Robert Pretzlaff, MD MBA, is currently Chief Physician Executive and President of Dignity Health in Nevada.
Prior to this position Dr. Pretzlaff spent 20 years as an academic pediatric critical care physician, with the last 12 years as the Chief of Pediatric Critical Care at the University of California Davis Children’s Hospital in Sacramento, California.
Robert began his education with a Bachelor’s degree in Philosophy from Michigan State. Followed with a Master’s degree in Biology at Wayne State University, in Detroit, and his Medical degree from the Wayne State School of Medicine. He completed Pediatrics training at the University of Michigan, and additional training at pediatric critical care at Children’s National Medical Center in Washington DC. Robert also earned a Masters in Business Administration from California State University, Sacramento.
Dr. Pretlaff took a faculty position at the University of California Davis, rising to the position of Chief of Critical Care Medicine for the Department of Pediatrics for the UC Davis School of Medicine.
He has authored or co-authored 28 journal articles and 6 book chapters.
Dr. Robert Pretzlaff is also an experienced public speaker and lecturer at the national, regional and local level.
FULL BACKGROUND AND BIBLIOGRAPHY
The author is a physician and senior healthcare executive who has been a clinician, teacher and academician over his more than 25 years in the profession. In his current position as Chief Physician Executive and president of the Dignity Health medical group in Nevada, he leads a medical group with over 40 providers and a clinically integrated network of over 750 physicians in the Las Vegas Valley. In this position he leads the transformation to population health care for Dignity Health in Nevada. Prior to this position Dr. Pretzlaff spent 20 years as an academic pediatric critical care physician, the last 12 years as the Chief of Pediatric Critical Care at the University of California Davis Children’s Hospital in Sacramento, California.
After receiving a Bachelor’s degree in philosophy from Michigan State University, Dr. Pretzlaff went on to earn a Masters degree in Biology researching the genetics of aging at Wayne State University in Detroit, Michigan. Following his Master’s degree Dr. Pretzlaff earned his Medical degree from the Wayne State University School of Medicine. He then completed his pediatrics training at the University of Michigan and trained in pediatric critical care at Children’s National Medical Center in Washington, DC. While completing his fellowship he did further basic science research training at the National Institutes of Health in the laboratory of Dr. William Gahl. As his career evolved into larger leadership roles he earned a Master’s in Business Administration from California State University, Sacramento in 2012.
Transitioning from basic science research to research in ethics and medical decision-making, Dr. Pretzlaff took a faculty position at the University of California, Davis. While at UC Davis Dr. Pretzlaff rose to position of Chief of Critical Care Medicine for the Department of Pediatrics and Associate Professor of Clinical Pediatrics for the UC Davis School of Medicine.
He is the author or co-author of 28 journal articles and six book chapters on topics ranging from basic and clinical science to publications on bioethics, law and medicine, and healthcare finance. Recent published articles include an article on healthcare financing, Markets and Health in the Physician Executive Journal, a book chapter on legal issues in medicine, Legal Considerations in Pediatric Critical Care in the book of Comprehensive Critical Care, and a chapter on medical decision-making, Effects of Stress, Language and Culture on Decision-making in the Critical Care Environment in the Psychology of Decision Making, and the short article Moral Choice in Public Policy in the Encyclopedia of Medical Decision Making.
Dr. Pretzlaff is an experienced public speaker and lecturer on the national, regional and local level. He is frequently called on to speak on educational and issue related topics to large groups and small, on camera and off. He has authored, produced and narrated multiple training and educational videos, and recently found himself in Marie Osmond’s ‘Music is Medicine’ video.
The co-author for the story, Elen, is the mother of the subject of the study. She is a mother, teacher and diarest. She is a dedicated professional who has worked with youth and children her entire life. Elen is presently a high school teacher of Spanish, and holds a Masters degree in Transpersonal Counseling. She is devoted to elevating the people she works with spiritually. She is a woman of strong Catholic faith. Most importantly she is the person who was literally at Prisma’s side throughout her life-threatening illness, recovery, rehabilitation and shared each of her daughter’s struggles.
“It’s an unbelievably complex subject. Nobody knew health care could be so complicated.”
Donald J. Trump
The rejection of the Affordable Care Act (ACA), as evidenced by the recent “debate” in congress, reveals the understanding by many that healthcare in the US is badly fractured. However, despite inarguably being the most wealthy nation in the world, we have created the world’s costliest healthcare that provides its citizens care barely worthy of a third world country. This state of affairs is a product of decisions made over the past 80 years and has resulted in healthcare spending that is 17.6% of GDP and costs greater than $8000 per person/year. A level more than twice that of other leading industrial nations. Though in composite measures of quality and access the US ranks 37th in the world. Poor care at high cost is evidence of a failed system, and dollars spent on healthcare are not available for other uses. These are poorly spent dollars that compromise not only the nation’s health, but the ability to support the nation’s education, infrastructure and security. Ultimately, healthcare is a moral issue as much as an economic one, and the care a country provides it’s people is a reflection of its values, resources, policies and politics.
The practice of medicine is about caring for people. The title, “My Side of the Bed,” refers to a scene played out daily in a pediatric intensive care unit of a physician and parent discussing a critically ill child’s care and condition over the unconscious figure lying in the bed between them. Differences in knowledge and understanding, differences in hopes and goals create a void that must be crossed to create a bridge of understanding that is necessary to provide care. In our story the voice of the patient is provided by Elen, Prisma’s mother, who provides the human dimension of what it means to be sick. Elen’s journal entries provide the context to reach a greater understanding of the impact of being critically ill. It is the thread of Prisma’s illness and her day-to-day journey that will highlight the complexities and uncertainness inherent in clinical medicine. ‘My Side of the Bed’ is also a metaphor for the debate about the future of healthcare. Differences that create the divide between physician and parent similarly exist between the different sides of the healthcare debate. An improved understanding of what can be done and what cannot be done, what is knowable and what is not will better inform the debate as this country struggles with the question of what care should be provided, and at what cost.
The aim of this book is to provide a greater understanding about health and healthcare as a prerequisite for moving our ceaseless debate from chaos to care. It is my hope that as a physician and healthcare executive I can outline the overlooked, and yet elemental, components of healthcare to reset the conversation in a productive direction. This book will provide the reader an understanding of medicine at multiple levels. First, as an exploration of the moral, economic and political issues that are the foundation of a nation’s healthcare system. Second, as an examination of what it means to care for patients from the voice of those who deliver that care. This book fills a void in the current literature on the inadequacies of healthcare as it connects the complexities of healthcare delivery with the medical context and perspective of the patient. The creation of a solution to improve the health of our country will necessitate replacing ignorance with understanding.
A further theme of this book is that the healthcare a country provides its citizens is as much a moral question as it is an economic one. In the certain knowledge that we are all patients, ‘My Side of the Bed’ is written to provide the reader a greater comprehension of medicine and its impact on those who deliver it and those who receive care. ‘My Side of the Bed’ is written to serve as an introduction to the issues that make up the dynamics of healthcare delivery. Debating healthcare in the abstract without having knowledge of its complexity results in a debate that is superficial and inadequate to solving the chaos that exists. Whether by accident or design our current national conversation obscures the fact that the most expensive healthcare in the world fills the purses of those with a stake in the system as it is. The ideas expressed in this book will light a path to providing care that is better and less expensive, and is based on the simple recognition that health is cheaper than illness.
October 25, 2008
Last night I had to decide on whether to send Prisma to U.C. Davis. Dr Crucio recommended she go because they have better pediatric care. As dramatic and repetitive as he was, Noel Crucio was up front, and informative. So, I decided that it would be best for Prisma to go, even though the risk of transport scared me. I went with the transportation team in a Molokai’i type plane, small, single engine, just enough room for Prisma and her team. Prisma was well monitored and cared for. I remember not breathing when they took her with all her equipment and had to put her into the plane by turning the stretcher. There was one woman just on the respirator, and at least four other persons monitoring her as she was put into the plane. It was jam packed. I sat last on the right, and the aisles were very close together. I felt very confident in the way she was cared for, and had no idea what the next minutes, hours or days would bring.
I am glad she was moved to UC Davis. She was moved to the Intensive Pediatric Unit. It was incredibly busy getting her from the plane to the unit. The unit staff what seemed like 20 people took her from the transport team, and in a maze of glass doored and walled rooms, Prisma was transferred from airplane stretcher to her room. Prisma was fairly calm throughout the transfer. I had no idea how long she would be, or what would happen to the life I knew; my job, my house, my pets. I just stayed present in every moment, and prayed more than I have in my entire life. I was told that three more tubes would have to be inserted into Prisma’s pleural cavity. The pneumonia has spread to Prisma’s left lung. They did a C.T. scan this morning, and you can see the whiteness of her right lung which is partial pneumonia/partial fluid. With this C.T. scan, Dr. Lu said they can see more clearly what to remove. I’m again asking God to protect her, so there are no complications, and so that the infections stop, pneumonia doesn’t spread, no bleeding and no big incision! It could spread, but God won’t let that happen! I am afraid, but calm at the same time. I really trust that Prisma will be o-k. I know God won’t let us down and knowing this has helped me to be very positive.
My Mother, Joyce and Sister, Mare came as we came at about 6:30 p.m. We didn’t get to U.C. Davis until 2:30 a.m, and my Mother and Sister at 4:30 a.m. They slept in the car and I in a chair. I slept for about three hours.
Today is a big day. Prisma will be undergoing a Video Assisted Thoracotomy (VATS) procedure. She has edema-puffiness everywhere, and empyema (an infection in her pleural space. I pray this procedure will clear her up.
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