Monday, July 3, 2017

Distracted: A Book Review


Distracted
 
Distracted: How Regulations are Destroying
 the Practice of Medicine and Preventing
 True Health-Care Reform
By Matthew Hahn, M.D.
Skyhorse Publishing, 206 pp., $24.99
Print ISBN: 978–1-5107–1511-0
Ebook ISBN: 978–1-5107–1513-4
By Michael D. Shaw June 26, 2017
 
Modern day country doctor Matthew Hahn, MD applies his scalpel to much that is wrong with American healthcare in this excellent new book. Clearly, it takes a physician who is on the front lines to gain such perspective. We’re talking about a small staff; and plenty of patients with inadequate insurance, limited financial means, and a host of chronic conditions. No wonder Hahn’s practice carries the motto “A new way to practice old-fashioned care.”

Hahn laments that “The once great American healthcare system has fallen seriously ill. Millions of Americans are suffering the consequences.” In the book’s introduction, he lays out the all too well-known symptoms:
  • Too many patients have limited or no access to medical care.
  • American healthcare costs too much.
  • American healthcare is poor-outcome healthcare.
These symptoms may be well-known, but despite massive efforts to fix them, they are only getting worse. Hahn states one of the biggest reasons why: “More and more, doctors and nurses fight not against disease, but against a rule-crazed administrative system hell-bent on wasting their time and denying patients care. They are…forced to focus instead on compliance with an ever-expanding universe of pointless rules and regulations devised by bureaucrats and administrators who have no idea what they are doing and little regard for the consequences of their actions.”

The practice of medicine, providing care to patients, has been shoved aside, replaced by a sea of distractions.” Thus, the incisive title. In each chapter, Hahn provides exhaustive detail, along with recommendations on how to fix the problems. He throws down the gauntlet early:

It is not really ‘healthcare’ that is failing—what is failing is the administration of health care. [I]t is necessary to distinguish healthcare, referring to the doctors, the nurses, the diagnostics, the treatments, and the patients, from healthcare administration—referring to the government bureaucrats and health insurance executives and administrators, the bureaucracy they have created, and their heavy-handed and ineffective methods. That is at the root of what is sickening our healthcare system.”

Where the rubber meets the road on how healthcare administration interacts with healthcare providers, is via the universally despised electronic health records (EHRs). Hahn devotes an entire chapter to EHRs, and riffing on the oft-criticized “Meaningful Use” program, he calls it “Computerizing Medicine—Meaningless Use.” As it happens, Hahn was involved in the development of an EHR system, which he uses in his own practice, and that has been commercialized. To be sure, he criticizes EHRs, but during my interview he offered these thoughts (which are covered in the book):

With good EHR systems, doing the things that I know they are capable of, American healthcare could move forward light years very quickly. To right what is wrong in computerization, we really need a national system. We need to start over. We need to have a competition to find the ‘great usable system’ and make it available to anyone who wants it—at low cost.”

Since EHRs are at the very heart of the system, Hahn’s ideas on this subject are among the most important in the book. Indeed, his two biggest overall precepts are streamlining the payment system, and vastly improving EHRs. He doubts that any reform can occur without both of these taking place.

Other chapters are devoted to health insurance and proposals to measure quality of outcomes. As to quality metrics, Hahn is on-board, but notes that must change. Is it fair that he can be judged on how well he controls the blood pressure of elderly patients, when their insurance denies coverage of basic generic blood pressure meds? How fair would it be if the meds were covered, but they did not take them on a regular basis? Indeed, what about the entire aspect of patients actually taking some ownership in their own health? A physician can only browbeat so much.

In an avalanche of books telling us what is wrong with healthcare in America, Distracted is one of the good ones. I give it my strongest recommendation.

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