Recently, I blogged about a new book that tackles the US healthcare system. Nathan Moore, a co-author of the book and current medical student at Washington University in St. Louis, Mo., was kind enough to take some time away from his studies to tell me more about The Health Care Handbook.
TheONC: You're a medical student at Washington University. What do you intend to practice upon graduating? What made you decide that you wanted to be a doctor?
Nathan Moore: I'm planning to go into internal medicine, likely primary care. I don't know if there's just one thing I can point to that made me decide to become a physician, but I really enjoy the mix of problem solving, research, and helping others.
TheONC: Why did you and Elizabeth Askin decide to tackle the US healthcare system?
Moore: Both Elisabeth and I struggled for years on our own to understand the healthcare system before we started medical school. The US healthcare system is incredibly complicated, but it's also incredibly important. It accounts for a sixth of our GPD and a tenth of employment in the US, so having a fundamental understanding is really important for those who work in the system. We had both been looking for neutral, easy-to-understand book that covered the basics of the whole system, and we were both surprised when we couldn't find one. We basically set out to write the book that we wanted.
TheONC: Why did you decide to publish the book in an electronic vs. traditional format?
Moore: We're publishing a physical version too (our paperback will be out in a couple of weeks; sign up on healthcarehandbook.com to be notified when it's ready) but we thought it was important to have an eBook because so many healthcare providers and students have moved towards that format. It's easy to update and sell and it saves a few trees along the way. However, I don't own an eBook reader, so I wanted to make a paperback too so I could read my own book.
TheONC: As you researched this book, what were the three biggest things you learned (in regards to being a future clinician) that surprised you about the US healthcare system?
Moore: Phew, that's a tough one... there were so many. I think the first would be that's there's no real US healthcare "system"; there's about seven of them. You've got the VA [Veteran's Administration], which is government-funded and provided; Medicare, which is a government-funded, privately provided; private hospitals and clinics; the Department of Defense; S-CHIP and Medicaid... the list goes on. Each mini-system has its own structure, rules, pros and cons, and set of issues.
Second, I was learning about the medical device industry. It's become a huge (and hugely important) industry in the healthcare field but most healthcare providers learn very little about it. For example, the vast majority of medical devices are approved by a process that's far more lenient than that for new drugs. Considering how prevalent medical devices are (think of pacemakers, knee replacements, MRI machines, etc.) it's somewhat unnerving.
Third, was actually how complex and convoluted the nursing system is. Trying to simply understand the different ways that nurses are educated and licensed took me about a week of research. Luckily I was able to learn from the dean of our local nursing school and Patricia Potter (author of Basic Nursing, among other books), who really took the time to explain the ins and outs to me. We're now working with the nursing school to develop an interdisciplinary education so that future physicians and nurses will know more about each other as they enter the hospital.
TheONC: What do you think will be the biggest impact of the Affordable Care Act for clinicians like oncology nurses?
Moore: That's a really tough question. It depends on how the ACA is implemented (or repealed), and the recent Supreme Court decision means that it'll likely differ state by state as well. Hopefully it'll lead to fewer patients who can't afford much-needed chemo treatments or follow-up oncology appointments. It'll likely also mean new delivery systems like Patient Centered Medical Homes and Accountable Care Organizations that will hopefully lead to improved outcomes and reduced cost. It may also lead to increased government regulation and even more forms to fill out. I won't pretend to know how it'll all turn out, but if healthcare costs in the US continue to spiral out of control, the way care is delivered in the country is going to change drastically, ACA or not.
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