When We Do Harm: A Doctor Confronts Medical Error by Danielle Ofri

53625428._SY475_Patients enter the medical system with faith that they will receive the best care possible, so when things go wrong, it’s a profound and painful breach. Medical science has made enormous strides in decreasing mortality and suffering, but there’s no doubt that treatment can also cause harm, a significant portion of which is preventable.

Drawing on current research, professional experience, and extensive interviews with nurses, physicians, administrators, researchers, patients, and families, Dr. Ofri explores the diagnostic, systemic, and cognitive causes of medical error. She advocates for strategic use of concrete safety interventions such as checklists and improvements to the electronic medical record, but focuses on the full-scale cultural and cognitive shifts required to make a meaningful dent in medical error.

4.5 stars

So many things can go wrong in modern medicine, from misdiagnosing a disease to administering the wrong medicine with disastrous results. While there’s all kinds of research about medical error most of it concentrates on procedural errors in inpatient settings, such as doctors forgetting to wash their hands before approaching a patient’s bed. The literature ignores that most medical care is given in outpatient settings (doctors’ offices, acute care) and many, many errors take place when a doctor tries to figure out what’s wrong with you in the first place.

Add in mistakes caused by the computerized charting system, exacerbated by poor hand offs, and ignored by know-it-all doctors and we have a mess. Ofri leads us through it all in her approachable, engaging, and beautifully written style.

Here are some things I learned:

  • According to one study (everything is clearly end noted, by the way) over 80 percent of errors are related to a problem in doctor-patient communication. Ofri points out that nearly every error she reviewed for the book could have been prevented, or had its harm minimized, had there been better doctor-patient communication.
  • Capitalism in health care messes up so much stuff. Electronic medical records started as a billing system. Diagnoses are connected directly to billing codes, and there is no billing code for uncertainty. If there’s a set of interrelated problems the doctor has to pick one as the diagnosis, risking that later doctors won’t grasp the complexity of the issue.
  • Don’t get me started on malpractice lawsuits.
  • Procedural errors can be fixed with checklists, but diagnostic errors are cognitive errors, and “fixing” how a doctor thinks is much, much harder.
  • Hospital culture matters. Do the nurses feel comfortable speaking up when they see something wrong? Are patients’ families listened to or dismissed?
  • Many proposed solutions assume slow, methodical thinking when much of what doctors do is in the moment, under time pressure.

I love Ofri’s writing style – suspenseful narrative nonfiction when going through a case, introspective and insightful when discussing her own experience with error.

There are days when I envy Sisyphus: at least it’s the same stinking boulder he’s pushing up the hill every day. For a doctor, it’s a sea of boulders, any one of which – if missed – could come crashing down on one of my patients. Or on me, in the form of a lawsuit.

Make no mistake, many cases in this book are hard to read. A wife watching her husband die before her eyes without the medical staff doing anything to stop it. Mistreatment of a burn victim leading to his death, despite the efforts of nursing staff to get him better care. But the last couple of chapters give us hope, as well as concrete things a patient and their family can do to prevent medical error. Websites, professional organizations to contact, laws to be aware of, how to word requests to doctors, it’s all here.

This is my favorite Ofri book to date, which is saying a lot. A must read if you have any kind of interest, and a natural follow-up to The Checklist Manifesto as Gawande only scratches the surface.

Thanks to Beacon Press and Edelweiss for providing a review copy.

A Silent Fury: The El Bordo Mine Fire by Yuri Herrera

Translated by Lisa Dillman

50697406._SY475_The alert was first raised at six in the morning: a fire was tearing through the El Bordo mine. After a short evacuation, the mouths of the shafts were sealed. Company representatives hastened to assert that “no more than ten” men remained in the shafts at the time of their closure, and Company doctors hastened to proclaim them dead. The El Bordo stayed shut for six days.

When the mine was opened there was a sea of charred bodies—men who had made it as far as the exit, only to find it shut. The final death toll was not ten, but eighty-seven. And there were seven survivors.

Now, a century later, acclaimed novelist Yuri Herrera has carefully reconstructed a worker’s tragedy at once globally resonant and deeply personal: Pachuca is his hometown. His sensitive and deeply humanizing work is an act of restitution for the victims and their families, bringing his full force of evocation to bear on the injustices that suffocated this horrific event into silence.

Review:

I jumped at the chance to read this book because I love Herrera’s novel Signs Preceding the End of the World, and I’m always excited to read nonfiction in translation. And read that jacket copy above – mine disaster! Intrigue!

I expected a wild ride but the book is subdued. An exhaustive investigation of the circumstances is impossible 100 years after the disaster so Herrera does the next best thing, critically examining the records left behind.

After outlining the sequence of events as well as we can know them, he looks at what isn’t in the record. How the stories of relatives, often women, are replaced with legalese. What the judge didn’t order investigated. How newspaper accounts were riddled with bias, to the point of obscuring all fact.

The book is a mere 120 pages long and as I reached the end I realized I probably read it too quickly. Some themes I picked up right away – how women were silenced and pushed aside, for example – but others I missed until the very end. Why didn’t I notice the pattern of Anglo names? Did I glance over something early that pointed to the fact that the mine was owned by a US company?

I’ll have to read this book again, at a slower pace, to pick up everything Herrera is putting down. If you’re expecting narrative twists and definite answers you’ll be disappointed. But if you don’t mind following the author has he wipes a century’s worth of dust off of a supposedly settled case he has interesting things to say.

Thanks to And Other Stories and Edelweiss for providing an advance copy.

Savage Appetites: Four True Stories of Women, Crime, and Obsession by Rachel Monroe

44463274._SY475_In the 1940s, a bored heiress began creating dollhouse crime scenes depicting murders, suicides, and accidental deaths.  In the aftermath of the Manson Family murders, a young woman moved into Sharon Tate’s guesthouse and entwined herself with the Tate family. In the mid-nineties, a landscape architect in Brooklyn fell in love with a convicted murderer through an intense series of letters. And in 2015, a teenager deeply involved in the online fandom for the Columbine killers planned a mass shooting of her own.

Each woman, Monroe argues, represents and identifies with a particular archetype that provides an entryway into true crime. Through these four cases, she traces the history of American crime through the growth of forensic science, the evolving role of victims, the Satanic Panic, the rise of online detectives, and the long shadow of the Columbine shooting.

Review:

This was my last read for the opening round of the Booktube Prize and it followed No Visible Bruises, a harrowing look at domestic violence. It feels weird to say, but the tone of this book was downright breezy in comparison.

It’s not a knock on the book. Monroe introduces us to women who identify with one of four archetypal roles – the killer, the victim, the attorney, and the detective. Tales from the author’s life, such as her stint volunteering at a law office and attending a true crime convention, are scattered throughout.

Overall I found the book was scattershot, examining bits and pieces without coalescing around a central narrative. I remember lovely lines and thoughts, but it failed to hold together as a whole for me. Not a bad read by any means – I both learned things and enjoyed myself – but it didn’t quite stack up to some of the other books this round.

Unvarnished by Eric Alperin and Deborah Stoll

48254184When it opened a decade ago, the acclaimed Los Angeles speakeasy The Varnish—owned, designed, and managed by award-winning cocktail aficionado Eric Alperin—quickly became the stylish standard bearer for modern bars.  Alperin and veteran bartender and writer Deborah Stoll push back against the prevailing conceit that working in the service industry is something people do because they failed at another career. They offer fascinating meditations on ice as the bartender’s flame; the good, the bad, and the sad parts of vice; one’s duty to their community as a local; the obsessive, compulsive deliberations of building a bar (size matters); lessons from Sasha Petraske—Eric’s late partner, mentor, and the forefather of the modern day classic cocktail renaissance—and the top ten reasons not to date a bartender. At the book’s center are the 100 recipes a young Jedi bartender must know before their first shift at The Varnish, along with examples of building drinks by the round, how to Mr. Potato Head cocktails, and what questions to ask when crafting a Bartender’s Choice.

Review:

It’s interesting to see how different people approach their craft. In Kitchen Confidential Anthony Bourdain centers cooking as a physical act – I can’t separate my image of him from banging pans and frantic kitchens. Marcus Samuelsson comes across as a more cerebral chef, chasing flavors as he’s led by his taste buds in Yes, Chef. Alperin tends towards the latter by paying great attention to detail while making the perfect drink – the right ice, ordering ingredients just so, arranging the workspace for maximum efficiency.

I especially appreciate this detail in the chapter about ice. It’s fascinating how far bartenders will go to get perfectly clear ice in the shape best suited for the drink. Overall I like the chapters that are close the to the bar best as Alperin, with the help of Stoll, does a great job sharing his knowledge about the hows and whys of bartending and how he applies them at The Varnish. His insights on hospitality and what his mentor calls “offhand excellence” are especially memorable. I like that he doesn’t name drop – there’s a couple of mentions of “a celebrity” stopping by, but nothing else. The memoir-esque sections concentrating on his personal life and boozing it up in LA are hit and miss, though.

Speaking of things that are hit and miss, footnotes are used heavily throughout. Sometimes it’s to define a term, other times to add a funny anecdote or source. I wouldn’t mind if they were limited, but at one point there were three within a couple of lines of each other. I was sick of clicking through. At that point it’s better to gloss P&L as “profit and loss report” and leave it at that.

There’s 100 cocktail recipes smack dab in the middle when, at least in the ebook, it would feel more natural at the end. And when we do get to the end we’re met by an afterward full of essays by people who are in some way connected to The Varnish – regulars, the piano player, bartenders, and so on. Not a couple, not even a dozen, but 26 essays. Some are great, and I love that the barback writes his in Spanish, but the sheer number feels like padding.

All in all, Unvarnished is a quick read with interesting bits as well as flaws.

Thanks to Harper Wave and Edelweiss for providing a review copy.

American Manifesto by Bob Garfield

9781640092808_e7adaAs is often observed, Trump is a symptom of a virus that has been incubating for at least fifty years. But not often observed is where the virus is embedded: in the psychic core of our identity. Garfield investigates how we’ve gotten to this moment when our identity is threatened by both the left and the right, when e pluribus unum is no longer a source of national pride, and why, when looking through this lens of identity, the rise of Trumpism is no surprise. Overlaying that crisis is the rise of the Facebook-Google duopoly and the filter-bubble archipelago where identity is tribal and immutable.

Review:

I was primed to like this book because I love On the Media, a public radio show Garfield co-hosts. He isn’t afraid to skewer received wisdom and group think, so I was curious to see what he thinks about the state of democracy in the United States.

Overall I agree with Garfield’s idea that we need to recognize that the internet has not been the democratization machine we’ve been hoping for (with some exceptions) and that Google and Facebook have an outsized influence on American society. I also agree that those in favor of democracy need to put aside some differences to work together for the common good.

The way these ideas are conveyed, though, is not my cup of tea. The first half of the book was hit or miss, with some chapters getting at interesting points and others feeling disconnected. It’s written in his voice, as he would write for radio, but some parts don’t work as well in print. The most glaring example is lists that are compelling when heard but easily skipped over on the page.

While the tone aims at irreverent it dips into coarse. Dick joke level coarse. I understand that he’s trying to get us mad, to funnel that anger into action, but I don’t think it works. At least not on me.

Near the end of his manifesto Garfield posits that America has split itself into too many “micro-identities”, casting themselves as a highly visible other. When you make yourself stick out, he implies, you shouldn’t be surprised that people backlash against you.

So that pissed me off.

And then he talks about a kind colleague that hinted that he shouldn’t start speeches with “ladies and gentlemen” because it’s subtly “oppressive”. You won’t be surprised to hear that I’m on the colleague’s side and think that we should try to use inclusive language that works for all people, not just those on the gender binary. His answer? It’s wasted effort when there are bigger fish to fry.

My response – it costs nothing to change a few words and as a result be kinder and more understanding of those around you. You say you want us to unite, so why are you clinging to a phrase that divides?

I was prepared to give American Manifesto a ho-hum three star review until these sections near the end of the book. There are decent points here and there, but I think they could have presented in a more engaging way, with less unnecessary coarseness.

Thanks to Counterpoint Press and Edelweiss for providing a review copy.

How to Be an Antiracist by Ibram X. Kendi

40265832Ibram X. Kendi’s concept of antiracism reenergizes and reshapes the conversation about racial justice in America–but even more fundamentally, points us toward liberating new ways of thinking about ourselves and each other. In How to be an Antiracist, Kendi asks us to think about what an antiracist society might look like, and how we can play an active role in building it.

In this book, Kendi weaves together an electrifying combination of ethics, history, law, and science, bringing it all together with an engaging personal narrative of his own awakening to antiracism. How to Be an Antiracist is an essential work for anyone who wants to go beyond an awareness of racism to the next step: contributing to the formation of a truly just and equitable society.

Review:

I first heard Kendi on the WNYC show On the Media being interviewed by Brooke Gladstone. He blew my mind twice in ten minutes so I knew I had to pick up How to Be an Antiracist.

The core tenet is that there is no such thing as being “not racist”. You either support and/or abide policies and actions that further racial inequities, as a racist, or you confront them, as an antiracist. Doing nothing, saying you’re “not racist”, only furthers the racist status quo.

Kendi breaks down a bunch of big ideas such as dueling consciousness and race as a construct, while interweaving stories from his own life. We watch him grow up from a boy who parrots the questionable ideas the world has taught him, to holding anti-white racist views in college, to appreciating and later fighting for not just antiracism but for those who fall at intersectionalities between race and gender, ethnicity, sexuality, and more. He’s not afraid to share ugly thoughts he’s had and how he worked past them – this is a man who has done the work and has the receipts.

The first few chapters of the book cover big concepts and I went through them slowly to take everything in. Once these basic concepts are set he talks about subsets and nuances before widening back out to end on the ideas of success and survival.

My ereader is chock-a-block with highlights – Kendi says so many things that are thoughtful and get at the core of an issue. He argues that antiracism and anticapitalism go hand in hand. That the idea that Black people can’t be racist is absurd. That racist ideas are born not of ignorance and hate but self-interest, and that holding up a mirror can be much more effective than trying to persuade those who support racist policies. You may not agree with every point but they are all presented clearly and grounded in history.

The historical overviews in the middle of each chapter may have been my favorite sections. Kendi summarizes history and scholarship in a way that provides all the essential details without being didactic. Sometimes I wanted to know more but I’m more than happy to read other books about the movements and people he mentions.

<i>How to Be an Antiracist</i> is an in-depth examination that encourages all of us, regardless of race and level of knowledge, to do our part to stamp out racism. I am thankful to Kendi for writing about his life experience and scholarship so openly and honestly, and now I’m looking forward to reading his other book, Stamped from the Beginning. I feel a bit changed inside, for the better.

How to Do Nothing: Resisting the Attention Economy by Jenny Odell

42771901When the technologies we use every day collapse our experiences into 24/7 availability, platforms for personal branding, and products to be monetized, nothing can be quite so radical as… doing nothing. Here, Jenny Odell sends up a flare from the heart of Silicon Valley, delivering an action plan to resist capitalist narratives of productivity and techno-determinism, and to become more meaningfully connected in the process.

Review:

Reading How to Do Nothing was an odd experience, mostly because I was intensely interested in some sections and was utterly bored through others. It didn’t feel coherent, which is weird and unfortunate because Odell obviously put a lot of thought into each chapter.

She starts by pointing out that social media and apps that increasingly demand our attention have changed the way we think, work, and spend our time. We aim for productivity, work in a gig economy, and scroll through addictive feeds while simultaneously feeling more worried about and separate from the world around us. After explaining the impossibility of running away completely she touches on ways we can refuse the attention economy, how to open ourselves to new ways of seeing, and the importance of connecting with where we live – its history, ecology, and the fellow humans living there.

Odell discusses some amazing concepts, and some will stick with me. There’s the idea that we can different people in different real-life groups – a happy drunk with college friends, a hard-working professional with coworkers, an erudite conversationalist at a dinner party. Once you put yourself on social media, however, you’re the same person to everyone from childhood friends to potential employers. As a result you have to water yourself down to the most innocuous version, else risk offending someone today or years down the line. You go from many identities to just one.

There’s the thought that algorithms on Facebook and Spotify do such an amazing job of predicting what you’ll like that it’s unlikely you’ll try something new or find a favorite song in a genre you usually don’t listen to. That we’re constantly pressured to be more productive… but who does that productivity serve?

They’re fascinating ideas to think about. Some chapters, though, are duds for me. I did not need to read dozens of pages about why various communes failed in the 1960s. I also didn’t like the long descriptions of paintings and performance art. I flashed back to reading Sara Baume’s A Line Made by Walking, but this is nonfiction and the writing isn’t as strong.

As a result I’m a fan of the concepts but not of the telling, and the dead boring sections prevent me from giving it anything more than three stars.

From the Periphery: Real-life Stories of Disability by Pia Justesen

44313724From the Periphery consists of nearly forty first-person narratives from activists and everyday people who describe what it’s like to be treated differently by society because of their disabilities. Their stories are raw and painful but also surprisingly funny and deeply moving—describing anger, independence, bigotry, solidarity, and love, in the family, at school, and in the workplace.

Review:

I’m a fan of oral histories so when I saw this book of narratives from folks with disabilities I knew I had to pick it up.

The good:

  • First and foremost, I learned a ton from this book. The interviewees are forthcoming about their experience, worries, and triumphs. In the process they taught me the difference between impairment and disability, rafts of stereotypes we need to smash post-haste, and how to be a better ally.
  • We meet people with a wide range of disability – visible and invisible, mental and physical. At the same time, we see how life for people with the same disability can very different depending on other factors.
  • I especially appreciated the interviews with more than one person. A mom might talk about what it was like to raise a small child with cerebral palsy, then we would hear from the child, now a teenager, about what their life is like. It provides a multi-faceted, insightful view on how disability can affect an entire family.
  • The book is intersectional across race, class, and generations. We see how disability is viewed within various communities, such as the African-American and Latinx communities. However, I have trouble remembering a single person who is not cis-gender and straight.
  • Justesen lets people self-identify, which I love. Most people say what their medical condition is right off the top, but not always. This is the way it should be – people are sharing their stories with us, and we have no right to demand certain information from them. Now and then you get to the end of narrative and realize that the exact disability was never stated and you know what? It doesn’t take anything away from their story.

The not-so-good stuff:

  • While there is a wide range of scope in some ways, most everyone interviewed is from the Chicago area and somehow affiliated with a particular advocacy group. This isn’t all bad – advocates are amazing at telling their story – I would have liked a wider range of experiences.
  • I’m not sure about Justesen’s chops as an interviewer. She has some amazing conversations with advocate spokespeople who are used to talking about themselves, but interviews with less media-savvy folks fall a little flat. I feel like there’s more insight there, waiting to be unearthed, but she didn’t get down to it.
  • There is very little by way of explanation, which is good because it’s places the focus on the interviewees, but I wanted more background. For example, many older folks talk about going to Catholic school. Why is that? Was there one Catholic school in Chicago that was accessible? Did the Church have a policy of providing education when public schools couldn’t or wouldn’t?

These detractors are relatively minor, though. I’m grateful that these folks shared their stories and in the process taught me so much – I gained all kinds of understanding feel like I’m on the path to being a better ally.

Thanks to Lawrence Hill Books and Edelweiss for providing a review copy.

Study is Hard Work by William H. Armstrong

1156272The text down the left side of the cover says that Study is Hard Work is “the most accessible and lucid text available on acquiring and keeping study skills through a lifetime”, and the table of contents points in that direction with headings like “The Desire to Learn” and “Acquiring Skill in Methods”.

I gobbled up the first few chapters which discuss the importance of listening, getting more from what you read, and the merits of scheduling your study. I found myself nodding and marking a couple of well written lines that I agree with.

After that Armstrong breaks out study strategies by subject, and it quickly becomes apparent that this book is aimed at middle and high school readers. How to build your vocabulary using prefixes and suffixes. How to outline a textbook chapter. How to structure a paragraph. While I could glean some tidbits from the first section there was nothing for me here.

Something that struck me is how much education has changed since this book was written in 1956. Armstrong talks extensively about tests that require paragraphs and full essays as answers, while much of what I encountered in school was short answer or multiple choice. I suspect that the balance has shifted even more in that direction since I graduated.  It’s refreshing that he doesn’t resort to “hacks” or how to rig technology to make your study more efficient, but the focus on middle school level material doesn’t suit me well. Might be good for a young person, but lifelong learners can move on.

Who Says You’re Dead? Medical and Ethical Dilemmas for the Curious and Concerned by Jacob M. Appel

46221669._SY475_Drawing upon the author’s two decades teaching medical ethics, as well as his work as a practicing psychiatrist, this profound and addictive little book offers up challenging ethical dilemmas and asks readers, What would you do?

In short, engaging scenarios, Dr. Appel takes on hot-button issues that many of us will confront: genetic screening, sexuality, privacy, doctor-patient confidentiality. He unpacks each hypothetical with a brief reflection drawing from science, philosophy, and history, explaining how others have approached these controversies in real-world cases. Who Says You’re Dead? is designed to defy easy answers and to stimulate thought and even debate among professionals and armchair ethicists alike.

Review:

3.5 stars

I wasn’t sure if I should pick up this book, but when I saw that the author is not only a practicing psychiatrist but also a bioethicist and attorney, I couldn’t resist.

Appel looks at 79 dilemmas, some rare (can a millionaire advertise for a new liver?) to situations many of us will face (decisions regarding end of life care). Each case is introduced in a succinct vignette and followed up with a reflection covering legal, ethical, and personal issues that may affect the decision made. It truly is a reflection – Appel doesn’t rule for one side or the other, and he’s sure to mention factors that could make a seemingly off-putting choice rational. The setup gives you a moment to sit and reflect on what you would do in that situation. If a patient revealed that he’s gotten away with murder, would you report it to the police? Would you give someone on death row a liver transplant? What do you do when the sisters of a dying patient disagree about treatment?

The situations themselves are crafted with care. Some are edge cases pushing beyond settled law, some straddle an ethical line, and others show the most sympathetic patient for a particular treatment or intervention. While the vignettes are fictional (doctors Scarpetta, Hawkeye, and Jekyll make appearances) they’re based on actual people and cases, mostly in the US and UK. If you’d like more info there’s a robust appendix pointing to related papers, articles, and books for each dilemma.

With the heavy and at times disturbing medical content it’s not a book I can recommend to everyone, but I found it fascinating. It helped clarify (or occasionally muddy) my thinking about these ethical issues, and pointed me towards some that I didn’t even know existed. Did you know that with gene editing technology it may be possible to use ancient DNA to bring a Neanderthal to term in a human woman? It’s creepy and seems like an absolute no-go, and while Appel leans heavily in that direction he does imagine a semi-apocalyptic scenario where it might make sense.

I had small quibbles with two scenarios. One struck me as slightly ableist and used small d deaf to refer to capital D Deaf culture and people. The other talked about wrongful birth, where a doctor is negligent tying tubes and the woman becomes pregnant and ends up giving birth to a child, her fifth. Juries find it difficult to award damages for having a healthy baby, wanted or not, but the discussion didn’t touch on ways that settlement money could help the family meet the unexpected expenses of raising another child, not to mention psychological impacts. The other scenarios offer nuanced thoughts so this one felt out of place.

Those are only two small concerns, though – overall I found Who Says You’re Dead? fascinating and engrossing. I put it down now and then to take a breath – who wouldn’t after delving into the ethics of full-body transplants? – but it’s a compulsive read for medical nonfiction fans and armchair ethicists.

Thanks to Algonquin Books and Edelweiss for providing a review copy.