The Toll Of Chronic Illness

Abstract

Can the average patient successfully navigate our health care system? If you have a chronic disease, does our current system serve you well? From the viewpoint of David Lawrence, chairman and chief executive officer of Kaiser Permanente, the answer is no— not without the use of care teams. In this book Lawrence takes stock of our nation’s health care system. In addition to being a practicing physician, Lawrence has years of experience with U.S. health care, having led Kaiser and having been a member of the Institute of Medicine research committee that produced three reports on quality and errors in the current U.S. health care system. Drawing from professional and personal experiences, Lawrence paints a dismal picture of what the solo or small-group practitioner must manage alone. Through the use of case studies, he provides insight into what it is like to be a patient with a chronic illness in a system that does not manage chronic illness well. Although these case scenarios will not shock most physicians and other medical providers, I am certain that all other readers will be surprised. Lawrence uses the story of Rebecca, a young girl with severe asthma, to highlight the problems of managing chronic medical conditions in a solo practice. He aptly shows what the family sacrifices—be it time, money, lifestyle changes, or family relationships—to keep Rebecca only marginally healthy. He also shows how the medical maze is a “nightmare to navigate...impersonal, confusing, demeaning, unresponsive.” Through the case of Dr. Landers, Lawrence highlights the stresses solo practitioners encounter in running a practice and managing patients, how communication between providers breaks down, and how Rebecca’s care eventually suffers. It is only when the family must change insurance to an organization that uses teams to manage chronic illness that both Rebecca’s care and her family’s satisfaction with her care (and financial strain) improve. This shift to team management does not come without frustration: The family must now learn to master another system, and both the parents and Rebecca must take responsibility for her health care. Lawrence feels that many of the pieces needed to create a healthy medical system using teams are already in place but that they are “scattered, disjointed, isolated from one another, fragments of a vast and costly puzzle.” To change the current system, Lawrence notes seven challenges that must be met: the changing expectations of patients; the expanding pace and scope of discovery in medical science and technology; the increasing number of Americans with chronic illness (by 2030 two out of three people will have one chronic condition); the growing complexity of medical care; the increasing demand for transparency and accountability; the nation’s growing diversity; and the external threats of environmental hazards and bioterrorism. He notes that the “seductive model of the autonomous, independent physician-craftsman is as ill-suited to meet the demands of modern medicine in a B o o k R e v i e w s