3 out of 4 stars
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Broken System by Tally Adams exposes the often-overlooked realities of the U.S. healthcare system. It is told from the perspective of a nurse with many years of experience in a variety of medical settings. Much of the text focuses on nursing homes and elder care, though hospice, acute care hospital settings, and surgery are also discussed. The author makes the general assertion that the system has moved away from a focus on effective patient care and has become centered around profit, to the detriment of nurses and patients alike.
Nursing homes are some of the sites with the most egregious examples of mismanaged care. The rehabilitation equipment is often minimal and outdated, most care is provided by overworked CNAs who receive little training, and many patients’ insurance policies do not pay for all the services the home theoretically provides. Because staff are treated as expendable and held to standards that are unrealistic (given the number of patients assigned), many are forced to bend administrative rules and requirements to get their tasks completed. Though administrators sometimes require documentation of additional safety measures, often the only changes that occur take place on paper, whereas live patients are left sitting in their excrement, or lying in their beds long enough to develop sores. The author includes several real case examples of well-meaning nurses and CNAs who inadvertently provided substandard care due to their insufficient training and/or resources.
The remainder of the book outlines additional problems in healthcare practices such as placing patients on “hospice” designations prematurely due to financial incentives, leading to a hastened demise. According to the author, hospitals are not immune to management issues, and nurses frequently find themselves in competitive and cliquey environments, where workload is sometimes directly related to the relationships one builds. Furthermore, they are subjected to murky legal situations in which administrative policies sometimes conflict with the knowledge imparted in nursing school. At times, nurses are even forced to risk their career by making life-and-death decisions without the backing of the medical institution. Even the surgery ward is far from immune from malpractice, and several anecdotes included in the text were shocking and scary in their implications of what goes on behind closed curtains.
I found this book fascinating, and quick and easy to read. The issues were outlined in simple terms, with moving examples provided to illustrate the dire nature of the situation. Each section was capped by a brief discussion on practical changes administrators and medical facilities should make to improve the conditions mentioned, as well as examples of steps patients and their families can take to protect themselves. I found these suggestions quite informative and believe almost any reader would benefit from reading this book because we all navigate the healthcare system at some point in our lives. Understanding that the facilities in question often have far different (financial) interests than the interests of the patient, and understanding what to look for to ensure safe and effective care are crucial to the provider selection process.
There were a couple of minor negatives that resulted in my rating this book 3 out of 4 stars. I found a handful of spelling and grammatical errors throughout, though these were not overly distracting. However, I also felt that some of the statements made by the author were oversimplified or overgeneralized, implying that every facility that fit under a certain descriptor operated in the same way. I would guess there is much variation by geographical region, among other factors. Similarly, some of the solutions proposed by the author also seemed overly simplistic, or even unachievable. Of course we would all benefit if medical corporations and their administrators focused less on lining their pockets and more on providing exemplary care, but the steps to achieving this are less clear than the problems with the status quo. Certain sections of this book read like an idealistic college essay – full of valid “best case scenario” proposals that unfortunately sound too good to be true. Nonetheless, it was a highly educational and motivating read, and I appreciate the opportunity to navigate the system from a more knowledgeable and empowered standpoint. Any reader with aging parents who are considering nursing care would certainly benefit from reading this book, but as I mentioned above, any healthcare consumer in this country would likely find this information useful.
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