Requiem for Doctor Edward Browne
"Requiem for Doctor Edward Browne is appalling; it's heartbreaking. That is not to say its a bad book; it's quite enthralling. It is appalling and heartbreaking because it's about our current health care system, told from a doctor's perspective. Although the book is a novel, the author is a doctor, and this gives the book the ring of truth.
"For the first half of the last century, doctors often worked with patients from birth to death. They made home visits. They sent cards and received presents. They got to know whom they helped. Welcome, managed health care, where doctors don't get to pick their patients, or vice versa, caseloads are often overwhelming, the paperwork load is staggering and patients sometimes have to wait, unless it's an emergency, for months to see a doctor, whoever is assigned to their case.
"Dr. Edward Browne is an old-time doctor modeled on those kinds of physicians. Managed care becomes popular among most practices in his small town. Our hero has one other doctor friend, Dr. Kennes, who stands by him throughout all their attempts to stay independent. Reflects Kennes, 'Blind faith in the wisdom of hospital administrators, the government and the insurance industry is what they want. When the blind lead the blind, both fall into chuck-holes.'
"Not only does the change to managed care affect Dr. Browne's practice, it affects his marriage. He is not willing to join a managed care office, his caseload keeps shrinking, he is unhappy and constantly worried. When his wife is offered work in her field, museum curating, out of town, she takes it. They stay in touch, but he is extremely lonely. Managed care has cost Browne almost everything.
"We hear so much about the patient's side of the health care situation in the U.S., its good to hear from the other important side of the equation. In the end, our hero is a hero, and some good comes of his attempts to preserve pieces of the profession he loves. The novel is engaging but long at 566 pages. The characters are quite well developed, if not a bit stereotypical. The author shows immense knowledge of the painting and museums fields as well."
THE US REVIEW OF BOOKS
Dr. Edward Browne shared an office with another physician, Dr. Meyer Benson, who had been in practice fifteen-or-so years longer than Browne and recruited Browne from a prominent medical residency program in the Mid-West. Their relationship was cordial with few disagreements about how to run their office, such as schedules, personnel, and other greater and lesser matters of everyday operation of a medical office. Browne wondered if their current fairly secure relationship could last with so much adverse publicity towards medicine and warnings of challenges to physicians.
Browne stood somewhat taller than Benson, who was somewhat stooped with age, and rather than trim like Browne, he was slightly endomorphic with a small paunch. Benson had a full head of white hair with a wave that remained from his youth. An aquiline nose showed effects of the sun while fishing, hiking and swimming. Benson had been a hard-driving, competitive physician who mellowed over the years becoming less intense and more personable. He always dressed like a professional man: a dress shirt, bow tie, cuff links, and manicured fingernails. Benson pursued pleasures of opera, theater, food and wine while Browne was satisfied with essentials; his wants did not become needs. “I’m down-market,” Browne said. Practical and down to earth, Browne was not as out-going or social as Benson but developed a loyal following in his medical practice as had Benson. Nor did Browne seek notoriety in his daily professional activities; his medical practice was its own reward.
“One of these days, I’m going to give it up, Edward. I’ve had enough of practice. I’ve been blessed to have a gratifying career here in East Valley. We’ve had a wonderful association over these years, and I want you to know how much I appreciate our partnership. I’ve saved a good sum, and with my retirement plan, I’m able to leave practice comfortably. I will miss being in the office, but I intend to stay active in hospital affairs. All this business of managed care, or whatever it’s called, will be interesting to see how it develops. An insurance crisis of some kind comes along every so often. I’ve seen quite a few in my time.”
“I’m quite a ways from retirement myself, Meyer. I suppose we should look at these health insurance proposals as a challenge. We will surely confront them before I get to the end of my days in medicine.”
“Things seem to work out no matter the criticism and complaining,” Benson said. “In the meantime, it’s turmoil, chaos and crisis-time. One wonders if there is any common sense or judgment left in human affairs, in Washington or executive suites of insurance companies. I’ll start looking for someone to take over for me. I promise I’ll find a compatible replacement. I wanted to let you know.”
Dr. Browne stood erect at six feet tall. His straight back made him appear taller than he actually was, though at times after a long day, round of a scholar’s hump appeared. His hair had thinned on top and grayed along the sides allowing long intervals between haircuts, which appealed to his Scot’s nature. A ruddy tint on his face showed effects of the sun but more often the pallor of a sage who preferred gentle light of libraries to sunlit golf links or tennis courts. He had a straight Celtic nose, thin slightly gray eyebrows and creases aside his cobalt-tinted eyes. He usually wore a white or blue, or striped button-down shirt, a college club-tie, gray or brown trousers, and plain black or brown shoes that he occasionally polished.
If Browne had an enduring interest, passion, or diversion in addition to his occasional outings at pool, it was the writings of Sir Thomas Browne, a seventeenth-century English physician. Like Sir Thomas, Dr. Edward searched through the surface of things. He did not succumb to excited enthusiasms of his day but took a longer view of events. The claims of revolutionary times in the practice of medicine were not new and could not have a lasting influence. Browne was neither fooled by threats from managed care proponents, nor liable to emotional appeals and intimidation from hospital administrators, healthcare planners, economists and consultants since many a strange fire has burned on the altars of medicine.
ForeWord Reviews: CLARION REVIEW
REQUIEM FOR DOCTOR EDWARD BROWNE
Richard Dean Smith
Three Stars (out of Five)
Insightful, well-researched, and timely, this cautionary tale provides an intriguing look at how managed care went wrong.
Requiem for Dr. Edward Browne is Dr. Richard Dean Smith’s cautionary tale about
marketplace competition invading the world of medicine. Detailed and insightful, Smith brings real-world knowledge to his story of how doctors and hospitals once did business, before “managed care” butted in and mucked up the system. The titular Dr. Browne is honorable and steadfast, remaining a holdout in his fee-for-service medical practice as he resists the push in his community to join managed care.
Dr. Browne’s world is upended when newcomer Dr. Forbes Q. Hazzig, a seemingly
brilliant doctor, raises havoc in the East Valley medical community by spearheading the push to join managed-care programs. Hazzig and his wife blaze a destructive trail and turn into bullies, playing the system for all it’s worth. Spouting propaganda and overall generalities about the future of medical care, the Hazzigs rope in the opportunistic and unsure, and flaunt their materialism and greed.
It’s an interesting journey, showcasing how mass movements begin, become wasteful
and counterproductive, yet continue to pull people in, quickly running out of control. The writing flows and the author’s experiences provide a glimpse into the real-world dilemmas of doctors, though explanations and buildups are long. The pace is deliberate, but it feels like the same things happen again and again: Hazzig gains influence and abuses his power and the flurry of paperwork impedes patient care. It’s a believable story, just too long; it could be condensed. One writing quirk is a tendency to drop the word “the” frequently: “Browne paced to end of Capitol Mall and back by time she returned.”
Dr. Browne is the voice of reason, a literary man who believes people will surely see
through the hype and resist the pull to join managed care, but his practice suffers. Dr. Hazzig is effectively developed as unconscionable, but Joanna, Dr. Browne’s wife, is one-dimensional and seems to only deliver one-sided lectures on art. Some names evoke laughter, but also make a point about the people involved in pulling off the managed-care hustle: Professor Ananais Blathersnivel and Munge Sackbutt.
The pool-hall buddies who advise Dr. Browne are one of the book’s highlights,
providing a realistic foil to the doctors and administrators. Eld Krone is actually like an “old crone” who has razor sharp insight and advice hidden under his rough exterior.
Two of the most memorable scenes take place toward the end of the book, one in the
pool hall, where Dr. Browne’s skill outmaneuvers a man sent by Hazzig to hustle him, and the second where Browne and Hazzig—long overdue for confrontation—cross paths. It’s easy to visualize these tense scenes and they provide long-suffering Dr. Browne his due justice, and an opportunity for the reader to cheer for him.
Insightful, well-researched, and timely, readers concerned with real-world issues may
enjoy the slow buildup and thoughtful story of Dr. Edward Browne.
— — —
BLUE INK REVIEW
REQUIEM FOR DOCTOR EDWARD BROWNE
Richard Dean Smith
iUniverse, 566 pages, (paperback) $29.95, 978-1-4401-3771-6
(Reviewed: March, 2014)
In the 1970s, managed care was introduced as a healthcare revolution that would benefit both physicians and their patients. But the promises proved to be fraught with problems. This unsettling cautionary tale explores the hidden side of the issue, from deceptions and greed on the insurers' and politicians' sides to perils that befell doctors who distrusted and fought the system.
Protagonist Edward Browne, an internist, is pleased with his bustling private practice and loves his independence. After his older partner retires, he brings on Forbes Quigger Hazzig, an ambitious, young doctor who soon becomes a fanatic for managed care. As the movement grows, Hazzig's extreme power plays threaten to ruin the medical community. When Browne and his best friend, Dr. Meyer Benson, push back, Hazzig plots to get them out of the way. Browne's wife, Joanna, is interwoven into the story as an art specialist. In her lectures about art history, she points out that social forces and political rivalries often made their way into the subject matter of the art. The author seems to be drawing a parallel between the art world and Dr. Browne’s situation as he fights managed care.
Richard Dean Smith, himself a long-time physician, draws strong characters with well-rounded and complex lives in this illuminating look behind the curtain of managed health care. The book is rich with intelligent writing and details, and shows impressive knowledge of the philosophies of artists and wordsmiths. While the novel isn’t a satire, the author has fun with names, such as lawyer Habeas Lien, Esq. and healthcare economist Ananais P. Blathersnivel.
Although his subject of the dark underbelly of managed care is deeply explored, Smith's plot ambles rather than sprints, offering fiction that is more informative than action-packed, save for a flurry of drama at the finish. Still, it’s an intriguing read for patients and healthcare workers alike, imbedded with warnings that are equally critical today as they were in the past.
Also available as an ebook.
— — —
REQUIEM FOR DOCTOR EDWARD BROWNE
Richard Dean Smith,
iUniverse (580 pp.)
$29.95 paperback, $9.99 e-book
ISBN: 978-1440137716; June 4, 2005
Smith (Trust in a Medical Setting, 2006, etc.), a California physician, portrays a rocky transition to managed medicalcare in this overly long but well-meaning novel.
Dr. Edward Browne, a physician at the East Valley Medical Center, has replaced his retiring partner with Dr. Forbes Quigger Hazzig, who turns out to be a wily individual. Hazzig’s hidden agenda manifests itself as a plan to merge EastValley’s services with those of a nearby health maintenance organization. The time frame for the ensuing battles between Hazzig and Browne, who is suspicious of HMOs, is withheld, and Smith doesn’t identify the state where East Valley is located. Similarly, place names could have provided more ambience, while the myriad of silly names sounds straight out of a W.C. Fields movie: Dr. Obadiah Clack, Annais P. Blatersnivel, Dr. Gurner Gumbahl, Habies Lien, Esq., etc. In a novel with such a serious, complicated premise, those names seem oddly out of key. Elsewhere, unanswered questions arise from the murky accounting practices described during Hazzig’s takeover of East Valley Medical. Here and there, Smith inserts pieces of HMO history into the narrative, yet the picture that emerges is far from clear or complete. He compassionately portrays the frustrations of patients denied insurance or access to their original doctors, but Hazzig and Browne aren’t rendered with enough depth to be compelling in their own rights. MDs familiar with HMO issues might enjoy this closer look at the industry, but it’s not informative or engaging enough for lay readers.
[Comment: Spelling errors corrected and missing text added to this review. RDS]
SOURCES AND SUGGESTED READING:
Edmund Burke. A Philosophical Enquiry into the Origin of our Ideas of the Sublime and Beautiful. (1757) Adam Phillips, editor. Oxford: Oxford University Press, 1990.
Matthew Arnold. Culture and Anarchy. (1869) J. Dover Wilson, editor. Cambridge and New York: Cambridge University Press, 1981.
Laurence E. Schmeckebier, John Steuart Curry’s Pageant of America. New York: American Artists Group, 1943.
James Johnson Sweeney. Stuart Davis. New York: Museum of Modern Art, 1945.
E.H. Gombrick. The Story of Art. Greenwich, CT: Phaidon, 1962.
John Rothenstein and Martin Butlin. Turner. New York: George Braziller, 1964.
Thomas Hart Benton. An American in Art: A Professional and Technical Autobiography. Lawrence, Kansas: University of Kansas Press, 1969.
Stuart Davis. Edited by Diane Kelder. New York, Washington, London: Praeger 1971.
Robert Hewison. John Ruskin: the argument of the eye. London: Thames and Hudson, 1976.
Cynthia Mines. For the Sake of Art. McPherson, Kansas: The McPherson Foundation, 1979.
Robert Hewison. New Approaches to Ruskin. London, Boston and Henley: Routeledge & Kegan Paul, 1981.
M. Sue Kendall. Rethinking Regionalism: John Steuart Curry and the Kansas Mural Controversy. Washington, DC and London: Smithsonian Institution Press, 1986.
Robert Hewison. Too Much. London: Methuen, 1986.
Ruskin on Turner. Edited by Dinah Birch. Boston, Toronto, London: Bulfinch Press, Little, Brown and Co., 1990.
Gerhard Richter. Sean Rainbird and Judith Severne editors. Millbank, London: Tate Gallery, 1991.
John Ruskin. Modern Painters. Abridged and edited by David Barrie, London: Pilkington Press, 1987, revised edition 2000.
Mary Acton. Learning to Look at Paintings. Abingdon, Oxon, Routledge, 1997.
Patricia Junker. John Steuart Curry: Inventing the Middle West. New York: Hudson Hills Press, 1998.
Simon Schama. Rembrandt’s Eyes. New York: A.E. Knopf, 1999.
Dinah Birch. Ruskin and the Dawn of the Modern. Oxford: Oxford University Press, 1999.
John Drury. Painting the Word. Christian Pictures and Their Meaning. New Haven and London: Yale University Press, 1999.
Sarah Quill. Ruskin’s Venice: The Stones Revisited. Aldershot, England: Ashgate, 2000.
Walter Sickert. The Complete Writings on Art. Edited by Anna Creutzner Robins. Oxford: Oxford University Press, 2000.
Robert Hewison. Ruskin’s Artists: Studies in the Victorian Visual Economy. Papers from the Ruskin Programme, Lancaster University. Robert Hewison, Editor. Aldershot, England: Ashgate, 2000.
Francis O’Gorman. Late Ruskin: New Contexts. Aldershot, England: Ashgate, 2001.
M. Therese Southgate. “Thomas Hart Benton.” JAMA 287 (2002) 2185.
Robert Storr. Gerhard Richter: Forty Years of Painting. New York: Museum of Modern Art, 2002.
Thomas Carlyle. Past and Present. (1843) Houghlin Mifflin. Richard D. Altick, editor. The Gotham Library. New York: New York University Press, 1965.
Charles Dickens. Hard Times. (1854). Introduction by Jane Jacobs. New York: Modern Library, 2001.
Charles Dickens. Little Dorrit. (1855-57).
John Ruskin. Sesames and Lilies. (1865) from The Works of John Ruskin. 39 vols. Editors Cook and Wedderburn, London: G. Allen, 1903.
J.A. Hobson. John Ruskin: Social Reformer. 2nd edition. London: James Nisbet & Co., 1899.
John Ruskin. Time and Tide, by Weare and Tyne in The Complete Works of John Ruskin Edited by E.T. Cook and Alexander Wedderburn, London: George Allen, 1905.
Richard H. Tawney. The Acquisitive Society. New York: Harcourt, Brace, and Howe, 1920.
Frank H. Knight. The Ethics of Competition and Other Essays. New York and London: Harper & Brothers, 1935.
Jacob Burckhardt. The Civilization of the Renaissance in Italy. Vol. 1. New York and London: Harper Colophon, 1958.
The Chicago School of Political Economy. Warren J. Samuels, Editor. East Lansing: Michigan State University Press, 1976.
Simon Schama. The Embarrassment of Riches: An Interpretation of Dutch Culture in the Golden Age. London: Collins, 1988.
Terry Burke, Angela Genn-Bash, and Brian Haines, Competition in Theory and Practice. London & New York: Routledge, 1991.
John Stuart Mill. “On Liberty.” In On Liberty and Other Essays. John Gray, editor. Oxford and New York: Oxford University Press, 1991
Robert H. Frank and Philip J. Cook. The Winner Take-All Society. New York and London: The Free Press, 1995.
Donald Winch. Riches and Poverty: An intellectual history of political economy in Britain, 1750-1834. Cambridge: Cambridge University Press, 1996.
John Ruskin. Fors Clavigera: letters to the workmen and laborers of Great Britain. Edited by Dinah Birch. Edinburgh: Edinburgh University Press, 2000.
David Hawkes. Idols of the Marketplace: Idolatry and Commodity Fetishism in English Literature, 1580-1680. Houndmills, Basingstoke, Hampshire, England: Palgrave, 2001.
Larry Elliott and Dan Atkinson. The Gods that Failed: How Blind Faith in Markets Has Cost Us Our Future. London: The Bodley Head, 2008.
Sir Thomas Browne. Sir Thomas Browne’s Religio Medici, Letter to a Friend, and Christian Morals. W.A. Greenhill, editor. Peru, IL: Sherwood, Sudgen, & Co., 1881, reprint 1990.
Thomas Hobbes. Leviathan: Parts I and II. (1651) Introduction Herbert W. Schneider. Indianapolis, IN: Bobbs-Merrill, 1958.
William M. Thackeray. Vanity Fair. (1847-1848).
Herman Melville. Moby-Dick or The Whale. (1851) Evanston and Chicago: Northwestern-Newberry Press, 1988.
Anthony Trollope. The Way We Live Now. (1875) London and New York: Penguin, 1993.
George Gissing. New Grub Street. (1891) New York: Modern Library, 2002.
C.S. Lewis. The Screwtape Letters. (1959) reprint. New York: Macmillan, 1980.
Dashiell Hammett. The Maltese Falcon. New York: Alfred A. Knopf, 1929. Reprint. Random House, 1972.
Wesley A. Kort. C.S. Lewis Then and Now. Oxford: Oxford University Press, 2001.
Lawrence D. Brown. Politics and HealthCare Organization: HMOs as Federal Policy. Washington, DC: The Brookings Institution, 1983.
Beyond the Crisis: Preserving the Capacity for Excellence in Health Care and Medical Science. Henry M. Greenberg and Susan U. Raymond, editors. Annals of the New York Academy of the Sciences, 1994.
The Flight from Science and Reason. Paul R. Gross, Norman Levitt, and Martin W. Lewis, editors. Annals of the New York Academy of the Sciences, 1996.
Richard D. Smith. Managed Care: Anatomy of a Mass Medical Movement. The Rhodes-Fulbright Library Series. Bristol, IN: Wyndham Hall Press, 2000.
Richard Dean Smith. Rise and Fall of Managed Care: History of the Mass Medical Movement. New York: Nova Science Publishers, 2002.
Justices Ginsberg and Breyer, Concurring. Aetna Health, U.S. HealthCare v. Davilla. Certiorari to US Court of Appeals for Fifth Circuit. 21 June 2004.
Jan Gregoire Coombs. The Rise and Fall of HMOs: An American Health Care Revolution. Madison, WI: University of Wisconsin Press, 2005.
James Harvey Young. American Health Quackery: Collected Essays. Princeton: Princeton University Press, 1992.
R. Alton Lee. The Bizarre Careers of [Dr.] John R. Brinkley. Lexington, KY: The University Press of Kentucky, 2002.
J.S. Mill. On Liberty (1859) in On Liberty and Other Essays. John Gray, ed. Oxford: Oxford University Press, Oxford and New York, 1991.
Gustave Le Bon. The Crowd: A Study of the Popular Mind. transl. La Psychologie des Foules. (1895) Atlanta, GA: Cherokee Publishing, 1982.
Gustave Le Bon. The Psychology of Revolutions. tranl. La Psychologie des Révolutions. (1912) Burlington, VT: Fraser Publishing, 1968
Adolph Hitler. Mein Kampf (1925-1927) translated by Ralph Manheim. Boston: Houghton Mifflin, 1943.
Eric Hoffer. The True Believer: Thoughts on the Nature of Mass Movements. (1951). New York: Harper & Row, 1966.
Charles P. Kindleberger. Manias, Panics, and Crashes: A History of Financial Crises. New York, Chichester, Brisbane, Tronoto, and Singapore: Wiley, 3rd edition, 1996.
Edward Chancellor. Devil Take the Hindmost: A History of Financial Speculation. New York: Farrar, Straus, Giroux, 1999.
Anne Goldgar. Tulipmania: Money, honor and knowledge in the Dutch golden age. Chicago: University of Chicago Press, 2007.
Adam Smith. The Theory of Moral Sentiments. (1759). Great Books in Philosophy. Amherst, NY: Prometheus Books, 2000.
Sydney Smith. “Bentham on Fallacies.” (1825) from the Edinburgh Review, in The Works of the Rev. Sydney Smith. New York: D. Appleton and Co., 1864.
Institute for Propaganda Analysis. "How to Detect Propaganda." from Propaganda Analysis, vol. 1, no. 2 (1937) in Propaganda edited by Robert Jackall. New York: New York University Press, 1995.
F.A. Hayek. The Road to Serfdom. Fiftieth Anniversary Edition. Introduction by Milton Friedman. Chicago: University of Chicago Press, 1944.
Sandra Billington. A Social History of the Fool. Sussex: The Harvester Press, 1984.
Barbara W. Tuckman. The March of Folly: From Troy to Vietnam. New York: Ballatine, 1984.
Joseph E. Stevens. Hoover Dam: An American Adventure. Norman and London: University of Oklahoma Press, 1988.
Robin M. Dawes and Richard H. Thaler, “Anomalies: Cooperation.” J. of Economic Perspectives 2 (1988) 187-197.
Mark S. Foster. Henry J. Kaiser: Builder in the Modern American West. Austin: University of Texas Press, 1989.
Jane J. Mansbridge. Beyond Self-Interest. edited by Jane J. Mansbridge. Chicago: University of Chicago Press, 1990.
Jon Elster. “Selfishness and Altruism.” Chapter 3, in Mansbridge, Jane J. Beyond Self-Interest. edited by Jane J. Mansbridge. Chicago: University of Chicago Press, 1990, pp. 44-52.
Terry Burke, Angela Genn-Bash, and Brian Haines. Competition in Theory and Practice. London & New York: Routledge, 1991.
John Henry Newman: Theology and Reform. Edited by Michael E. Allsopp and Ronald R. Burke. New York and London: Garland, 1992.
Matthew Rabin. “Incorporating Fairness into Game Theory and Economics.” American Economic Review 83 (1993) 1281-1302.
Paul R. Gross and Norman Levitt. Higher Superstition: The Academic Left and Its Quarrels with Science. Baltimore and London: The Johns Hopkins University Press, 1994.
Charles J. Stewart, Craig Allen Smith, Robert E. Denton, Jr. "The Persuasive Function of Slogans." from Charles J. Stewart, Craig Allen Smith, Robert E. Denton, Jr. Persuasion in Social Movements. 2nd edition. Prospect Heights, Ill.: Waveland Press, 1989, in Propaganda edited by Robert Jackall. New York: New York University Press, 1995.
Stephen B. Adams. Mr. Kaiser Goes to Washington: The Rise of a Government Entrepreneur. Chapel Hill & London: University of North Carolina Press, 1997.
Matthew Rabin. “Psychology and Economics.” Journal of Economic Literature 36 (1998) 11-46.
Robert H. Frank. What Price the Moral High Ground: Ethical Dilemmas in Competitive Environments. Princeton and Oxford: Princeton University Press, 2004.
Mitchell Zuckoff. Ponzi’s Scheme: The True Story of a Financial Legend. Random House, 2005.
Richard Dean Smith. The Circus of Medicine. The Rhodes-Fulbright Library Series. Lima, OH: Wyndham Hall Press, 2005.
Stewart E. Perry. San Francisco Scavengers: Dirty Work and the Pride of Ownership. Berkeley, Los Angeles and London: University of California Press, 1978.
Alex Boese. The Museum of Hoaxes. A Collection of Pranks, Stunts, Deceptions, and Other Wonderful Stories Contrived for the Public from the Middle Ages to the New Millennium. New York: Dutton, 2002.
Kitazawa Seed Co. Catalog, Oakland, CA, 2008.