Thursday, June 16, 2011

Dr. David Ansell and Two-Tiered Health Care

Dr. David Ansell has written an expose on what was Cook County Hospital. He has highlighted the levels (or lack thereof) of care offered to patients based on insurance status. It is not a story unique to Chicago. It is a story that is present in every major city in the United States. It's sickening. It kind of reminds me of the movie, John Q starring Denzel Washington. Do you remember that one? Unfortunately, that movie is what many Americans live. You can read more and listen to an interview from NPR's Fresh Air.
COUNTY: Life, Death and Politics at Chicago's Public HospitalCounty is the amazing tale of one of America’s oldest and most unusual urban public hospitals. From its inception as a “Poor House” dispensing free medical care to indigents, Chicago’s Cook County Hospital has been both a renowned teaching hospital and the healthcare provider of last resort for the city’s uninsured. County covers more than thirty years of its history, beginning in the late 1970s when the author began his internship, to the “Final Rounds” when hundreds of former trainees gathered to bid the enormous iconic Victorian hospital building an emotional farewell when it was closed to make way for a new facility.
Ansell writes of the hundreds of doctors who went through the rigorous training process with him, sharing his vision of saving the world and of resurrecting a hospital in critical condition. County is about people, from Ansell’s mentors, including the legendary Quentin Young, to the multitude of patients whom he and County’s medical staff labored to diagnose and heal. It is a story about politics, from contentious union strikes to battles against “patient dumping”, and public health, depicting the AIDS crisis and the opening of County’s HIV/AIDS clinic, the first in the city.
Finally, it is about an idealistic young man’s medical education in urban America, a coming-of-age story set against a backdrop of race, segregation and poverty.
Apparently County has provided fodder for others who have worked in the system. Here are a few other memoirs:

Cooked: An Inner City Nursing MemoirIn May 1971, Look magazine featured an article entitled "Chicago's Cook County Hospital: A Terrible Place." The article provided an in-depth look at the largest public hospital in the country, one located on Chicago's dangerous gang-controlled and drug-infested West Side. Months later, the author, then a naïve suburban teen, and one hundred other nursing students, began their training there, despite newspaper articles that warned that the hospital might close any day. At 'the County,' where nurse duties included swatting flies in the OR and delousing patients, both nurses and doctors were expected to provide care under the most desperate of circumstances. Cooked provides an inside look at the 2,000-bed ghetto hospital, often referred to as a "19th-century sick house," that provided health care to millions of Chicago's poor.

Hospital: an oral history of Cook County Hospital by Sydney Lewis. 
Hospital: an oral history of cook county hospitalIn 62 interviews, Lewis presents a fascinating picture of one of the largest U.S. public hospitals during the past 50 years. She draws on a wide range of informants, from a transporter and an elevator operator to a resident and the chairman of a department. Skills derived from previous work with Studs Terkel help Lewis bring out the personal, social, political, and religious views of her subjects. Intense feeling about the hospital--whether of love, respect, frustration, or even hatred--binds the diverse informants together. A nurse sums up the pervasive attitude: "I like the freedom, to do things for patients and really be where you're needed." Karl Meyer, Jim Haughton, and Quentin Young--the most forceful and controversial hospital leaders during the period covered--receive both favorable and unfavorable comments. The hospital itself--provider of health care for the poor and underserved, capable of arousing intense loyalty among its patients, and prized as one of the best sources of postgraduate medical education--is, however, the star of the book. ~ William Beatty

Intern in the Promised Land: Cook County HospitalTravel back to the 1960s and walk the halls of Chicago's Cook County Hospital with Douglas R. Gracey, a medical intern eager to learn the ways of medicine, help patients and impress his colleagues.
Back then, medical education was different. Diagnosis was not so certain, treatment options were severely limited and patients, for the most part, expected less from their doctors.
The patients at Cook County Hospital had to deal with poverty, racial discrimination and social stigma in addition to the symptoms caused by their diseases. The county system was the only realistic option for pregnant black women and other marginalized members of society. The hospital also faces dilemma as they suffer from poor management, rampant patronage, payroll padding and contract rigging.
Join Gracey in Chicago, where he must learn how to succeed in a broken system while providing care to his patients. Along the way, find out how medical education has changed in Intern in the Promised Land: True Stories from Cook County Hospital.

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