Monday, April 28, 2008

Book Review - A Little Book

I wish to acquaint you with my little 38 page book Navigating the Maze of the Health Coverage & Access: A Quick Guide for Physicians (, 800-067-7790).What follows are the book’s introduction and table of contents.


“The pernicious aspect of this cry for universal coverage is that it is too easy for politicians. The hard work is getting at the underlying inefficiencies in the health system, the perverse incentives that have everybody in the dark.”

Joseph Antos, PhD, Health Policy Expert, The American Enterprise Institute, “Coming Soon: Health Care Debate, Part 2,” New York Times, March 2, 2008

This little book contains 20 quick takes on health reform for doctors and patients. I present it as questions and answers on leading reform issues of today. This small manual is not intended to be exhaustive or inclusive, but rather to be instructive. Despite the 20 topics covered herein, the book lacks 20/20 vision.

The health system is complex. This book is simple. It follows Kipling’s instructions. Write on the Whats, Whys, Whens, Hows, Wheres, and Whos.

I keep six honest serving men
(They taught me all I knew)
Their names are What and Why and When
And How and Where and Who

Rudyard Kipling, 1865 - 1936
The Just-So Stories (1902), The Elephant’s Child

I do not pretend to be an expert on all reform issues, but I have learned a thing or two while writing three books over the last three years – Sailing the Seven C’s of Hospital-Physician Relationships, Voices of Health Reform, and Innovation-Driven Health Care.

The health system is more complex than it need be. The system, which critics insist on calling a “non-system,” is, in many ways, the worst of all possible worlds - a bewildering mix of arcane government rules, Byzantine private red tape, obstructive legal entanglements – and, for patients, waiting, waiting, waiting, not knowing what to expect.

An April 5, 2008, New York Times story, “In Massachusetts, Universal Coverage Strains Care”, reports that some patients must wait over a year for a physician in a primary care doctor’s office. And this in a state with more doctors per capita than any other state. Project this picture to states with far fewer doctors, and you begin to appreciate the magnitude of the universal coverage problem.

I believe in intelligent informed consumers and commonsensical doctors, acting together and deploying user-friendly Internet engines – Sermo, Google, Wikipedia. The three have exploded in growth over the last two to ten years and will galvanize reform. Information technologies will help lead the way out of the health reform wilderness.

Nobody is closer to patients than doctors. Together, with the help of electronic communication, redesigned practices, and more and better paid primary care doctors, patients and doctors will prevail.

Although I look at computer-generated information as a powerful transformative force, I do not believe in the Internet as the do-all and be-all. Doctors’ offices need broad band access, but they do not need electronic medical record systems with all the bells and whistles and the $50,000 per doctor investment required to install and maintain them.

Nor should every doctor aim for a “paperless” office. Canadian pulp manufacturers are doing more business than ever, thanks to paper downloading of Internet files. Much talk about health 2.0, and health 3.0, is sheer balderdash, geekspeak and cyber-chutzpah.

Paper has its place in the form of small manuals, check-off lists, and management modules. Besides, as Dr. Daniel Pallestrant , founder of Sermo, has observed, a computer in the same room situated between a doctor and a patient changes the human chemistry between the two. Some things are best expressed through the head of a pen rather than the click of a mouse. Computers are not magical machines. They are human tools.


Chapter One HEALTH 2.0 1

Chapter Two SERMO 2

Chapter Three GOOGLE 4

Chapter Four WIKIPEDIA 5




Chapter Eight TRANSPARENCY 13

Chapter Nine PATIENT SAFETY 15



Chapter Twelve THE UNINSURED 21

Chapter Thirteen EMRS AND PHRS 23

Chapter Fourtee RETAIL CLINICS 25

Chapter Fifteen ACCESS 27

Chapter Sixteen HARD TRUTHS 29

Chapter Seventeen HEALTH PLANS 31

Chapter Eighteen BIG PHARMA 33

Chapter Nineteen ENGAGING PATIENTS 35

Chapter Twenty MEDICAL TOURISM 37

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