Monday, May 10, 2010

Reece’s Pieces – May 10 Medinnovation Blog, Book Review: Obama, Doctors, and Health Reform

Preface:The following book review appeared in the May issue of Connecticut Medicine. Its author, Edward J. Volpintesta MD, is an expert on the toils and troubles of primary care. He frequently contributes to national health care and business publications.

Obama, Doctors, and Health Reform: A Doctor Assesses the Odds for Success, 308 pages, $21.95, IUniverse< new York, 2008, ISBN-10, 1440146764, ISBA-13m, 978-1440146763

For most doctors, and certainly most lay persons, the debate on health care becomes daily more confusing. And why not? The hodgepodge of reports appearing in the newspapers, on the radio, and on television come from federal and state agencies, academic medical centers, medical societies, insurance companies, and concerned individuals from all walks of life is mind-numbing. Often, the result is “statistics fatigue” brought on by the endless litany of numbers and percentages that vested interests report as they strive to impose their opinions and achieve credibility and dominance.

Dr. Reece takes on most of the issues in his book and puts them into context in simple language. There are no complex academic arguments in the book’s 291 pages which are divided into 41 chapters. To his credits, the author presents a balanced and objective look at both sides of the many arguments informing the national debate. The format is a compilation of essays and opinions that explain why transforming the health system reform will is difficult. Anyone interested in health care will learn something from it. Physicians will find the information in it helpful when discussing health care reform with patients. Physician advocates, when preparing for interviews by members of the media will also benefit from the concise presentation of the critical issues and conflicts involved.

Among the numerous topics discussed is the shortage of primary care physician which might be reversed by paying them more, thus attracting more students to primary care. But, also mentioned, and aptly so, is whether there might be other factors besides money being, as the author put it, the “turn-off” for primary care. This is a quintessential question that has been ignored. It should be addressed.

The author included a comment by Mr. Timothy Norbeck, a past executive director of the Connecticut State Medical Society and current director of the Physicians’ Foundation. A physician survey of 12, 000 physicians most of who were primary care physicians showed that primary care doctors were demoralized and frustrated because “the paperwork and red tape hassles” in their daily work did not give them enough time to spend with patients. Is it any wonder that so few students are entering primary care?

The chapter on electronic medical records (EMR) makes it clear that although they have the potential to make data easily retrievable, serious breaches of patients’ confidentiality remains a serious problem. The start-up and maintenance costs are prohibitive for many doctors. Dr. Reece points out that significant number of physicians discontinue using EMR. Another side effect is that EMR could be used to monitor and control physicians’ behavior and even make serious misjudgments of their competence. These issues need further study.

The benefits of large clinics like the Mayo Clinic where doctors are salaried and not paid for the number of procedures and patients they see, but rather for the total care of the patient, are discussed; but I was happy to see that the question of whether demographics also play a critical role in the much-touted efficiency of the Mayo clinic.

The future of the “medical home”, health savings accounts, and the spread of physician blogging sites and how they have changed the way doctors communicate with each other and their organizations are other examples of the numerous topics discussed.
In a telling interview, the CEO of the Texas Medical Association explained that it managed to get a $250,000 cap on pain and suffering because the association worked hard on its grassroots network and maintained a close relationship with its county medical societies.

The book’s encyclopedic approach is ambitious but its direct, non-academic style
makes it readable both for members of the public and for physicians.

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