Caught in the Crosshairs of American Healthcare

by Lloyd I. Sederer MD

Overview

The inspiring true story of how a small group of dedicated leaders led radical and relentless change to save McLean, Harvard’s historic psychiatric hospital.

Lloyd I. Sederer, MD, recounts the unfettered story of how McLean survived impending closure or sale to once again prosper and regain its international stature as the hospital where you would want a loved one to be treated for a psychiatric or substance use disorder.

Only growth and innovation can reverse an institutional fiscal crisis. Dr. Sederer describes how, over five years of hemorrhaging money, McLean eluded the now pervasive corporatization of American healthcare and was clinically and financially rebuilt despite the odds, all while serving with integrity and soul more patients than ever before. 

Caught in the Crosshairs of American Healthcare offers leaders and aspiring leaders in healthcare and other complex organizations a candid look behind the curtain of McLean’s transformation into a hospital open to all, no longer only the rich and famous. Dr. Sederer also finely details

• the corporatization of medicine putting profits before patients,
• endless insurance hurdles, 
• how to prove clinical improvements, and 
• our broken and inequitable health and mental health systems of care.

​Caught in the Crosshairs of American Healthcare shows readers that, with grit, brains, and support, we can still change our world.

Product Details

ISBN-13:	9798886451290
Publisher:	Greenleaf Book Group Press
Publication date:	01/09/2024
Pages:	208
Product dimensions:	5.50(w) x 8.50(h) x (d)

About the Author

Lloyd I. Sederer, MD, is a psychiatrist, public health doctor, and non-fiction writer. He is an adjunct professor at the Columbia University School of Public Health, who has served as Chief Medical Officer and EVP of McLean Hospital, Mental Health Commissioner of NYC (in the Bloomberg administration), and Chief Medical Officer of the NYS Office of Mental Health. He has published fourteen books and approximately 500 articles for print and online publications, including the New York Times, the Wall Street Journal, Scientific American, The Atlantic, Psychology Today, and US News and World Report (where he wrote an opinion column for three years).

What People are Saying About This

From the Publisher

“Lloyd Sederer’s brilliant book about the revival of McLean Hospital from a near-death experience teaches us how to ‘rethink the status quo’ of any institution or organization. Caught in the Crosshairs of American Healthcare shows us step by step how to replace established but dated practices with what works now, and how to improve and prove the effectiveness of the changes made. By doing so, Sederer reveals how we can save, reshape, and rethink the destiny and relevancy of our institutions, bureaucracies, and communities.”
—Francis Greenburger, CEO, Time Equities; CEO, Greenburger Literary Agency; President, Greenburger Center for Social and Criminal Justice 

“An untold chapter in the history of a celebrated American hospital, a compelling look at the evolution of the healthcare industry, and an inspiring example of leadership succeeding in the face of challenge. In helping to save McLean, Lloyd Sederer did a great service for health. In telling the story in this engaging and informative book, he has done another.”
—Sandro Galea, MD, DrPH, Dean, Robert A. Knox Professor, School of Public Health, Boston University

“Dr. Sederer takes aim at the ‘corporatization of American healthcare.’ Where profits eclipse patients, administrative waste and burden are vast, and we medical consumers regularly are dismissed or overcharged. If, indeed, there is the possibility of our creating a more just and beautiful world, Caught in the Crosshairs of American Healthcare takes us there. Read this book. You won’t be disappointed. Indeed, you will be greatly edified.”
—Eve Konstantine, MPH, the Georgetown Coaching Partnership, Founder/CEO, Social Impact Investor

“Lloyd Sederer is a brilliant psychiatrist and a compelling writer. Caught in the Crosshairs of American Healthcare is a deeply personal account of how one of the nation’s premier institutions dealing with serious mental illness went from near collapse to a restored and revitalized identity. Part memoir and part deep analysis, honest and insightful, it is indispensable for those who care about our broken mental health system.” 
—Norman Ornstein, Emeritus Scholar, American Enterprise Institute

“American healthcare has needed fixing but the now-dominant, for-profit, corporate-driven cure is making matters worse, in ways we all feel as patients, families, and clinicians. Sederer tells a wise and cautionary tale using a Harvard teaching hospital as a case study of how to survive without losing your integrity and soul. Don’t miss reading Crosshairs.”
—Siddhartha Mukherjee, MD, MS, Pulitzer Prize-winning author of The Emperor of All Maladies, The Gene, and The Song of the Cell

“In Caught in the Crosshairs of American Healthcare, Dr. Sederer, using clinical vignettes and explanatory narratives, brilliantly tells the story of saving McLean Hospital when he was its Chief Medical Officer and EVP. He teaches us that despite the now prevailing, noxious corporatization of American healthcare, a paradigm of clinical and cultural rebirth can preserve the integrity and humanism of modern medicine. A must-read.”
—Andrew L. Chen, MD, MS, Chief Medical Officer, USA Nordic; Olympic

“Dr. Sederer models a rare combination of clinical expertise, executive savvy, eloquence, and old-fashioned compassion as he recounts a dramatic story of leading clinically necessary change in a revered but fraying hospital. This book should be required reading for anyone who wants to understand transformational leadership.”
—Donald M. Berwick, MD, MPP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement 

“What happens when a venerable old hospital must come into modern healthcare or die? Caught in the Crosshairs of American Healthcare tells the story. Sederer had been hired to help prevent the renowned McLean Psychiatric Hospital from closing. The corporatization of medicine was engulfing it with drastic cuts in payment and it was on a downward spiral of losing money. It wasn't as impossible a task as it might have been, though, because Sederer knew that McLean's long-term model of psychiatric care was counterproductive. What worked in psychiatry was rapid medical treatment, family involvement, and team care. It took six years but, in the end, McLean succeeded, and today the beautiful old hospital is still open and has maintained its unique place in psychiatry, with the triple mission of clinical care, training, and research. We need more of such successes.”
—Victoria Sweet, MD, PhD, best-selling author of God's Hotel and Slow Medicine

“Most of us want to relate to healthcare on the most personal of terms—'seeing’ the doctor in moments intimate and private. In Caught in the Crosshairs of American Healthcare, Dr. Sederer reveals the interlocking system of for-profit corporate policies and practices that makes us feel small, alone, and helpless. He uses a case study of saving a Harvard hospital, where he was Chief Medical Officer, by providing science-based clinical care so that patients, like you and me, families and hospitals too, come first—not profits.”
—Monsignor Donald Sakano, priest, Archdiocese of New York

“Lloyd Sederer is not only one of our nation’s most storied public health psychiatrists, he is a masterclass storyteller. Sederer spins the tale of the near-sinking of the famed McLean Hospital in the wake of managed care’s torpedoing American healthcare and its rescue by instating research-backed clinical models of care. An illuminating book for anyone concerned about people suffering from psychiatric illnesses and the ideas and forces shaping their care.”
—Lisa Gornick, PhD, author of Ana Turns and The Peacock Feast

“Psychiatrist, problem solver, prolific author, and captivating storyteller—that’s Dr. Lloyd Sederer. Caught in the Crosshairs of American Healthcare—Lloyd's fourteenth book—is the story of how corporate, profit-driven insurance companies now dominate American medicine, to the detriment of patients, families, and hospitals. He uses a Harvard teaching hospital where he served as medical director as a case study of how to survive, then prosper, holding to compassionate, accessible, equitable, and science-based care.”
—Lipi Roy, MD, MPH, FASAM, physician, national addiction medicine expert, and media medical commentator

Editorial Reviews

2024-01-29
Sederer recalls his fight to save a foundering mental hospital in this searching memoir.

The author, a former New York City mental health commissioner, recollects his 11-year stint, starting in 1989, as chief medical officer of McLean Hospital, Harvard University’s psychiatric teaching hospital and an institution storied for treating celebrities and poets. The hospital was hemorrhaging money; McLean’s model of monthslong inpatient stays, centered on psychoanalytic talk therapy, was too expensive—and medically ineffective, the author contends—to survive. Sederer introduced a radically different acute-care model based on two-week stays, during which doctors stabilized patients with the help of psychiatric drugs before discharging them for long-term outpatient care. The shift enraged the hospital’s more entrenched attending physicians; they were further miffed, the author asserts, by initiatives to expand the hospital’s services and bring in more patients, all of which meant more work for them. Much of the book is an intricate study of managerial change, with Sederer describing how he built his executive team, cultivated his board, and eased out opponents. He also recaps colorful psychiatric cases, including that of a doctor who eloped with a manic-depressive patient, necessitating a police manhunt. The author offers a biting critique of corporate medicine’s fixation on profits over patients while advocating for a more streamlined, cheaper, more pharmacological, and less Freudian psychiatric paradigm. He also attacks what he considers bad practice: Sederer opposes psychoanalysis for psychotic patients (he says it can destabilize them), calls for simplifying complicated drug regimens, and frowns on restraining and sedating patients. The author’s lucid, plainspoken prose makes medical issues accessible to laypeople while conveying the drama of McLean’s bitter office politics. (One attending physician “sat at his rather empty, big old oak desk, squarely facing me. He said I would fail, that I would be out of McLean in disgrace in short order, too. I said nothing in response. It was a brief meeting.”) Doctors and casual readers alike will find interesting food for thought here.

An absorbing insider’s view of upheavals in mental health care that explores the human impact of cold economics.

Kirkus Reviews