Archive for January, 2010


This bookgroup was special in few ways. Principally because Ken Hillman, author of – Vital Signs – Stories from the ICU, came along, but also because he is a friend and relative of the group. The book itself is non-fiction, but the stories that illustrate the issues discussed are very dramatic and very human. At least half of the book involves telling the stories of these individual ICU patients, their diagnosis, treatment, outcomes and the impact on their lives. The other half is a discussion of the even more complex process of diagnosing and prescribing treatment for sick hospital systems.

The key issue raised is the question of how best to deal with terminally ill patients. In particular, the merits of continuing or extending what is usually painful, invasive and very expensive treatment when it is likely to add only days or hours, of unconscious or uncomfortable, life to the patient. At least half the book concerns this issue. The issue is discussed from the clinical, economic, ethical, hospital organisational hierarchichy, and political perspectives. Critically the purpose of the book is not just to lecture on the issue but to humanisie it with numerous real life stories from Ken’s professional life. To his credit the author tries to include perspectives from patients, relatives and a wide range of hospital staff in these stories, but in the end the dominant perspective is his, that is the person responsible for running the ICU and for what happens in it.

Some of the other issues raised include the increasing specialisation of modern clinical staff and how this works against holistic patient centered care. Interestingly, Hillman provides a brief history of the modern hospital that neatly explains why they are the way they are, the path they are headed down, and some promising new directions for patient centered cared that are being tried in some places.

The book also includes some interesting digressions on the way the circulation works, the way breathing works, and the way the gut works, all illustrated by the stories of various ICU patients.

The other key issue raised is public perceptions of the miracle working power of modern medicine. Hillman spends some time on what he calls the myth of CPR to illustrate this wider issue. He points out that the success rate of CPR in real life is miniscule, particularly in hospital, but huge resources continue to be poured in to it. He shows how this public perception leads to excessive government investment in what is a largely ineffective process and technology. He also shows how this miracle working perception can lead the relatives of patients to demand continuing or extending care to their terminally ill relative even when its futile.

The bookgroup discussion also focussed on the death theme, but with perhaps a stronger policy focus, what could be done to successfully lead change in the industry?

The group were very engaged in the book, everyone appeared to have a story of their contact with the hospital system that resonated with some of the themes and stories in the book, and/or some professional experience that related to the book.

The overall impression was that it was a difficult read at times, due to the tragic stories being told, it was also a fascinating insight into what it is really like to work in the mysterious world of hi-tech medicine, as opposed to the tv sitcom/melodrama take on the environment. It also, uniquely, shows how this medical world is intimately connected with the grubbier, less glamorous worlds of politics, budgets, the culture of the medical profession, and to the extent that it sucks up resources from other parts of the health system, primary health care and home care.

Importantly I think we also took time out to acknowledge that while hospitals could be improved they really are tremendous, and particularly for the very sick. If you are very sick, there a few better places to be than a big modern teaching hospital in sydney.


January 21, 2010 at 6:52 am Leave a comment


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