Writing the Book on Our Health Care System

Author: Lucy Schultze

A frustrated med student, Dr. Nathan Moore co-wrote the successful Health Care Handbook to guide physicians through the maze of dealing with the system.

Midway through medical school, Nathan Moore could name all 206 bones of the axial and appendicular skeleton. But of the inner workings of insurance filings and the mysteries of a million acronyms — he had no clue.

Along with classmate Elisabeth Askin, he searched for good resources to help explain the vast world of policies and payers and professionals in which they suddenly found themselves as their hospital rounds began. But every book they found was either too academic or too narrow or too biased.

So, they wrote their own.

“It really came out of our own frustrations,” said Moore, whose 2012 publication of The Health Care Handbook alongside co-author Askin became a runaway success.

Now in its second edition, The Health Care Handbook bears the bold subtitle “A Clear and Concise Guide to the United States Health Care System.”

In just over 256 pages, it breaks down topics including the different types of health insurance; the pharmaceutical, medical device and medical research industries; the various health professions and what each one does; economic factors that make health care expensive; and how proposed reforms to the system would work.

“If we had known how much work it was going to be, we never would have started this,” said Moore, who initially envisioned the project as a 10-page pamphlet he and Askin could share with their classmates.

For the duo, the process of compiling research and conducting interviews was a task to rival medical school itself. For every answer they unearthed, more questions came to the surface.

“One of the biggest realizations for me was how complicated our healthcare system truly is,” Moore said. “Even things that seem very straightforward: If you dig a little bit, they’ll turn out to be not the way you expected.”

Encouraging their work along the way was William Peck, MD, former dean of the Wash U School of Medicine, who wrote the forward to the book. The school provided a grant for publication, and the authors hoped to sell a couple hundred copies.

That’s when The New York Times got wind of the project. A July 2012 article about two medical students grappling with the vast and unwieldy U.S. health care system helped catapult the book to broad success. It has gone on to sell more than 20,000 copies and is being used in more than 60 academic programs at the undergraduate, graduate and residency levels.

For Moore, much of what he learned along the way about the U.S. healthcare system was fairly discouraging.

“Finding out that our healthcare system ranks so poorly against that of other countries was a bit of a shock to me,” he said. “We spend more than anyone else and our outcomes are so poor.”

Still, the project didn’t dissuade Moore from continuing on course toward a career in medicine; he’s now a resident physician in internal medicine at Barnes-Jewish Hospital.

What the book project changed was his focus and his approach.

“I wasn’t planning on going into primary care,” he said. “But after researching and writing the book, the evidence was pretty clear that primary care is the most effective way to improve outcomes for the population.

“People are realizing that, over the next 10-15 years, there will be a big shift from a high-cost, procedural, do-as-much-as-you-can approach, to something that’s more rational.

“I’m invested in participating in that and trying to figure out how to provide good care for lots of people, effectively, at a lower cost. That’s easier said than done, but there are a lot of interesting experiments going on now, which I find pretty exciting.”

In fact, for Moore, being part of the conversation over how the U.S. healthcare system should evolve is virtually inescapable.

“This project has changed my perspective,” he said. “Instead of focusing on the single patient in front of you, you become a little bit more aware of things that are going on behind the scenes that led to that person not getting the care they need.

“I think a lot of people go into medicine so they don’t have to deal with the other crap, like money and laws. And I understand where people are coming from, because it is a very frustrating situation to work in. But if you really do want to do the best for your patients, you can’t ignore it. The system has to be improved for your patients to get better care.”

For Moore and his co-author, a key motivation in producing the book became wanting to help other healthcare professionals better understand their own system — so that they’re better equipped to advocate within it.

“I think it’s naïve at this point for medical professions to say, ‘I don’t want to engage in changing the system. I just want to take care of my patients,’” Moore said.

“Part of the reason we’re in the mess we’re in is that most medical professionals say, ‘I don’t want to deal with that. It’s somebody else’s problem.’ Other people are the ones who end up creating the rules for us, and the doctors just bitch and moan about it.”

The second edition of the Health Care Handbook was released in October 2014, through a grant from the Missouri Foundation for Health. It is available on Amazon.com as a paperback ($16) and e-book ($8).

Moore and Askin plan to update the book every couple of years to keep up with changes in the healthcare system.

A native of Oklahoma, Moore completed his undergraduate studies at the University of Texas. He became interested in medicine while working at a veterans’ hospital during college. He is on track to complete his residency in 2016.

“I would love to stay in St. Louis; I like it here,” he said. “At this point, I have no idea what the future will hold.”



The New York Times: http://well.blogs.nytimes.com/2012/07/12/two-medical-students-navigate-the-health-care-maze/?_r=0

Healthcare Handbook: http://healthcarehandbook.wustl.edu/



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