From the back cover: A construction worker in his fifties is seriously injured in the collapse of a scaffold. A middle-aged railroad dispatcher develops a high fever that makes him wildly delirious. A young worker nearly severs his hand from his arm in an accident. A woman traveling alone has persistent chest pain and is treated by a doctor on a TV screen. A mother of three is diagnosed with a life-threatening disease.

My reactions
These five patients’ cases are used to illustrate the workings of a large academic medical center: Massachusetts General Hospital. Crichton, best known for thrillers and the TV show E.R., wrote this nonfiction explanation of how a hospital works when he was barely out of medical school himself – November 1969. I happened to get a 25th anniversary edition, which includes a “new” Author’s Note dated 1994. In that forward he writes: “When I reread the book recently, I was struck by how much in medicine has changed – and also, by how much has not changed. Eventually I decided not to revise the text, but to let it stand as a statement of what medical practice was like in the late 1960s, and how issues in health care were perceived at that time.”

Another twenty years have gone by and Crichton’s comments still ring true. Much has changed, and much remains the same. The system of training new physicians has changed little, though residents no longer have the gruelingly long hours that were the norm when Crichton was writing. Technological advances have certainly changed the way in certain services are delivered, but third-party payers (i.e. insurance companies, including government programs such as Medicare) have much more to say about what services the patient receives and how. (A friend recently had a mastectomy as an outpatient procedure!)

So, while this work is obviously dated, I still found it interesting.
( )

ça date... de 1970, c'est donc daté. Il n'en reste pas moins qu'il y a des choses intéressantes ( )

A forerunner to Atul Gawande-type essays, this is a collection of case studies on five patients, where each case provides a jumping-off point for Crichton to examine aspects of healthcare: its history and the general operation of hospitals and emergency rooms; healthcare costs and financing; the history of surgery; medical technology and medical research; and the hospital-based training of doctors.

Definitely dated, yet forward-thinking too (especially about technology and the expansion of patient knowledge and involvement in care), and with issues contemporary enough to recommend it for readers interested in medical history, economics and sociology. ( )

I generally love Crichton books but this one fell short... probably why I found it on the $1.00 rack at 1/2 Price Books. The book details 5 case studies of patients with various maladies. In typical Crichton fashion, it's easily seen that he devoted much research to this book. However, as a work of fiction goes he may have devoted a little too much as it reads more like a history book on the hospital and medicine. I won't deny that there was some intriguing information contained here, but I don't tend to enjoy history nor did I buy this book to brush up on my medical knowledge. His writing tends to involve jargon and references I have know understanding of largely because I have zero background in medicine. The stories of the 5 patients hold some potential to be captivating, but Crichton kept interrupting his stories with more history, statistics, and facts, slowing down the entire book to a textbook-like read.

Perhaps I could rate this book higher if I had known what I was getting myself into before I started reading it... like I said, it *is* interesting, but in a that's-an-interesting-bit-of-trivia way and not a that's-a-great-story way. Bottom line, if you're interested in this history of hospitals and medicine you may very well enjoy this. If you're looking for the type of Crichton story found in Jurassic Park, Airframe, Prey, or Pirate Latitudes, then there's really nothing to see here. ( )

While the story was broken up across the patients as described, I rated this a little higher because it was thought provoking. It gave me pause to sit down and think about how the examples are still true today. ( )