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RECOMMENDED BOOK

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Ken Pope recommends this book. He has good taste. He writes the following, and my comments are at the tail:

Many of you know of Mark Vonnegut’s book from decades ago: *The Eden Express: A Memoir of Schizophrenia.* (Kurt was his father.)

After he wrote that account of his various hospitalizations, he applied to 20 medical schools but was accepted only by Harvard. He later became a successful pediatrician. But then he experienced another psychotic episode.

His new book, *Just Like Someone Without Mental Illness Only More So: A Memoir*, which I just finished reading, is a fascinating account of his training as a doctor, his pediatric practice, his falling apart again (he tried to jump out a window and the police took him away in a straightjacket), how he pulled his life back together again (which included convincing his practice partners that he was ready to return), and what has happened since then.

He also provides an insider’s critique of doctor-patient relationships and our healthcare system.

Here are a few passages — copied by hand so likely seasoned with typos — that will give you a sense of the writer and his approach:

“If you’re lucky enough to survive going crazy and get back to the point where you can pass for normal, it builds a question into the rest of your life.  You have to forgive people for wondering, ‘How all right can he be?'”

“Somewhere in high school I came across Mark Twain’s statement that it should not be held against someone if they know more than one way to spell a word.  Years later,
at a conference on ADHD, a colleague said that Huck Finn had ADHD and would be treated today and have a better life. I said that the best treatment could achieve would be to make him into a second-rate Becky Thatcher, and we should worry, at least a little, about that.”

“When I open the office on Sundays to see acutely sick kids, it takes my wife at least twice as long to check a patient in and verify insurance information as it takes me to diagnose and treat the problem.  There’s an excellent chance even with all that checking that the insurer will find a way not to pay. Medical care has become a lot of crust and precious little pie.”

“It is important to me that I owned the house they took me out of in a straightjacket.”

“I wanted to be a good diagnostician…  I was watching and learning from masters.  The doctor’s job was to shut up long enough to let the patient be the most important person in the room.”

“The beginning of the end came when we were told we couldn’t give out advice on the phone anymore; everyone had to be told to come in and be seen.  Someone somewhere thought someone might be wrongly reassured or misinterpret what we said or we might make a mistake that would end up with an injured or dead patient and a lawsuit….  There was not a single case of things going badly because of out phone advice or any study about phone advice in general that the powers that be were responding to.  It
was an administrative answer to an administrative concern.”

“In the fine print it became illegal for us to charge the uninsured or anyone else less than we charged our insured patients and it also stipulated that the insurer would pay us at a discounted rate for our charges.  The net effect was that my professional services went from something they could easily afford to something that, without insurance, they couldn’t.”

“There’s an unfortunate hustle built into medical care, which favors doing things over not doing things.  Most medical care is delivered by a provider who doesn’t know the patient and will never see him again.  Doing things in more comfortable than not doing things.  Doctors have much more at stake in their relationships with insurers and business managers than in their relationship[s with patients.”

“What doctors should be doing ias advocates for their patients — as advocates for change — is grading and reviewing the hospitals and insurers, but instead they
cower in fear.”

The Amazon page for the book — which offers it for $16.32, a 32% discount — is at:
<http://amzn.to/KenPopeMarkVonnegutBook>

The Barnes & Noble page for the book — which offers it for $19.31, a 19% discount — is at:
<http://bit.ly/KenPopeNewMarkVonnegutBook>

Ken Pope

MINDFULNESS RESOURCES FOR CLINICAL TRAINING & PRACTICE:
<http://bit.ly/KenPopeMindfulness>

“Somewhere in high school I came across Mark Twain’s statement that it should not be held against someone if they know more than one way to spell a word.  Years late,
at a conference on ADHD, a colleague said that Huck Finn had ADHD and would be treated today and have a better life. I said that the best treatment could achieve would be to make him into a second-rate Becky Thatcher, and we should worry, at least a little, about that.”
–Mark Vonnegut, M.D, in *Just Like Someone Without Mental Illness Only More So*
DR J SAYS:

There is a lot to enjoy in Ken’s quotes and I think this book will be worth reading. One comment: Note the proscription against giving phone-based advice. That rule is based on AN IMAGINARY PROBLEM. And that is the problem with letting government at any level into the business of setting rules about the practice of medicine. The rules are
going to be made up to avoid, NOT SOLVE problems. It is in the nature and disposition of almost all people that when they get authority over others, they will want to control those others. Bureaucrats justify their existance by bossing others around.

That they feel righteous and correct and justified matters not one whit. The effect is always the same: layer after layer of insensible rules, accreting like stalagmites over centuries of rule-making.

When I was taking an oral exam to become an instrument-rated pilot, the FAA examiner said, “Well, you know the rules, but I am not sure that you know that every one of these rules is written in someone’s blood.”

This was hugely impressive to me at the time. Today, years later, I look back and wonder. While inspiring and impressive, and while I agree that pilots must be exceedingly careful if they are to survive, I think that cannot be the case. It would violate the first rule of bureaucracy: Think up imaginary problems and make a rule to prevent them.

Anyway, that’s how it looks from my thirty-five years of practice.

Send me your opposing views and I’ll publish them.

Gratefully yours,
Dr J

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