A career physician ponders the positive and negative aspects of how health care reform is transforming the delivery of care and the medical profession itself.
Nussbaum’s (The Pocket Guide to the DSM-5 Diagnostic Exam, 2013) passionate appeal for the “renewal of medicine” stems from his clinical career and psychiatry directorship at Denver Health and the many incarnations he’s embodied there as a patient, educator, student, and ethicist. Clinical professionals view health care reform as a “series of competing initiatives,” and the author cleverly equates it to sailing at sea following an unmarked course of undetermined duration rather than a “well-organized race” toward the goal of cost-efficient, effective, quality care. Nussbaum begins with memories of his time in medical school, clinical residency, and his early career as a physician, when he learned, however detachedly, “to see people as a compendium of parts and a source of income” and to step back to view modern health care through the lens of both the everyday consumer and caregiver alike. He relates wonderfully to an esteemed array of medical intellectuals such as disheartened doctor Abraham Verghese, who advocated for the integration of heart into health care. Nussbaum also relates prophetic metaphors of Canadian physician Sir William Osler and the proposals of radical health pioneer Archibald Cochrane. Nussbaum even considers noted surgeon and public health advocate Atul Gawande’s suggestion of boosting generalized health care’s productivity by using the Cheesecake Factory’s operational business model. Particularly striking is the author’s keen if underdeveloped commentary on the medical marijuana conundrum, which begs for further introspection. In sharing the many tribulations of real-life patients and physicians, Nussbaum unveils a thoughtful, well-rounded, yet thorny vision of the current state of medicine. His generous narrative offers clarity and direction on how the industry can avoid sacrificing humanity to the trappings of an industrialized, unsympathetic, automated version of health care.
A revealing and stirring directive aiming to heal medicine from the inside out.