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December 01, 2011

Book Review: A Bitter Pill: How the Medical Care System Is Failing the Elderly

“A Bitter Pill” tells of one doctor’s experience leaving behind a traditional hospital and office-based practice and developing an unconventional community-based practice providing in-home care to medically fragile patients. The book describes lessons the author, Dr. Sloan, learns about conflicts between “best practices” medicine that focuses on prevention and rescue and the desires of many medically fragile patients. Medically fragile patients have multiple, chronic illnesses or health conditions that make them dependent on others for activities of daily living. Dr. Sloan found that for many of these patients the number one priority is not prevention or rescue, but being able to function on a daily basis. The book does an excellent job of exploring how modern “best practices” medicine fails to meet the needs of a patient who has an incurable, unpreventable illness and who merely wants to do his or her best to enjoy the life they have remaining. The author explains medical biology in understandable and lay terms. I found most useful an explanation of how patients with impaired liver or kidney function respond differently to drugs, requiring great care when treating with generally accepted prescribing standards. Dr. Sloan goes farther to question the value of medical attempts to “control,” cholesterol, for one example, in a patient with multiple chronic conditions. He argues that these patients are beyond prevention or cure, but accepted best practices dictate treating to correct the numbers. Dr. Sloan urges concentrating on the patient’s desires. If the patient wants every possible medical intervention, that should be the goal. But if the patient wants to live as normally as possible, while acknowledging that doing so may mean that they may live a shorter life, medical providers should empower the patient with treatment aimed at allowing maximum autonomy. This is a book I wish I had read years ago. I would recommend it to anyone who works with fragile clients and their families. Health care decision-making is a multifaceted issue. This book offers a useful look into patient-centered palliative care.



David Godfrey

Senior Attorney, ABA Commission on Law and Aging

About the Author: David Godfrey is a Senior Attorney at the ABA Commission on Law and Aging.

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