A burly Midwesterner in his mid-20s, he had entered medical school determined to become a primary care physician. But over the last two years, despite encouragement from mentors and good experiences helping patients at the local free clinic, the resolve of the young doctor-to-be had wavered. On the eve of his third year of medical school, he had become more apprehensive than ever.
One recent afternoon, seeing his eyes turn glassy and his smile freeze, I realized that my own attempt to encourage him was failing to restore his determination.
"I appreciate what you're trying to tell me," he said. "But there's a big difference between your experiences and mine." He paused to search for words to explain, then smiled when the television down the hall began blasting the latest news on health care reform.
"You knew what you were getting into when you started, but us," he said, gesturing toward the television, "we have no idea of what health care or our futures will look like."
For several years now, doctors and patients have been struggling to reimagine the future of health care. Policy makers, health care experts and pundits have been eager to help, churning out well-meaning op-eds and essays and cobbling together exhaustive blogs and books. Trying to help the rest of us understand, for example, they have described how Medicare will rely increasingly on "accountable care organizations" and "bundled payments" and eventually eliminate "the doughnut hole."
Unfortunately, there's been one problem with these earnest and well-intentioned attempts to help: It's hard to understand what they are saying. In fact, few of us fully understand how the health care system works in the first place, let alone what these august experts are trying to say.
Now Elisabeth Askin and Nathan Moore, medical students from the Washington University School of Medicine in Saint Louis, have set out to help all of us understand. Motivated by their own anxiety about the future, they have written "The Health Care Handbook" (self-published with their medical school), an astonishingly clear "user's manual" that explains our health care system and the policies that will change it.
It's the kind of book to share not only with your doctors and colleagues, but with your friends and Aunt Dorothy, too.
In their unpretentious voice, Ms. Askin and Mr. Moore make clear from the beginning that their explanations are neither in-depth nor definitive. But given their evenhanded and highly organized prose, it's hard not to put their book in the same revered category as a medical textbook or dictionary. In a mere 175 pages, and with an impressive roster of references and well-placed graphics, "The Health Care Handbook" illuminates the maddeningly opaque terms, acronyms, organizations, personages and policies that abound in health care. The authors do so not by expounding on the minutiae, but by jettisoning the jargon and gobbledygook and presenting only the core ideas.
For example, they explain the Affordable Care Act using a series of questions. In the process Ms. Askin and Mr. Moore distill the law's more than 2,000 pages --- "a little longer than a Harry Potter book," they deadpan - down to one of the best explanations I've seen. It can be read in under 20 minutes.
And thanks to their particularly winsome literary voice, what usually is mind-numbingly dull turns into a good and even occasionally funny read. "Everything is always more complicated than you think," the two authors write in the introduction, putting it in bold, italicized and underlined type to embellishing their warning. ("If we could have underlined that phrase obsessively in each copy of this book, we would have," they continue.)
That medical students, and not a group of rarefied experts, would write such a book comes as no surprise to some. "No one knows what is going to happen tomorrow," said Rebekah Apple of theAmerican College of Physician Executives, a professional organization that has begun reaching out to young doctors to help them develop management and leadership skills in the face of uncertainty. "But these young doctors are even more acutely aware of the shifting sands."
Unlike physicians who finished their education and training even a decade earlier, current medical students must learn to practice in a system that is constantly changing, and their medical schools, already overburdened with an ever-growing list of required courses and competencies, have few or no resources to help them. Many students have taken matters into their own hands, putting together health policy and economics discussion groups and lecture series for themselves.
The idea of "The Health Care Handbook" was hatched a little over a year ago in such a student-initiated discussion group. "We wanted to write the book we were looking for," Mr. Moore said. With guidance from Dr. William A. Peck, director of the Center for Health Policy at Washington University and former dean of the medical school, and the help of close to 50 expert and lay readers, Mr. Moore and Ms. Askin wrote the book in under a year while managing their medical school obligations.
With the future of health care wide open, "The Health Care Handbook" is being published primarily in e-book form to allow for quick revisions (the newest edition came out within a week of the Supreme Court decision). A paperback edition is scheduled to come out at the end of the summer, and there are plans to offer video modules and other supplemental materials.
While Ms. Askin and Mr. Moore still have a year or more of medical school to complete, they hope to keep the inspiration for the book and its future iterations in the hands of those who need it most. After they graduate, a group of students from their medical school will be chosen every year to update and revise the book as needed "to ensure that fresh student perspective."
"We wanted to write a book that would be like giving people little floaties to help them learn to swim through the vast and confusing ocean that is health care," Ms. Askin said.
She added: "It's exciting to us that our book could actually be helping people."