Pros: A lot of very useful information
Cons: Some one-sided information; VERY dry at times
Rating: 4 out of 5
Review book courtesy of Lisa Roe.
The US healthcare system is broken—I don’t know of anyone who disputes this idea. Patients are getting less time and attention; costs are going up; meanwhile, doctors are getting lower reimbursements and having greater demands placed on them by insurance companies if they want to keep what reimbursements they’re getting. In this system, everyone loses:
To provide health care, one needs to balance three interrelated factors: access, cost, and quality. The unfortunate truth is that only two of the three can be optimized. … The worst scenario would be to provide limited access and low quality at a high cost. This, currently describes our healthcare system.
It’s nice and all to talk about what the ideal healthcare system might be, but the unfortunate truth is that as patients, we need to concentrate on making the most of what exists right now. And that means being educated about what our options are, how best to take care of ourselves, and how to best make use of the healthcare resources available to us.
This is what Dr. Davis Liu set out to do in Stay Healthy, Live Longer, Spend Wisely—educate us as to how best to take advantage of the current, flawed health care system.
There is a great deal of information in here; I’ll give you a brief run-down on it. Dr. Liu starts out by tackling health insurance—why it’s so important, and what your tradeoffs are for different levels of cost. He discusses HSAs as well as more traditional plans. Unfortunately, while this is important stuff, it’s incredibly dry. By leading off with it, he may well cause some folks to put down the book before they even get started. As it was, it took me months to finish this book largely because I kept not being able to slog my way through this section.
Part two covers “mastering the ten-minute doctor office visit.” Since we get so little face-time with doctors these days, it’s important to make the most of it. Simple techniques like making sure your doctor has your medical history, having an “establish” visit with her early on, and having a clear agenda upon each visit can maximize your doctor’s ability to help you in the time you have together. Dr. Liu does a great job of detailing these techniques.
Part three is all about doing your part to stay healthy. It details recommended guidelines for when you should get various screening tests, immunizations, etc. This is meant not just to ensure that you get the proper tests, but also to keep you from wasting your time, money, and energy on visits and tests that won’t have any practical value for you. For example, the traditional view that we all need a yearly physical is changing—studies have found that these visits don’t tend to uncover anything useful. We’re better off going in when we have problems or need specific screening tests.
Part four details the typical types of doctors you might deal with, from generalists to specialists. This will help you to understand the qualifications of your doctors, what they’re capable of, what training they’ve had, what they can help you with, and so on. It also tells you about Physician Assistants and Nurse Practitioners—two types of medical professionals you’ll be more and more likely to run into now that fewer doctors are going into general medical practice.
Part five talks about medications. It covers the harsh truths about pharmaceutical companies and their marketing techniques, and how this affects your decisions, doctors’ decisions, and your treatment. For folks who don’t already know about this sort of thing, it can be a real eye-opener.
Part six is a round-up of topics labeled “buyer beware.” It covers a new trend for wealthier patients called “concierge care,” body scans (which are becoming trendy), herbal and dietary supplements. One of the things I like about this chapter is the open, straightforward tone to it. Dr. Liu doesn’t scoff at new things just because they’re different; nor does he champion them just because they’re new and exciting. He has a very even-handed and open-minded approach to things, and is big on doing your homework, weighing your costs and benefits, and making the right decision for yourself.
Part seven discusses some new and emerging trends in patient care such as the use of hospitalists and group visits, providing you with information that will help you decide whether and how to take advantage of these things should you be given that option.
Part eight discusses the fact that the best way to reduce your health care concerns and costs is to take care of yourself and your health—eat well, get exercise, avoid things like cigarettes and excessive alcohol, and take simple precautions like buying a safe car (as Dr. Liu points out, “In 2002, the death rate for motor vehicle accidents was triple the HIV death rate and 60 percent of the breast cancer death rate”).
Most of this information is spot-on helpful, extremely well-balanced, and absent of obvious agendas and biases on Dr. Liu’s part. However, there’s one thing that caught my eye early on that got my back up a bit and it took me a little time to set that aside, so I wanted to talk about it here. Toward the end of the book Dr. Liu mentions the recent trend toward “evidence-based medicine”—medicine based on proven techniques and studies rather than trial and error or traditional cures. He does briefly bring up the fact that not everyone suits these models.
Now, early on in the book he mentions that it was found some time ago that surprisingly few doctors and hospitals were actually following major recommended guidelines regarding treatments, procedures, and follow-up treatments (i.e., this evidence-based medicine—which I’ve also heard referred to as “population-based medicine”). How did insurance companies solve this? By offering financial incentives to doctors for following recommended guidelines. Dr. Liu seems 100% enthusiastic about and delighted by this and it’s one of the very few things in the book that’s depicted as having no real down-sides.
Unfortunately, I’ve seen the negative sides of this all too often, and they’re two-fold. Some “ethically challenged” doctors who care more about financial incentives than about their patients will ignore the fact that some patients don’t fall into those population-based models and try to force treatments on them that they don’t want. I know of a diabetic who, after quite a bit of research and a second opinion, decided he really didn’t want to be on Statins. His doctor threatened to report him to his insurance company as non-compliant, which would have reduced or threatened his coverage. When he explained that he was well aware of the financial incentives involved and that he had no compunctions about involving his lawyer, she backed down—and he found a new doctor.
Then there are the ethical doctors who don’t want to give their patients unnecessary or unwanted treatments, but who face having their reimbursements reduced if they don’t match certain treatment quotas. These days general practitioners actually make a surprisingly small amount of money from reimbursements given the kinds of medical school debt they rack up, so this is a tough spot to put them in.
This population-based medicine makes sense if you assume good judgment will be tempering it (and that there’s no chance of pharmaceutical companies muddying the water by finding ways to affect what an insurance company offers incentives for), but financial incentives are just about the worst way I can think of to inspire good judgment. I’m rather surprised, given his level-headedness in other areas, that Dr. Liu didn’t seem to see this.
Overall, I do recommend this book if you would like to become well-informed about your healthcare options and how to make the most of them. My only real reservation is that it’s dry enough at the beginning and pitched at a high enough intellectual level that many of the people who could really benefit from it won’t end up reading it.
Appreciated the thoughtful review. I am quite aware of the potential pitfalls for evidence based medicine that some doctors may be driven to put patients into a category that they don’t fit in. However, I would also note that not having any guidelines or treatment based on theory and not proven (note high-dose chemotherapy followed by bone marrow transplant for late stage breast cancer, all the rage a few years ago, was shown to kill more women than the illness it was supposed to cure) is far worse.
As you recall from the book, a large number of patients don’t get the basic preventive care they deserve often because the doctor doesn’t remind them. Is compensating doctors for practicing evidence based medicine the way to go? Time will tell. Asking doctors to simply do the right thing in the past unfortunately didn’t work.
For your contact with diabetes, what was described was highly unusual. I would however, recommend reading this article as the number one cause of death for diabetes is heart attack / heart disease. http://www.nytimes.com/2007/08/20/health/20diabetes.html?_r=2&oref=slogin&oref=slogin
Best wishes for good health,
— Davis Liu, M.D.
You are right – a large number of patients don’t get the basic preventive care they deserve often because the doctor doesn’t remind them. There is a trend I am seeing, however, more and more patients are turing online for care or at least to get their general medical questions answered through various online consultation resources. I wonder if this will be a wake up call to doctors who might otherwise loose their patients to those who are more accessible.
everyone hates going to the doctor. I know I wait until I am in dire pain until I give in and go. I have tried to self diagnose online before and it has helped. Not that it should replace consulting your doctor, but it’s easier to have an idea of what could be wrong and have whatever questions you have prepared before going. this insures that the small amount of time you have with your doctor will be the most productive.
Sounds like an interesting book with some good points, all of which make me even more convinced that everyone needs to know what their Health Care Options are. A lot of us don’t even get to the stage of working with doctors effectively, we’re still trying to sort out the right kind of health insurance to get. And it’s more important than ever right now, considering the options we might be faced with after election day.
Sometimes doctors tend to ignore your health problems, this happens in poor countries where doctors doesn’t get paid well enough, so relying on your doctor to diagnose your problems is not always a good idea, the best solution would be to combine both doctor’s answers and your own, researched answers to your health problem.
As a vet, I receive excellent health care from the VA. I should have opted for this form many years ago but I struggles with my thoughts that government health care was all “bad” and private health care is all “good”. Well, I found out that at least with VA health care there is a very large lot of “good” when it comes to government health care. Perhaps this is only for the vets and because of the culture of the VA – caring for the vets – the high level of care actually blew me away. But, is there a possibility that this culture could be carried over all while assuring health care providers are adequately compensation? I guess we’ll find out under Mr. Obama, won’t we?
There was a time that the care at the VA was second rate. Nevertheless over the past few years the medical care and service provided is as good as and often better than that of private insurance. Read the FORTUNE article – http://money.cnn.com/magazines/fortune/fortune_archive/2006/05/15/8376846/index.htm which profiled the dramatic cultural change at the VA.
It is clear that integrated organizations like the VA, where doctors are salaried, work together to the benefit of the patient, and surrounded by information technology provide superior care than those in the community who compete against each other for business and use their own proprietary computer systems or paper charts.
While I understand the clear advantages of an integrated healthcare delivery system like the VA, I am unfortunately very skeptical that the level of reform needed to move to that direction is too difficult even for the best presidential leader.