Demanding Medical Excellence: Doctors and Accountability in the Information Age

Michael L. Millenson's Demanding Medical Excellence is guaranteed to make you feel good about the managed care industry--especially after he gets finished chronicling the medical nightmares of the past. Prior to the days of HMOs, doctors were like the gunslingers of the Wild West, operating under their own rules, with no standards by which to measure the quality of their care and no systems to regulate consistent practices. Millenson, a science writer, shows that--until the mid-'80s, when managed health care became more in demand--medical practices varied wildly from place to place and doctor to doctor. In some areas of Minnesota, for example, cesarean births were as high as 48 percent, while in others, they only comprised 9 percent. Even worse, many doctors are still unaware of the latest discoveries in treating life-threatening conditions. For Millenson, managed care is a way of systematically assuring quality control in the health field, making sure that information about new techniques and treatments are widely disseminated, and that the caliber of care is consistently high.