The summary below summarizes the highlights of each chapter to aid those who wish to avoid delving into the details of each chapter. They can pick and choose any chapter that might pique their interest

Chapter 1: Experts assert that one-third of healthcare can be omitted without adverse health outcomes.

Chapter 2: One in five patients incur harm while receiving care in hospitals in OECD countries.

Chapter 3 :The Cochrane Collaboration is a not-for-profit organization that produces and maintains systemic reviews of the effects of healthcare interventions.

Chapter 4:There are potential harms(harms greater than benefits) associated with interventions based on testing because of false positive and false negative results which are not uncommon in medical practice

Chapter 5:A medical reversal occurs when a better-designed study contradicts an accepted medical practice, such as a medication, diagnostic test, or procedure.

Chapter 6: Healthcare quality (IOM) is defined as the degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes consistent with currrent professional knowledge. Elaborating further, care delivered should be safe, effective, patient-centered, timely, efficient and equitable.

Right care in the right place at the right time at an affordable cost(as per the Australian Institute of Health )

Chapter 7: Healthcare consumers are under increasing financial pressure. The consequences include rising annual out-of-pocket expenses, higher rates of underinsurance, and self-rationing of healthcare.

Chapter 8: Most Americans and most health brokers make poor health insurance choices as there are too many confusing choices with a bewildering array of options.

Chapter 9: LOW-VALUE CARE is defined as care that is of “little benefit to patients, have potential to cause harm, incur unnecessary costs to patients or waste limited health resources.”

Chapter 10: Evidence-based medicine applies the best available research to patient-oriented care. It requires integrating evidence with clinical expertise and patient values.

Chapter 11: Medical screening can lead to Overdiagnosis. Unnecessary harm can occur by pursuing early screening. Overdetection identifies abnormalities that may not progress, progress slowly, or resolve spontaneously.

Chapter 12: This chapter provides miscellaneous resources that patients can research for specific issues

Chapter 13: This chapter provides tips and resources to tackle high medical bills

Chapter 14: US spends $ 500 billion on drug prescription costs. US Hospitals spend $ 200 billlion on medical devices.US pays twice as much as other developed countries

Chapter 15: Two thirds of annual hospital ED visits are avoidable. ED costs are ten times higher than at physician offices or urgent care centers.

Bedside Clinical Care

My medical education at Guy’s Hospital Medical School (University of London) in the early 1960s placed a great emphasis on bedside clinical training. During that era, physicians relied on seeing, hearing, and touching a patient to make a diagnosis. 

With the advent of scientific advances in medicine and technological innovations over the past 60 years, current medical care has become highly complicated and fragmented. Stanford University, located in the heart of Silicon Valley — home to the world’s leading technological and biomedical companies — recognized that there has been a decline in bedside clinical skills. This prompted Stanford to recruit Dr Abraham Verghese to lead the school’s Bedside Medicine Program. Under his leadership, the Stanford 25  program was instituted. This program consists of live and video presentations to reinforce clinical skills for students and other healthcare professionals.

The fundamental concept of bedside clinical medicine is the thorough collection of a clinical history and a physical examination.  It is widely accepted throughout the medical community worldwide that a carefully obtained history can lead to a diagnosis in 75% to 85% of patients. William Osler, a world-renowned physician at Johns Hopkins Medical School in the 19th Century, famously quoted, “Always listen to a patient, they might be telling you the diagnosis.”                                    

The inexorable march of technology and scientific medicine is unstoppable. Artificial Intelligence and algorithms will be increasingly incorporated into healthcare delivery systems in the future. These advances will play a crucial role at the institutional level in healthcare delivery systems and protocols. For the individual patient, though, medical care will be unfulfilling. Trust is the bedrock foundation for clinician-patient relationships, which medical science cannot provide.  

We will need to balance science with the art of medicine, where medical care will be directed by clinicians with the aptitude and skills to cater to patients’ needs and preferences with a compassionate and empathetic attitude. 

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