Brief Summary
Prescription for the Future provides an order and framework for clinical practice evolution. The key principles and recommendations outlined in this book are well known to healthcare insiders, and yet the adoption of these principles is still far wanting.
Dr. Emanuel builds the narrative around ‘Failing Miss Harris,’ a conscientious elderly woman with access to healthcare and doctors that care for her various ailments associated with aging. She has regular check-in appointments with specialists that are a burden to keep, that do not provide any lasting benefit to her, and are scheduled despite her DNR wishes. Yet while Ms. Harris can access expensive care with medical specialists, she lacks support for the basic life tasks that are much lower cost and that would significantly improve her quality of life. Ms. Davis doesn’t need another check-in with her cardiologist as much as she needs assistance with stairs and bathing. The story of Ms. Harris reveals that even when the system is ‘working’ it is still missing the boat: we are still over-treating with costly medical needs and under-treating with basic human needs.
Achievable, Yet Rare, Interventions
Like all good how-to books, Prescription for the Future includes a numbers-driven answer, with 6 Essential Elements of Transformation followed by 12 Practices to achieve this transformation. These include addressing office infrastructure, provider interactions, and expanding the scope of care. Dr. Emmanuel refreshingly provides real world examples of providers that are doing these steps well. The examples reveal that the interventions he suggests are achievable and also shine light on how rare they are just because they are so different from the healthcare many of us access.
There is no doubt that if all of healthcare fully adopted the practices outlined in this book, we would have better care and greater sanity with how we access and pay for it. And yet, I couldn’t shake the feeling that the time and investment needed to transform all of incumbent healthcare to fulfill these practices could end up being too little too late as non-traditional and innovative companies are looking to disrupt this expensive and inefficient industry. Still, any practice that improves along these dimensions is both better and more likely to survive.
Technology and Virtual Care Dismissed
The only part of the book that truly puzzled me was Emanuel’s dismissive description of how virtual care could coordinate with, augment, and expand the reach of our healthcare system. He positions himself as a sane voice in contrast to those wacky virtual medicine extremists who expect virtual medicine to solve all problems. He cites evidence of the lack of true impact virtual medicine has had so far to prove his point. I struggle with his stance on this topic in two dimensions:
1. Discounting the Potential Because of the Past: Emanuel tends to dismiss the potential of telemedicine based on the problems of the past. Because initial forays into virtual medicine have often included separate networks and discontinuous workflow, they have fallen short of expectations. The power of virtual medicine will be much greater when a virtual approach becomes not just a standalone solution, but just another way to talk to your doctor. I think that when virtual medicine achieves its potential we won’t be talking about ‘virtual visits’ or ‘telehealth’ at all – it will be just another way to interact with our providers. Thank goodness we didn’t judge the potential impact of mobile phones based upon the limitations of the early heavy, expensive, cell phone models.
2. Dismissing Techno-utopians: Emanuel regularly dismisses the overstated expectations of ‘techno-utopians’ who predict that virtual visits will replace traditional medicine and transform healthcare. I think he is creating a false enemy to push against. Other than perhaps sales representatives for virtual medicine companies, I don’t know any of these crazy, over-the-top techno-utopians. Everyone I know working to transform healthcare is eager to do so in a smart and thoughtful way and would like to use every arrow in the quiver to get there, including figuring out how to harness the potential of virtual medicine.
Overall, what I liked most about the book was how accessible he made transformation seem. Although the best practices described could be costly and painful to achieve, they all should eventually become standard of care. Providing an order and framework for these changes hopefully makes them easier to envision and expect by those both working in and accessing care from our healthcare system.
Recommend? - Yes, it’s good for you.
I enjoyed reading Prescription for the Future like I enjoy eating a steamed vegetable medley….I know it is good for me, and it has some great parts, but it’s not going to get me as excited as a delightful vegetable korma with nuts and just a taste of spice. There was something healthy about wading through real-life examples of healthcare organizations who are doing well at the things that are all too obvious to do well. It is painful to note that these organizations are outliers. Highlighting them does provide a powerful call to action by underscoring how important and accessible these critical developments are.
My Ratings
Engaging/Interesting - 3 stars - I found the book to be well-written, well-organized, informative, and interesting throughout.
Compelling Purpose - 4 stars - To my peers in the industry – let’s do better. We need to make all of these practices our standards of care.
Relevance to Healthcare - 5 stars - This book highlights essential practices which, taken en masse, may not revolutionize healthcare but certainly would make it less dangerous, more rational, and more kind as well.
Overall Recommendation - 4 stars - I never called a friend excited after reading a chapter just dying to discuss my sparked enthusiasm. That said, I’m glad I took the time to read this book and add Dr. Emanuel’s framework to the arrows in my quiver that I bring to my own career in healthcare transformation.
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Nancy Wise, Managing Partner, Spring Street Exchange
Nancy founded Spring Street Exchange because she wanted to work with like-minded individuals in striving to make healthcare how it should be, rather than the way it has always been. Her work in the industry has ranged from tiny, community-based nonprofit service organizations to billion-dollar insurers, and most things in between. She specializes in the intersection between big ideas and practical planning, which she believes can only be accomplished through radical collaboration and using a new set of tools. Her secret sauce is in leading strategic planning and visioning initiatives.
Nancy has a master’s degree in Public Health and an MBA from the University of California at Berkeley and a BA in American Civilization from Brown University. She is from both Pittsburgh and Alameda, CA, but now lives in Lexington, MA, where the shot was fired that was heard around the world.