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Archive for the 'Book of the Week' Category

Friday, October 31st, 2014

Preface to Losing Tim: How Our Health and Education Systems Failed My Son with Schizophrenia

Losing Tim, Paul Gionfriddo

“But I think [Tim] under­stood that if his story could help change the way we think and move us to action, it was worth telling. Plus, he loves me, and I love him.”—Paul Gionfriddo

We conclude our week-long feature on Losing Tim: How Our Health and Education Systems Failed My Son with Schizophrenia, with an excerpt from the book’s preface in which Paul Gionfriddo discusses why he decided to write about his son. For more of the book you can also read the book’s first chapter, Tim Brings a Gun to School.

When my son Tim was a very young boy, he knew that I was an elected official, and he understood that elected officials made many of the “rules” by which people live. “My dad is important,” he used to volunteer to people when we were introduced to them. The prob­lem was that he pronounced the word as “impotent,” which typically elicited a giggle that puzzled Tim. Giggles aside, he had no idea how apt a description that would become when it came to my helping to make his own life more tolerable.

This book is in part a reflection on public policy and the way public policy decisions I made in good faith affected Tim’s life….

As i imagine is the case for most parents of children with serious chronic illnesses, in the course of over two decades I amassed hundreds of hard-copy and electronic documents relating to tim. they traveled with me from Connecticut to Texas and then to Florida. I saved all that I could, although there were plenty of times I wanted to burn the whole pile of paper or smash the computer in frustration. but after twenty years of storing them I decided it was time to make sense of them. So I began to do what I had been wanting to do for a long time— piece them into a narrative. I had no idea what the ending would be. I just wanted to understand better what had happened to Tim and me as we traveled his path of serious mental illness.

This book is the result. At first, it was all about Tim and not at all about me. But then i realized that I needed to describe better how iI felt about what was happening to Tim. When I started to do this, it dawned on me that I also needed to write more about the role I played as a policy maker in determining what happened to him….

Tim did something i found to be very courageous. He graciously gave his permission in writ­ing for his story to be told. when he did so, I don’t think that he ad­mired policy makers as he once had or had much respect for the rules they’ve created that affected him most directly. But I think he under­stood that if his story could help change the way we think and move us to action, it was worth telling. Plus, he loves me, and I love him.

(more…)

Thursday, October 30th, 2014

Paul Gionfriddo — “The Dangers of Stage 4 Thinking about Serious Mental Illnesses”

Losing Tim

“Until we take a different approach and move upstream in the disease process, we’re going to continue to put our resources in all the wrong places, and we’re going to continue to fight about all the wrong things. And people will still cycle between homelessness and hospitalization, outpatient treatment and incarceration, and crisis and stability.”—Paul Gionfriddo

The following is a post by Paul Gionfriddo, President/CEO of Mental Health America and the author of Losing Tim: How Our Health and Education Systems Failed My Son with Schizophrenia, originally published on Mental Health America. In the post, Gionfriddo argues for the importance of early detection and treatment of mental illness:

During my first hundred days at Mental Health America, I have frequently made the case that mental health policymakers and practitioners are too often mired in “Stage 4” thinking when they think about serious mental illnesses.

Here’s what I mean—they use an “imminent danger to self or others” as a standard for determining who gets care. That near-death time typically only comes during the latest stages of a chronic disease process, or Stage 4.

There are several dangers in using such a standard. The first is that it furthers the myth that mental illness causes violence. The second is that it leads to the over-incarceration of people with mental illnesses. The third – and perhaps most dangerous – is that it deflects our attention away from intervening early in the disease process, when we can do the most good and get the best results.

We don’t treat any other chronic diseases this way. Imagine the outcry if we waited until Stage 4 to treat cancers, cardiovascular diseases, or diabetes!

I haven’t come across anyone who thinks there’s a clinical basis for using the “imminent danger to self or others standard” to determine eligibility for care. But this hasn’t stopped us from using it for decades.

Until we take a different approach and move upstream in the disease process, we’re going to continue to put our resources in all the wrong places, and we’re going to continue to fight about all the wrong things. And people will still cycle between homelessness and hospitalization, outpatient treatment and incarceration, and crisis and stability.

At Mental Health America, we believe that it is past time for investing heavily in early identification and intervention. That’s one of the reasons we launched a new mental health screening program this year, with screening tools available on our website or at www.mhascreening.org.

And we’re pretty sure that people agree with us. After all, in just four months, the first 100,000 screens will have been taken, typically by people who are experiencing early symptoms of what may become over time severe depression, anxiety, or bipolar disorder.

They’re concerned about their mental health now, and so are we.

And they don’t want to wait ten years or more, and be forced to progress to Stage 4, for everyone else to take notice.

Wednesday, October 29th, 2014

Losing Tim, Losing Time — Paul Gionfriddo

Losing Tim, Paul Gionfriddo

“We created a system that neglected our children when we could have made a difference and inevitably led them to homelessness, hospitalization, and incarceration.”—Paul Gionfriddo

The following post is by Paul Gionfriddo, author of Losing Tim: How Our Health and Education Systems Failed My Son with Schizophrenia. For more on the book, you can also read an interview with Paul Gionfriddo.

I’d like to travel back in time. Just twenty-five years would do. Because if I knew then what I know now, I don’t think I would ever have to have written Losing Tim.

Because public policy matters in the lives of people like Tim.

I’m sure this won’t come as a shock to anyone, but policymaking isn’t a perfect science. As I write in Losing Tim, a very wise Connecticut legislator—a college professor by trade—once remarked that when she arrived in the state legislature, she assumed that the best proposals coupled with the best-reasoned arguments would lead to good public policy. Then the legislative session began, and she learned that gut feelings and emotion often carried the day, and the policy that resulted was as much a reflection of these as it was of logic and reason.

Imagine what this did in the area of mental health. We were faced with a huge challenge in the 1980s. We were closing the doors of expensive and ineffective institutions, and were returning thousands of people to their families and communities.

But their families and communities weren’t ready to receive them. This was in part because they were afraid of the way they looked and acted, and in part because they didn’t really know what to do for them. Still, I write, we believed that anything that happened to people in the community would be preferable to what had happened to them behind the locked doors of those large psychiatric facilities.

Except that it wasn’t, because we just moved folks from behind one set of locked doors—state psychiatric hospitals—to another—county jails and state and federal prisons.

This was not our intention, but we didn’t know any better.

(more…)

Tuesday, October 28th, 2014

An Interview with Paul Gionfriddo, author of “Losing Tim”

Losing Tim, Paul GionfriddoThe following is an interview with Paul Gionfriddo, author of Losing Tim: How Our Health and Education Systems Failed My Son with Schizophrenia:

Question: Losing Tim is a policy memoir, a reflection on your life as much as Tim’s. Can you talk about that?

Paul Gionfriddo: I was a state legislator in the 1980s, and helped build the failed community-based mental health system that we have today. Then I adopted an infant son who developed a serious mental illness when he was very young and had to live within the system I helped to build. And so over more than two decades, I experienced the effect of our policy decisions from the other side. And through writing the book, I’ve had the opportunity to make some sense of what we went through, and to say how we could do things differently to fix the problems we policymakers unintentionally created—and perhaps save some lives.

Q: But aren’t our options pretty limited when it comes to treating people with serious mental illnesses?

PG: Some people think so, but that’s usually because they only see serious mental illnesses in their later stages and think they are synonymous with violent tendencies. This is a myth that has led us to making jails our 21st century mental health institutions. The truth is that ten years typically pass from the time there are early symptoms of mental illnesses to the time we begin to treat them effectively. Those are ten years of lost opportunities to intervene early with the right diagnosis, the right drugs, the right therapies, and the right individual, family, and social supports—all of which can lead to recovery.

(more…)

Monday, October 27th, 2014

Book Giveaway: Losing Tim: How Our Health and Education Systems Failed My Son with Schizophrenia

This week our featured book is Losing Tim: How Our Health and Education Systems Failed My Son with Schizophrenia by Paul Gionfriddo.

In addition to featuring the book and the author on the blog, we will also be posting about the book on twitter, and facebook.

We are also offering a FREE copy of Losing Tim to one winner. To enter the contest please e-mail pl2164@columbia.edu and include your name and address. The winner will be selected Friday, October 31 at 1:00 pm.

Paul Gionfriddo’s son Tim is one of the “6 percent”—an American with serious mental illness. He is also one of the half million homeless people with serious mental illnesses in desperate need of help yet underserved or ignored by our health and social-service systems.

In this moving, detailed, clear-eyed exposé, Gionfriddo describes how Tim and others like him come to live on the street. Gionfriddo takes stock of the numerous injustices that kept his son from realizing his potential from the time Tim first began to show symptoms of schizophrenia to the inadequate educational supports he received growing up, his isolation from family and friends, and his frequent encounters with the juvenile justice system and, later, the adult criminal-justice system and its substandard mental health care.

You can also read the chapter “Tim Brings a Gun to School”:

Friday, October 24th, 2014

B*E*R*K*S*H*I*R*E — The Values of Warren Buffett

Warren Buffett, Berkshire Hathway

The following is a post by Lawrence Cunningham, author of Berkshire Beyond Buffett: The Enduring Value of Values:

Berkshire Beyond Buffett: The Enduring Value of Values tells the stories of Berkshire’s 50 significant direct subsidiaries, which define the company today, representing 80 percent of its value.

As I examined each, through archival research plus interviews and surveys, a pattern emerged: the same traits began to appear repeatedly, nine altogether. These intangible traits translate into financial gain. They also secure the company’s future, hence the book’s sub-title: The Enduring Value of Values.

Those nine values define the book’s central chapters, each chapter telling the stories of four or five subsidiaries that exemplify given values. After I organized and wrote the book, I played around with the nomenclature to form an acrostic from these values that spells out the company’s first name, as seen below, which also captures the essence of each and notes an illustrative subsidiary. The book then weaves these stories and values together to reflect what amounts to a profound succession plan.

B*E*R*K*S*H*I*R*E

Budget-mindedness
Essence: A penny saved is a nickel earned
Illustration: GEICO

Earnestness
Essence: The value in promise keeping
Illustration: Gen Re

Reputation
Essence: Results benefit from reputation
Illustration: Clayton Homes

Kin-like
Essence: Wealth can last more than 3 generations when families value identity and legacy
Illustration: Ben Bridge Jeweler

Self-starters
Essence: To the entrepreneur go the spoils
Illustration: Dairy Queen

Hands-off
Essence: Delegate everything but reputation
Illustration: Pampered Chef

Investor savvy
Essence: Price is paid, values are exchanged
Illustration: BH Energy

Rudimentary
Essence: Impossible dreams are impossible, so stick to your knitting
Illustration: Fruit of the Loom

Eternal
Essence: Berkshire as a permanent home, a Boys Town for the corporate homeless
Illustration: Brooks Running Shoe

Thursday, October 23rd, 2014

What Will Happen to Berkshire afer the Buffett Era? — Lawrence Cunningham

“What will enable the great company to endure beyond the Warren Buffett era, is Berkshire’s corporate culture.”—Lawrence Cunningham

Berkshire Beyond BuffettThe following post is by Lawrence Cunningham, author of Berkshire Beyond Buffett: The Enduring Value of Values.

What will happen to Berkshire Hathaway after the Warren Buffett era? The answer to that multi-billion dollar question lies in my book, Berkshire Beyond Buffett: The Enduring Value of Values, which lays out in detail Berkshire’s five-pronged succession plan with all its nuances and complexities. Here is a thumbnail sketch.

At most companies, succession planning focuses on grooming a senior manager who can assume the role of chief executive. Today you hear about who should succeed Jamie Dimon at JPMorgan and 15 years ago about who should succeed Jack Welch at General Electric. The personnel aspects of Berkshire’s succession plan are a bit more involved—although, despite enormous attention, they are also the least significant parts of its plan.

Buffett’s management roles will be divided into an executive function (CEO) and an investment function (CIO). The next CEO will come from among existing Berkshire executives, probably one of its 50 significant subsidiaries. This successor will get responsibility for Berkshire’s acquisitions and allocating capital. Chapter 9 of the book shows how many Berkshire managers excel in these areas, providing a wealth of managerial talent.

The second function is handling investments. Berkshire hired two people in the past half-decade—Ted Weschler and Todd Combs—for that job. They’ll face challenges ahead, including tough choices about when to sell big stakes and what to do with the proceeds. While still important, the investment side of Berkshire has greatly declined in significance in recent years, now representing only about 20 percent of its value.

Third, for board chairman, Buffett says he’d propose a member of his family, widely assumed to be Howard, his eldest son. That job would be to sustain the cultural heritage I outline in Berkshire Beyond Buffett. In an interview for the book, Howard noted that Berkshire is his father’s life’s work, and sustaining the legacy is vital to him.

(more…)

Wednesday, October 22nd, 2014

Lawrence Cunningham — Warren Buffett and Tom Murphy on Management

“Although Berkshire is one of the world’s largest and most famous corporations, few people understand it as an institution that will be Buffett’s legacy.”—Lawrence Cunningham

Lawrence Cunningham, Berkshire Beyond Buffett

The following post is by Lawrence Cunningham, author of Berkshire Beyond Buffett: The Enduring Value of Values. For more on the book you can also read an interview with Lawrence Cunningham.

While everyone knows that Warren Buffett modeled himself after Ben Graham as a stock picker, few know that as a manager, he modeled himself after Tom Murphy.

Murphy is the legendary executive whose skillful acquisitions and leadership resulted in the Capital Cities communications empire. In 1985, he engineered the acquisition of ABC, Inc. for $3.5 billion, among the largest takeovers of the time, and a decade later facilitated its acquisition by Walt Disney Co. for $19 billion.

When I asked Buffett who should write the foreword to Berkshire Beyond Buffett, he immediately suggested Murphy. Warren, an early investor in Capital Cities who later asked Murphy to join Berkshire’s board, explained that “everything I know about management I learned from Tom.”

Judging by Berkshire’s operational success over several decades, Buffett clearly knows a lot about management. Reading Murphy’s foreword together with my book, it’s clear that the management principles Murphy exemplifies animate Berkshire as well. Among those principles, three stand as bulwarks against skepticism of Berkshire’s size, governance, and durability: a commitment to permanence dismisses calls for Berkshire to shrink by divesting some businesses; a belief in autonomy explains its unusual approach to internal control; and a savvy acquisitiveness proves the track record of its deep managerial bench that will sustain its future.

Permanence: Observers ask whether it might be desirable to divide Berkshire’s 50+ direct subsidiaries into multiple corporations or spin-off certain businesses. Some argue that size is an albatross that limits growth and that vastness is a veil that obscures the real value of many subsidiaries. See’s Candies, for instance, would fetch billions if auctioned to Hershey or Nestlé, but Berkshire’s stock market price might not register such value.

The answers to petitions to shrink or break-up Berkshire are an emphatic no and no. Doing so would undermine two sources of value contributed by the bedrock principle of permanence. First, permanence elongates managerial time horizons to enable increasing long-term value in excess of short-term gain. Second, the promise of permanence offered when acquiring new businesses enables Berkshire to pay a cash price less than business value. Divisions and divestitures are antithetical to both sources of value.

(more…)

Tuesday, October 21st, 2014

Interview with Lawrence Cunningham, author of Berkshire Beyond Buffett

“Berkshire practices a philosophy of capitalism that does well by doing good, is sensitive but unsentimental, lofty yet pragmatic, and public-spirited but profitable.”—Lawrence Cunningham

Lawrence Cunningham, Berkshire Beyond Buffett

Question: What inspired you to write this book and what are some of its key implications?

Lawrence Cunningham: People have been asking for 20 years what happens to Berkshire Hathaway if Warren Buffett gets hit by the proverbial bus; the question now has added urgency since the billionaire businessman is 84. The popular answer became paradoxical: Buffett tried to build an enduring institution at Berkshire and yet even great admirers doubt that the company can survive without him. My book demonstrates how Berkshire’s corporate culture is designed to make the company outlast any one person, making the culture part of its succession plan.

Q: How did you research this book and what did your research reveal?

LC: Background research dates to the 1990s when I published The Essays of Warren Buffett: Lessons for Corporate America, based on a symposium with Buffett and Berkshire vice chairman, Charlie Munger. In that era, Berkshire looked like a mutual fund, primarily owning stocks. Today, the company is instead defined by its 50+ wholly owned businesses and so my immediate research focused on them. In addition to traditional archival material, I interviewed, with Buffett’s permission, many Berkshire insiders, including numerous subsidiary CEOs. I also surveyed 500 Berkshire shareholders. The result is, I hope, a comprehensive portrait of Berkshire Hathaway.

Q: Who is Tom Murphy and why did he write the foreword to your book?

LC: Tom Murphy is a legendary manager who built Capital Cities/ABC into a broadcasting powerhouse in which Berkshire invested. When I saw Warren during the weekend of Berkshire’s 2014 annual meeting, I asked him who he thought should write the foreword. He immediately named Murphy, explaining that he learned most everything he knows about management from Tom. Readers will discover that Murphy, now a Berkshire director, fostered the same culture at Capital Cities/ABC that characterizes Berkshire today. Tom writes, “From afar, it may look like Berkshire’s wide-ranging businesses are very different from one another. In fact … they span industries, they are united by certain key values, like managerial autonomy, entrepreneurship, frugality and integrity.”

(more…)

Monday, October 20th, 2014

Book Givewaway! Berkshire Beyond Buffett

This week our featured book is Berkshire Beyond Buffett: The Enduring Value of Values by Lawrence Cunningham.

In addition to featuring the book and the author on the blog, we will also be posting about the book on twitter, and facebook. You can also follow news about the book on the Columbia Business School Publishing twitter page.

We are also offering a FREE copy of Berkshire Beyond Buffett to a lucky winner. To enter the contest please e-mail pl2164@columbia.edu and include your name and address. The winner will be selected Friday, October 24 at 1:00 pm.

Berkshire Hathaway, the $300 billion conglomerate that Warren Buffett built, is among the world’s largest and most famous corporations. Yet, for all its power and celebrity, few people understand Berkshire, and many assume it cannot survive without Buffett. This book proves that assumption wrong.

In a comprehensive portrait of the distinct corporate culture that unites and sustains Berkshire’s fifty direct subsidiaries, Lawrence A. Cunningham unearths the traits that assure the conglomerate’s perpetual prosperity. Riveting stories recount each subsidiary’s origins, triumphs, and journey to Berkshire and reveal the strategies managers use to generate economic value from intangible values, such as thrift, integrity, entrepreneurship, autonomy, and a sense of permanence.

Friday, October 17th, 2014

Video: Herve This takes us into His Lab to Show Us Note-By-Note Cooking

We conclude our week-long feature on Note-by-Note Cuisine: The Future of Food, by Hervé This, with this great video via the BBC. This takes us into his lab/kitchen to discuss and show us how to cook using the principles of note-by-note cooking and how to employ compounds into your dishes! Happy viewing and Bon Appétit!

Thursday, October 16th, 2014

Herve This on Why Note-by-Note Cooking Is Good for the Future of Food

“Thanks to note-by-note cooking, we have a whole new slew of cooking possibilities in front of us as well as new consistencies, new odors, new tastes, and new flavors.”—Hervé This

Herve This, Note-by-Note CookingThe following is a post by Hervé This, author of Note-by-Note Cooking: The Future of Food. (For more on the book, you can also read an excerpt or an interview with Hervé This):

Fittingly, Columbia University Press added “the future of food” on the cover of my new book since note-by-note cooking is truly the future of food and more and more chefs are exploring and employing its techniques in their cooking.

If you look to the current developments of culinary art, you don’t see much novelty except note-by-note cooking. Wild plants? The eminent French chef Michel Michel Bras has been cooking them for decades. Molecular cooking? Even if you call it “science-based cooking”, or “modernist cooking”, or “techno-emotional cooking” (what is this need to give more names when one was already given?), that was proposed as early as the 1980′s!

Yes, there is no newer proposal for culinary art than note-by-note cooking, and we are living a very exciting time. Thanks to note-by-note cooking, we have a whole new slew of cooking possibilities in front of us as well as new consistencies, new odors, new tastes, and new flavors.

(more…)

Wednesday, October 15th, 2014

Interview with Herve This, author of “Note-by-Note Cooking”

Herve This, Note-By-Note CookingThe following is an interview with Hervé This, author of Note-by-Note Cooking: The Future of Food:

“All food is ‘artificial’! Do you think that barbecue meat hangs ‘naturally’ on the trees of the wild forest?”—Hervé This

Question: How does note-by-note cooking differ from molecular gastronomy?

Herve This: Molecular gastronomy is a scientific activity, not to be confused with molecular cooking. Indeed, molecular gastronomy, being science, has nothing to do with cooking. In other words, science is not about making dishes. Science looks for the mechanism of phenomena. That’s all. And technology uses the results of science to improve technique. So, note-by-note cooking is a technique.

Another question could be, how is note-by-note cooking different from molecular cooking? And here the answer would be that the definition of molecular cooking is “to cook using modern tools” (such as siphons, liquid nitrogen, etc.). But you still use meat, vegetables, etc. However, with note-by-note cooking, the instruments are not important, and the big revolution is to cook with pure compounds, instead of meat, vegetables, fruits, eggs, etc.

Q: Where does the name Note-by-Note Cooking come from?

HT: In 1999, when I introduced the name “molecular cooking,” I was upset, because it was a bad choice, which had to be made for many complex reasons. Unfortunately, people now confuse molecular gastronomy and molecular cooking. So, For note-by-note cooking, I wanted a name that could appeal to artists and it’s fair to say that note-by-note cooking is comparable to a term such as electro-acoustic music.

Q: Won’t not-by-note cooking produce artificial forms of food?

HT: Yes, but all food is “artificial”! Do you think that barbecue meat hangs “naturally” on the trees of the wild forest? Or that French fries appear suddenly from potatoes? No, you need a cook, to make them. In ordinary language, “natural” means “what was not transformed by human beings”, and “artificial” means that it was transformed, it was the result of human “art”.

Instead of “artificial,” it is better to think of “synthetic”, and again in this sense, note by note is synthetic in a similar way as electro-acoustic music. But just listen to the radio and synthesizers are everywhere, often with sometimes beautiful sounds. Moreover, in art, the scope of what is possibile increases with more choices. And more choice is better!

(more…)

Tuesday, October 14th, 2014

Book Giveaway! Win a Free Copy of “Note-by-Note Cooking” by Herve This

Note-by-Note Cooking: The Future of Food, Hervé ThisThis week our featured book is Note-by-Note Cooking: The Future of Food by Hervé This.

In addition to featuring the book and the author on the blog, we will also be posting about the book on twitter, and facebook.

We are also offering a FREE copy of Note-by-Note Cooking to a lucky winner. To enter the contest please e-mail pl2164@columbia.edu and include your name and address. The winner will be selected Friday, October 17 at 1:00 pm.

Note-by-Note Cooking is a landmark in the annals of gastronomy, liberating cooks from the constraints of traditional ingredients and methods through the use of pure molecular compounds. Hervé This clearly explains the properties of naturally occurring and synthesized compounds, dispels a host of misconceptions about the place of chemistry in cooking, and shows why note-by-note cooking is an obvious—and inevitable—extension of his earlier pioneering work in molecular gastronomy.

Read an excerpt from the introduction, “Why the Need for Note-by-Note Cooking Should be Obvious”:

Friday, October 3rd, 2014

How Poverty and Income Disparities Influences Doctor-Patient Relations — Dennis Rosen

Dennis Rosen, Vital ConversationsWe conclude our week-long feature on Vital Conversations: Improving Communication Between Doctors and Patients, with an excerpt from the book in which Dennis Rosen explores how socioeconomic disparities affect communication between doctor and patient:

Even when socioeconomic disparities between physician and patient are not glaringly obvious, they can and often do heavily influence the quality of physician-patient communication during the visit as well as its outcomes. Researchers have found that patients from lower socio­economic backgrounds tend to participate less in medical decision making, which … results in lower adherence and higher overall health-care costs. These patients are also generally provided with less information and socioemotional support by their physicians. In contrast, patients from higher socio­economic backgrounds tend to be much more involved in the man­agement of their own care. There are many possible explanations for this, including societal boundaries that limit the scope of communi­cation between people of different social stations and differences in education levels that can impede the ability of physician and patient to find a common language. Whatever the reasons, however, the fact remains that some patients are consistently less engaged by physicians than others, with consequent effects upon their participation in defin­ing the parameters of their care and, ultimately, their adherence with the treatment.

Disparities in socioeconomic status can also have profound effects on how disease is contextualized and understood. In some cases, these can lead to active resistance on the part of patients to public-health disease prevention and treatment efforts. Marilyn Nations of Har­vard and Cristina Monte of the Federal University of Ceara Medi­cal School, Brazil, interviewed the indigent residents of two favelas (shantytowns) that were hit hard by the 1993 cholera epidemic. Their aim was to understand more fully why there had been such a high degree of resistance by the favelados to governmental efforts to control the outbreak, such as water purification and the use of prophylactic antibiotics. Nations and Monte confirmed that in many instances the favelados’ refusal to cooperate with the campaign was a response to a longstanding sense of marginalization and stigmatization, which was potentiated by the use of certain metaphors in the prevention cam­paign that seemed to blame them for becoming sick in the first place. By rejecting the government-sponsored prevention efforts, the fave­lados were also rejecting the stigma of being made responsible for the epidemic.

(more…)

Thursday, October 2nd, 2014

A Doctor, a Rabbi and a Chicken — Dennis Rosen

“Deeply held beliefs .. need not only to be recognized and respected, but also integrated into the therapeutic approach in order for treatment to succeed. It is a lesson that has served me well, and which has helped me to serve so many others over the years.”—Dennis Rosen, MD

Dennis Rosen, Vital ConversationsIn a recent New York Times op-ed entitled A Doctor, a Rabbi and a Chicken, Dennis Rosen, the author of Vital Conversations: Improving Communication Between Doctors and Patients, explores an odd yet pivotal moment in his medical career.

While working in a hospital in Israel, Rosen explained to the son of 75-year-old stroke victim what lay ahead for his father in terms of rehabilitation. The son then asked if a rabbi could enter his father’s hospital room. While such a request might not have been strange, what was different was that when the rabbi walked in the room he was carrying a live chicken and then proceeded to wave it above the patient’s head.

Rosen learned that it was a custom of the local Persian-Jewish community to help heal the sick. In describing the experience, Rosen writes:

I was very impressed by how deftly the son was able to maneuver between two very different belief systems explaining his father’s disease and paths towards possible recovery: biomedical and religious. As evidenced from our repeated discussions about tests and treatment plans for his father, he clearly understood — and valued — what modern medicine could offer. And yet, his belief in Divine mercy and intercession was unshakeable….

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Wednesday, October 1st, 2014

Staying Out of the Hospital — Dennis Rosen

Vital Conversations, Dennis Rosen The following post is by Dennis Rosen, author of Vital Conversations: Improving Communication Between Doctors and Patients

Hopefully, all of you will live long and healthy lives that will end peacefully in your sleep sometime after seeing your youngest great-grandchild head off to college. Unfortunately, it will be a lot less rosy for most of us. Disease and illness are natural parts of our lives, and as science and technology advance people now live longer—and with more coexisting medical conditions—than ever before. As we get older we tend to consume more medications, and the likelihood of being hospitalized because of an acute health crises increases.

Unfortunately, the high cost of health care has resulted in growing pressure to shorten the length of stays in hospital as much as possible. And while there are many good reasons for doing this—reduced expense, lower likelihood of picking up a secondary infection or experiencing a medical error)—there can be significant downsides as well. Among these are the risks patients face when sent home from the hospital before they are well enough to care for themselves or before they understand how it is, exactly, that they are supposed to do so.

Almost one in five Medicare patients discharged from the hospital will be readmitted within the next thirty days. Interestingly, this also corresponds to the percentage of patients who experience an adverse medical event or complication, two thirds of which involve the medications they are taking. This suggests that better pre-discharge patient education needs to take place. And yet, one study of adult patients being discharged from a large academic hospital in New York found that only 28 percent could name all their discharge meds (on average, fewer than four), and that almost two thirds did not understand why they had been prescribed the medications in the first place.

Although this information is supposed to be included in a printed discharge summary, it is often not as clear as it should be, or even that easy to find among the many pages of small-font verbiage. Let’s not forget as well, that many patients are too anxious, in pain, or simply hazy from the meds they’re on to make sense of the discharge summary as carefully as they should. When you add in the fact that more than one third of Medicare patients possess marginal or insufficient health literacy skills, it’s surprising that the rate of adverse medical events following discharge is as low as it is.

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Tuesday, September 30th, 2014

Interview with Dennis Rosen, author of “Vital Conversations”

Vital Conversations, Dennis RosenThe following is an interview with Dennis Rosen, author of Vital Conversations: Improving Communication Between Doctors and Patients:

Question: So what is Vital Conversations about?

Dennis Rosen: Vital Conversations is about why good communication between doctors and patients is so important to achieving better—and less expensive—health outcomes. It explores many of the reasons that this communication becomes compromised, such as cultural and socioeconomic differences; stigma and bias; and external meddling in the actual content of the medical visit that takes away from the direct face time between doctors and patients. Vital Conversations concludes with clear suggestions—for both patients and doctors—about ways each can improve the quality of their interactions in order to get more out of them. It also provides suggestions for how the health-care system can prioritize this issue in ways that will serve us all.

Q: I notice you spend a lot of time in Vital Conversations discussing how cultural differences between patient and physician influence the quality of their communication. What made you decide to focus on this?

DR: I’ve spent most of my own life moving among different cultures. I was born in the US, lived in Canada until I was 15, then in Israel for the next 19 years, and have been living in Boston since 2001. I completed my medical education and pediatric residency in Israel, and did additional training as a resident and fellow at Boston Children’s Hospital before becoming an attending physician eight years ago. I have also worked in Haiti and Guatemala several times over the last five years. All of these experiences have given me deep insight into how the ways we perceive and understand what happens to and around us influence our ability to explain it to others, and to understand their explanations in turn. When the underlying concepts are different, this can become very difficult.

Although magnified when working with people from different cultures—and let’s not forget that one quarter of American physicians were trained abroad—it is also true even when both doctor and patient are of the same culture. One issue that I explore in Vital Conversations is the differences between the objective disease, subjective illness as experienced by the patient, and sickness as defined by society. A person with a broken finger has obvious disease, and the illness process she is suffering as a result is likely to be straightforward to the physician. By virtue of this shared understanding, the doctor’s treatment recommendations are likely to be easily understood and carried out by the patient. However, a person who comes to the doctor’s office and is found to have high blood pressure may feel absolutely fine, i.e. have disease without illness. Unless the doctor is able to convince him of the need to take medications to keep the hypertension from leading to heart disease or stroke, he may be inclined to stop taking the medicine at the first sign of side effects, leading to progression of disease.

All throughout the book I’ve included numerous personal stories and vignettes from my career as a physician that illustrate these and other points I make. Even though I wish I could claim otherwise I still don’t always get it right, despite my best attempts to, as the stories make clear. As fascinating and entertaining as the stories themselves are, I think that they really drive home the central message of the book, which is that good communication between doctors and patients is vital for medical care to be effective.

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Monday, September 29th, 2014

Book Giveaway! Vital Conversations by Dennis Rosen

Vital Conversations, Dennis RosenThis week our featured book is Vital Conversations: Improving Communication Between Doctors and Patients by Dennis Rosen, MD.

In addition to featuring the book and the author on the blog, we will also be posting about the book on twitter, and facebook.

We are also offering a FREE copy of Vital Conversations to a lucky winner. To enter the contest please e-mail pl2164@columbia.edu and include your name and address. The winner will be selected Friday, October 3 at 1:00 pm.

The health-care system in the United States is by far the most expensive in the world, yet its outcomes are decidedly mediocre in comparison with those of other countries. Poor communication between doctors and patients, Dennis Rosen argues, is at the heart of this disparity, a pervasive problem that damages the well-being of the patient and the integrity of the health-care system and society.

Drawing upon research in biomedicine, sociology, and anthropology and integrating personal stories from his medical practice in three different countries (and as a patient), Rosen shows how important good communication between physicians and patients is to high-quality—and less-expensive—care.

Read an excerpt from the first chapter “Better Outcomes, Lower Costs”:

Friday, September 26th, 2014

From Radio to Film … And Beyond — Rey Chow

“Long before I came to study film academically, these visits [to my mother's film studios] had opened my eyes to the utterly fragmentary making of the artwork in the age of technical reproducibility.”—Rey Chow

Rey Chow, Not Like a Native SpeakerWe conclude our week-long feature on Not Like a Native Speaker: On Languaging as a Postcolonial Experience with another excerpt from the book’s final chapter “The Sounds and Scripts of a Hong Kong Childhood”. In the following passage she explores the influence of her mother’s film career on her own writing and intellectual development:

Because of my mother’s involvement with film, I had opportunities to visit film studios during the time when some of her scripts were being shot. Long before I came to study film academically, these visits had opened my eyes to the utterly fragmentary making of the artwork in the age of technical reproducibility. If, say, a particular corner of a living room was the focus, the rest of the room could be left in chaos, filled with makeshift equipment, un­used props, and other messes as long as they did not intrude into the frame to be captured on camera. In a face-to-face dialogue between a female char­acter and a male character that was shot from the waist up, an actress who was somewhat short could be made to stand on a phonebook so that her height in relation to the actor would appear aesthetically proportionate on screen. On yet another occasion, I was captivated by the skilled martial arts movements performed by a well-known actress (Chan Bo-jue/Chen Baozhu) playing an assassin. Those movements were shot while a whole group of us bystanders were in the movie studio, but when the scene was shown in the movie theater, the cinematographic illusionism had been ren­dered so complete by the editing process that the actress’s stunts appeared as though they had happened all by themselves in another world, miraculously devoid of us, the witnesses.

Inspired by these films, I wrote, at the age of about ten, the synopsis of a film featuring a modern-day female knight errant called White Rose. My mother showed my penciled draft to one of her director friends, Mok Hong-see/Mo Kangshi, who reportedly said it was an interesting story. Needless to say, I was very disappointed that he did not proceed directly to filming my script!

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