Summary:

The movie opens with a shot of a young man stitching up a laceration in his own knee. Another describes how he had to select which of two severed fingers would be re-attached because he could not afford both operations. They are among the millions of Americans without health insurance. But, the narrator says, the movie is not for them; rather it is for the majority of U.S. citizens who do have medical insurance and believe themselves protected.

Through a series of riveting vignettes, for-profit health care is shown to tyrannize the well, ruin the ill, and destroy families. It also erodes the psychological and moral fiber of the people working in the industry. Excursions to England, Canada, France and Cuba are presented in a series of encounters with physicians and patients, none of whom believe that they would be better off in the United States. A French doctor opines that he earns an adequate salary for a good quality of life. Even those seated in a Canadian waiting room profess satisfaction with the care given and understanding about delays. When asked why anyone would accept to pay the expenses of others, an elderly golfer explains patiently that it is what we do for each other in a caring society. Ex-pat Americans gather at a bar to describe their positive experiences with foreign health and maternity care.

Interviews with emotionally distraught people who have worked in the insurance industry reveal the relentless pressure to deny coverage and its reward system that favors those who generate the biggest savings. Special attention is given to Dr. Linda Peeno who testified before Congress in 1996, confessing that she had harmed people for the economic benefit of the insurance industry.

Moore gathers up a group of people whose sorry dilemmas within the U.S. system have left them with serious health problems. He escorts them to Cuba where physicians and nurses are only too pleased to diagnose and treat their illnesses– for free. The movie ends with an exposé of the superior health care given prisoners at Guantanamo and Moore’s stunt at trying to bring the unhappy Americans there for treatment.

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The Cold War. America and Russia (or rather "us" and "them") have both developed miniaturization technology that enables them to reduce objects, including human beings, to microscopic size. The Americans are unable to control the objects’ return to normal size after an hour; the Russians can. An American spy called Benes has stolen this information from the Russians but on his return to America he is injured when the Russians try to kill him. He develops a blood clot in his brain.

To remove the clot, a team of western scientists, led by the surgeon Duval (Edmond O’Brien) and a British vascular specialist, Michaels (Donald Pleasance), is miniaturized inside a submarine which is injected into Benes’s carotid artery. Dr. Duval has a laser gun with which he is to destroy the clot. Also on the submarine are Grant (Stephen Boyd), a military employee in charge of security, and Cora Petersen (Raquel Welsh), Duval’s technical assistant.

The team has an hour to reach the patient’s brain and destroy the clot. They overcome various hurdles, including being washed through an arterial-venous fistula in the jugular vein, having to travel through Benes’s heart (which is temporarily arrested by the outside surgical team to keep the submarine from being crushed), being attacked by antibodies in the lymphatic system, and having to replenish their air supply by breaking through the wall of an alveolar sac.

Finally, they reach the brain and find the clot, but Dr. Michaels turns out to be spying for the other side, and tries to sabotage the mission. He crashes the submarine, but is thwarted by Grant and ingested by a white blood cell. Duval destroys the clot and the crew escapes Benes’s body via the optic nerve. They are washed out in a tear just as they are beginning to return to normal size. Benes is never seen to wake up, but the film’s ending implies that the mission has been successful.

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In a future society in which biological reproduction is restricted and humanoid robots ("Mechas") are routinely manufactured to supplement the economic and social needs of humans ("Orgas"), Dr. Hobby (William Hurt) creates a prototype child Mecha, David (Haley Joel Osment), who has "neuronal feedback," the ability to love, and "an inner world of metaphor, self-motivated reasoning," imagination, and dreams. David is given to Henry and Monica, a couple whose biological child Martin is incurably ill and cryopreserved, awaiting a future cure.

More specifically, David is created out of Hobby's own loss and given to aid Monica's mourning for Martin, whom she has been unable to "let go" of as dead. It is thus Monica (Frances O'Connor) who must make the decision to perform the "imprint protocol" that will make David love her. After she stops resisting the desire to love a child (of any kind) again and implements the protocol, Martin is unexpectedly cured and comes home.

The ensuing turmoil sends David, accompanied by a robot Teddy bear, out into a nightmare world of adult Mechas, comprised of both Rouge City, where functioning Mechas like Gigolo Joe (Jude Law) do their sex worker jobs and also the fugitive realm where unregistered, discarded Mechas try to find the spare parts they need to rebuild themselves and elude trappers who take them to reactionary "Flesh Fairs" where they are publicly destroyed as an expression of rage against artificial technologies.

Joe and David, both set up and betrayed by humans jealous of their superiority at performing human functions, join together on a quest to make David "real" and return him to Monica. The quest takes them to a partly submerged Manhattan and sends David and Teddy two thousand years into the future to resolve the dystopic narrative.

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Part of a series, "Letters to a Young . . . [fill in the career]," this collection of essays by pediatrician-author Perri Klass is addressed to her son Orlando during the recent period when he was applying to medical school. The essays follow a chronological sequence, beginning with the decision to apply to medical school, the first two years of medical school, learning how to examine and talk to patients, residency training, physicians as patients, making mistakes, grappling with the most fundamental human issues in medicine, and the mingling of professional work and life.

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First published in 1991, and available in reprint edition, this is a compendium of selected artworks and excerpts of diverse medical and literary writings from pre-Hippocratic times to the end of the 20th C. Each chapter integrates selections from medical or scientific treatises, with commentaries written by historians, essays by physicians and writers, and prose and poetry by physicians and by patients. The 235 images in this book include illustrations from medical textbooks and manuscripts, as well as cartoons, sculptures, paintings, prints and sketches. The colour illustrations are stunning and copious, and provide a visual narrative that resonates with each chapter of the book.

The first part of the book, Traditional Medicine, includes chapters on Ancient, Medieval, Renaissance, and Enlightenment medicine. These serves as a preamble for the second part, Modern Medicine, which includes art, medicine and literature from the early 19th century to the end of the 20th century.

The chapter “From the Patient’s Illness to the Doctor’s Disease” illustrates the rise of public health and scientific research with excerpts from works by Edward Jenner, John Collins Warren, René Laënnec, and John Snow, together with experience of epidemic diseases described by writer Heinrich Heine in his essay on “Cholera in Paris”. The chapter on “Non-Western Healing Traditions” includes botanical research by Edward Ayensu, a short story by Lu Hsun and the writing and paintings of George Caitlin on North American Indian healing.

In the patient-focused chapter, “Patient Visions: The Literature of Illness,” are stories of sickness by Thomas DeQuincey, Leo Tolstoy, Giovanni Verga, Katherine Mansfield, André Malraux, and Robert Lowell. The chapter which follows, “Scientific Medicine: the Literature of Cure,” provides the medical counterpoint with personal correspondence by Freud, medical treatises by Wilhelm Roentgen and Louis Pasteur, an essay on surgical training by William Halsted, and an excerpt from George Bernard Shaw's play, Too True to Be Good, in which a microbe takes centre-stage.

There are chapters on “Medicine and Modern War,” which includes personal writing by nurses Florence Nightingale and Emily Parsons, and poems by Walt Whitman, and Emily Dickinson, and “Art of Medicine,” with works by Arthur Conan Doyle, Anne Sexton, James Farrell and W.P. Kinsella.

The final chapter, “The Continuing Quest for Knowledge and Control,” contains no medical treatises but rather ends with personal reflections by the writer Paul Monette on AIDS, and by physician-writers, John Stone, Sherwin B. Nuland, Lewis Thomas, Dannie Abse, and Richard Selzer.

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In How Doctors Think, Jerome Groopman explores clinical decision making with a particular emphasis on the poor communication skills and cognitive errors that often lead to misdiagnosis and inappropriate treatment. He uses a narrative approach, filling the book with compelling stories that illustrate the world of patient-physician interactions. Why did a second doctor quickly conclude that Blanche Begaye suffered from aspirin toxicity, while her first doctor mistakenly diagnosed viral pneumonia? Why did several physicians fail to diagnose Maxine Carlson's ectopic pregnancy until the day it ruptured? Groopman's storytelling skill permits him to convey complex concepts (e.g. availability bias, anchoring, and Ockham's razor) through conversation and narrative.

Three major themes run throughout the book, and each is presented with several variations. The first theme is that doctors who don't listen to their patients are likely to make serious mistakes in diagnosis and treatment. The second is that doctors frequently don't have the self-awareness to understand their own errors, especially those that involve dealing with ambiguity and understanding the importance of emotions. The final theme is that that patients ought to be active participants in their own care. This is not a new message, but Groopman frames it in a new way. Given the complexity of clinical decision making, and the many cognitive errors physicians may fall prey to, patients can improve their own care by helping their doctors minimize or avoid such errors. Among other things this means asking thought-provoking questions like "What else could it be?", "What is the worst thing it could be?," or "Is it possible I have more than one problem?"

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The poet beautifully captures the connection between a successful neurosurgical operation that restores "the jitterbug of impulses" of the brain, with the neighbors' "word of the cure." He likens the neighbors' conversations to "the way, in Montana prairie country, / the first telephones let the local secrets / and sorrows pour through the survey-staked / barbed-wire fences now doubling / as makeshift transmission lines."

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This collection of essays by surgeon-writer Atul Gawande (author of Complications: A Surgeon's Notes on an Imperfect Science --see annotation) is organized into three parts (Diligence, Doing Right, and Ingenuity) and includes an introduction, an afterword entitled "Suggestions for becoming a positive deviant," and reference notes. Each part is comprised of three to five essays, which illustrate, as Gawande explains in the introduction, facets of improving medical care - hence the title of the collection: Better: A Surgeon's Notes on Performance. In typical Gawande style, even the introduction contains tales of patients - a woman with pneumonia who would have fared far worse had the senior resident not paid close and particular attention to her well-being, and a surgical case delayed by an overcrowded operating room schedule. Such tales are interwoven with the exposition of themes and the detailing of the medical and historical contexts of the topic at hand.

The essays, though loosely grouped around the improvement theme, can easily be read as individual, isolated works. The concerns range widely both geographically (we travel to India and Iraq as well as roam across the United States) and topically. For instance, we learn about efforts to eradicate polio in rural south India and the dedicated people who devise and implement the program. Another essay, far flung from the plight of paralyzed children, is "The doctors of the death chamber," which explores the ethical, moral and practical aspects of potential physician involvement in the American system of capital punishment (from formulating an intravenous cocktail ‘guaranteed' to induce death to the actual administration of such drugs and pronouncement of death).

In sum, the topics of the eleven essays are: hand washing, eradicating polio, war casualty treatments, chaperones during physical examinations, medical malpractice, physician income, physicians and capital punishment, aggressive versus overly-aggressive medical treatment, the medicalization of birth, centers of excellence for cystic fibrosis treatment, and medical care in India. The afterword comprises five suggestions Gawande offers to medical students to transform themselves into physicians who make a difference, and by including this lecture in the book, what the reader can do to lead a worthy life.

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Tracy Kidder met Paul Farmer in 1994 when the former was writing an article about Haiti. They next met again in 1999 but it was only when Kidder expressed an interest in Farmer and his oeuvre that Farmer emailed him back, writing "To see my oeuvre you have to come to Haiti" (17). Kidder did just that, following the peripatetic workaholic Farmer to Peru, Russia, Boston, and wherever Farmer flew, which is anywhere there is poverty and disease, especially infectious disease.

In Mountains Beyond Mountains (MBM), Kidder chronicles Farmer’s childhood, medical school years (almost a correspondence course with Farmer’s frequent trips to Haiti), his founding of Partners in Health (PIH) and the construction of the medical center in Cange, Haiti, where "Partners in Health" becomes Zanmi Lasante in Creole.

The story of Farmer’s crusade for a more rational anti-tuberculosis regimen for resistant TB; his political struggles to wrestle with drug manufacturers to lower the price of these and medicines for HIV; his charismatic establishment of a larger and larger cadre, then foundation of co-workers; the story of Jim Kim, a fellow Harvard infectious disease specialist; Farmer’s marathon house calls on foot in Haiti; endless global trips punctuated by massive email consultations from all over the world; and gift-buying in airports for family, friends and patients--these are fascinating reading. In the end one is as amazed and puzzled by the whirlwind that is Paul Farmer--surely a future Nobel Peace Prize laureate like Mother Teresa--as Tracy Kidder was and grateful to have the opportunity to read about it by such an intelligent writer.

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This film combines light-hearted scenarios of poor to absurd communications with patients on issues of death and dying, with measured advice from physicians expert in such communications. In addition, a scenario of a woman physician and her patient with advanced breast cancer models a positive example for doctor-patient communication on issues of planning for death and choosing life-sustaining options.

The film opens with a madcap grim reaper dancing and singing a message from Dr. Fletcher to a patient at home: you have six months to a year to live. These same actors morph through a series of roles sprinkled through the film: a physician using medical jargon with a non-comprehending patient, an ad for a phrase book to "speak like a patient," another doctor-patient scene with the physician now graphically describing cardiopulmonary resuscitation using wild gestures, and a waiter advising a patient/patron on item selection from the Terminal Cafée menu (no vegetables!).

The experts discussing death and dying are: Michael Clement, MD; Lisa Capaldini, MD; Doriane Miller, MD; Bernard Lo, MD and Kate Christensen, MD. They offer sage advice on communication, avoidance of medical terminology (even words like 'diagnosis' and 'procedure' can be misunderstood), pain management, informing patients of anticipated poor outcome with cardiopulmonary resuscitation, asking patients what is important to them, goals of treatment, who should make medical decisions, and the setting of such discussions. Cultural sensitivity is briefly discussed, with an emphasis on respecting the patient's individuality rather than assuming a fit within cultural expectations.

The exemplary scenario demonstrates positive qualities and key points: both physician and patient are seated and dressed; the physician asks the patient if she wants another person present for the ensuing discussion and also inquires as to the quality of discussions with the spouse, whom the patient designates as the one to potentially make medical decisions; the specific fears and desires of the patient are sought; and the physician recaps what the patient says and asks her if the summary is correct. In addition, resuscitation is explained in detail. The visit concludes with the doctor encouraging future discussions and allowing decision changes.

The film ends with the finale to the opening scene. The patient slams the door on the grim reaper, who, beset by dogs, returns to Dr. Fletcher and advises the doctor to talk to his patients himself.

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