I have had the privilege of working at an organization which is actively improving the lives of its members and also was mentioned by the President as a model for the nation. Over the past few years.
I have also demonstrated to first year medical students what 21st century primary care should look and feel like – a fully comprehensive medical record, secure email to patients, support from specialists, and assistance from chronic conditions staffBut as my students know, there are also some suggested reading assignments. I’m not talking about Harrison’s or other more traditional textbooks related to medical education. If the United States is to have a viable and functioning health care system, then it will need every single physician to be engaged and involved. I’m not just helping train the next group of doctors (and hopefully primary care doctors), but the next generation of physician leaders.
Here are the books listed in order of recommended reading, from easiest to most difficult. Combined these books offer an understanding the complexity of the problem, the importance of language in diagnosing a patient, the mindset that we can do better, and the solution to fixing the health care system.
Patients with the same illness are getting more costly medical care in certain parts of the country but actually do worse. The amount of medical care delivered is driven by the number of specialists, hospitals, and technology available in the community. The more doctors and hospitals add new services and technology the more likely those expensive services are used regardless of whether patients need it but because the providers can get paid for it. When organizations and committees try to set up guidelines or do research to see if current therapies are effective, special interests and politics kill the initiatives.
Hospitals focus on generating more business in departments which are profitable, like oncology, with newer buildings and the latest medical equipment so that they can afford to run emergency departments which continually lose money. Doctors and patients are enamored with the latest treatments and interventions which often are far more expensive, aren’t better than existing therapies, and like the case of bone marrow transplant for metastatic breast cancer patients, are more lethal.
The pharmaceutical industry is intimately linked to doctor education and invariably influences which prescriptions are prescribed and market prescription medications as easily as consumer companies promote common household products. It is money not science that drives the healthcare system.
The author believes that solving the dysfunctional healthcare system requires that doctors and hospitals align themselves into integrated healthcare organizations like the Mayo Clinic, Kaiser Permanente, and the Veterans Health Administration. Unfortunately, however, because she makes such a compelling case of how each of the various providers and businesses each have a financial self interest to keep the current system going at the detriment of patient care, it is difficult to see how the transition will occur, if ever.