed from the title that this would be just another in the growing cottage-industry of inside this or that medical specialty by one of its practitioners. Not so. This is the drama of surgery conveyed by an eyewitness with the smarts of an American business watcher.

Morris spent a year at New York's Columbia-Presbyterian Hospital watching coronary bypass surgeries, transplants, valve replacements and congenital-defect corrections, perf...more I was surprised by how much I liked this book. It had seemed from the title that this would be just another in the growing cottage-industry of inside this or that medical specialty by one of its practitioners. Not so. This is the drama of surgery conveyed by an eyewitness with the smarts of an American business watcher.

Morris spent a year at New York's Columbia-Presbyterian Hospital watching coronary bypass surgeries, transplants, valve replacements and congenital-defect corrections, performed by some of the world's best-the surgeons, anesthesiologists and nurses. No question, the doctors are dedicated (and well paid). Surprisingly, those at Columbia form a mutual-admiration society-no primal egos here. The author reiterates what the data show: If you're a patient, you would be wise to go to a top-tier hospital whose ORs are busy 24/7 rather than one performing a few procedures a year. While Columbia treats some indigent patients, Morris leaves to the end the issue of haves and have-nots, seeing only incremental changes to expand insurance coverage and lamenting the emphasis on high-cost, high-tech therapies rather than prevention. The tech focus is largely driven by R and D, he observes. Science is moving toward less invasive procedures: stents to open blocked arteries and robotic instruments working through small incisions, rather than the breaking-the-chest-bone-and-entering styles of the past. Thus interventional cardiology, the medical specialty which allows placement of stents and angioplasties, is the hot new field, while heart surgery declines. The future may see a merger of the two specialties.

"Charles R. Morris, the author of several books, including Tycoons, and The Cost of Good Intentions, has written for the New York Times, Atlantic, and Harpers, among other publications."

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The Surgeons provides a succinct history of heart surgery and heart transplants. Morris notes their increasing safety, even as they are made more available to more and more older and sicker patients. Between 1970 and 1995, there was a 70 percent drop in the rate per 100,000 of death due to heart attack. By the 1980s transplant technology was on the verge of entering mainstream medicine; and there are probably 200,000 Americans walking around today with a functioning organ from someone else’s body (Morris includes information on how to become a donor).

In working on his book, the author discovered that the future holds alternatives to transplants, and that battery-assisted mechanical hearts will soon enter the mainstream. There are also alternatives to heart surgery, with interventionist cardiologists threading catheters, first with tiny balloons, now with stents, to open blocked arteries. Laparoscopic, camera-assisted surgery will soon be joined by robotic surgery. Such escalating medical complexity makes increasing demands on quality control as well as hospital and doctor accountability. Morris believes that patient safety would be better served by replacing the current system of malpractice litigation with a kind of workman’s compensation system based on expert panels.

The policy implications of these mind-boggling medical breakthroughs evoke a different kind of awe. Within 30 years or so, health care spending could consume about 30 percent of America’s G.D.P. Here Morris is a model of non-ideological rational humanness. He recognizes that in the face of rising costs it will not be easy to keep alive and make more available the kind of patient-centered care he found at Columbia-Presbyterian. Morris suggests a national medical policy that, while falling short of a single-payer system that he deems politically unfeasible, more fully involves government—especially by way of a more progressive tax, so that our health care rests more on our shared human dignity and less on our ability to pay.

In unison with earlier public intellectuals now regarded as sages—Galen, Aristotle, Maimonides—Morris reminds us that good medicine can flourish only in a good society....less

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Terri Ann rated it:

03/26/08

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Read in March, 2008

The Surgeons provides a fine basic understanding for the layperson of the workings of an academic surgical practice. Morris lived in the Columbia cardiothoracic division for 6 months, observing, surgery, meetings, attendings, residents, practice, and billing. I found the story quite compelling and learned some interesting information about certain surgeries. It helps be to be better at my job to more deeply understand the motivations and actions of surgeons. I really appreciated the stories Morr...more

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The Surgeons: Life and Death in a Top Heart Center

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