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January 30, 2022

Book Review- Patient or Pawn

Reviewed by David Godfrey

The full PDF in which this article appears can be found in Bifocal Vol. 43, Issue 3.

We are in the midst of the perfect storm when it comes to health care in the United States. The baby-boomers are bringing record numbers of patients into age the of highest health care utilization, the millennial generation has even more members than the boomers, assuring a large number of older persons for at least the next four decades. More younger adults have chronic health conditions, conditions that require seeing a health care provider at least once a year, resulting in higher demand for health care than ever before. At the same time there is an unmeasured under supply of health care providers and many health care providers are reaching the age of retirement or burning out and leaving the profession. Technology is changing health care, in many good ways, and at the same time with risks. The key to quality and desired health care is for every person to become health literate, to engage their support system to be health literate and to play an active role in the decisions about the health care they receive or decline.

That rambling first paragraph is a summary of the facts, and nothing but the facts.  The first half of the book is filled with incredible detailed research and statistics on the demographics of our population leading to an increased demand/need to quality health care, and the mind-boggling statistics on the lack of health care providers and the inexcusable lack of reliable statistics on the shortages of trained health care providers.  Many of the statistics that are being relied on to project supply and demand in health care are decades out of date, with no viable excuse for why new data is not available.  Congress mandates new studies, then fails to fund the work.  On some issues such as heath literacy virtually all of the research is on the supply side with providers, and next to none on the demand side of asking people what they need to give informed consent.  The analysis is a combination of economic theory, health policy, public health, law, and social policy. 

While resplendent with facts and research, this book is anything but an emotionless recitation of facts, figures, and policy.  The facts should provoke emotions and outrage. This text describes what is happening with emotion, outrage, and sarcasm.  It is an easy and stimulating read. Don’t rely on this one to lull you to sleep, actually, ; thinking about this book may keep you awake at night.   

The chapters in the second half of the book offer bullet pointed strategies for becoming an informed health care consumer.  The authors’ primary point is that we need to become active and informed health care consumers, and the key to that is health care literacy.  The book offers three key points for health care consumers, we need to be able to 1: identify and access reliable health literacy resources, 2: practice shared decision making (with our health care providers) and 3: actively participate in documenting our health and action steps. 

The book should be helpful for anyone who is a health care consumer, or anyone who is involved in advising consumers on health care planning and obtaining desired health care and avoiding unwanted care (it discusses some of the pitfalls of standardized advance health care directives,) and for anyone curious or concerned about the future of health care in the United States.  The book provides a ton of detailed information, in an easy-to-read format. 

The book is listed at 214 pages, about 40 pages of that are detailed endnotes – for those who want to do further reading on any of the issues. It is available from major book sellers and there is also an e-book version available. The book is published by Providentia Publishing, with a reasonable list price of $21.95.  The copy I read was supplied by the author. It was worth reading, I should have gotten to this one sooner.  I have a personal policy that I don’t write reviews of books that I don’t like. I read a lot of books, this one was well worth my time.  The author Jo Kline is an attorney, advocate for health literacy and an accomplished author.