A leading hand surgeon with a medical degree from NYU, multiple accolades, and decades of experience, Dr. Alejandro Badia, based in Doral, has spent more than a quarter-century in the trenches of U.S. healthcare. His new book Healthcare From The Trenches: An Insider Account of the Complex Barriers of U.S. Healthcare from the Providers and Patients’ Perspective is an open discussion of the failure of the U.S. healthcare system from the perspectives of its clinicians and patients. I had the opportunity to read his new book and just finished it last week.
Entitled The Hidden Journey of a Medical Professional, the first section of this book is an autobiography of Dr. Badia’s journey from early childhood where he aspired to be a surgeon, to his undergraduate years at Cornell, medical school at NYU, residency in Pittsburgh, fellowships in California and Europe before landing in private practice in Miami. In a proud yet non-arrogant way, the author describes his achievements, both academic, athletic and even ballroom dancing. He also details many fascinating cases. One that stands out is the New Year’s gunshot wound victim in the ER, who later died, and the desperate search to find the tiny bullet hole which had caused so much internal damage. It’s common knowledge that the physician career track is a long and difficult one. That said, this personal story of a Cuban American growing up in a middle class suburb in New Jersey is fascinating and inspiring. Totaling about 175 pages, this section could stand alone. It’s a great read for anyone who wants to become a doctor, works with doctors or just wants to understand their personal physician better. We are also introduced to a number of colorful characters, mostly other doctors as well as patients, that the author interacts with. As section one moves along, Dr. Badia gradually loses his naivete and learns some hard truths about the profession. And by the close, we are ready for the second section: The Economics of Healthcare.
It’s in this second section that Dr. Badia, through numerous first-hand accounts, details examples of what is so wrong with our current health system. Over regulation, perverse incentives, non-clinicians with too much power, insurance companies and other middlemen (who add cost with little value) are among the listed contributors to the dysfunction. Hospitals and health systems are also the subject of the author’s wrath. Meanwhile, Dr. Badia also points out that socialized medicine is not the panacea that many progressive claim it to be. The middle section prepares us for the finale where we examine moral injury, politics (and it’s negative effect on healthcare) plus doctors and money.
The third section really drives home how angry and frustrated Dr. Badia and his colleagues really are. The book is over 400 pages and it’s in this final section that some potential solutions are discussed. The last twenty-five pages examine the German healthcare system as a possible model to emulate and proposals ‘from the trenches’ are presented. Clinicians and administrators (several surgeons, an emergency medicine doctor, two healthcare executives and an occupational therapist) weigh in with suggestions. The ‘Where do we go from here?’ chapter is just the starting point of the solution discussion. But recommending a comprehensive fix is not the goal of this author. The purpose of the book is urgent and it’s more fundamental: Dr. Badia is sounding the alarm.
The ‘from the trenches’ metaphor should not be lost on the reader. We are losing the ‘war’ against ineffective and unsustainable healthcare delivery because the men and women in the trenches are demoralized and cynical. No war can be won when the soldiers have lost hope. With fast rising health costs (just under 20% of GDP!) and persistent issues with quality, access and patient satisfaction, we need to focus on re-imagining the American health system. The health and wealth of our great nation depends on it.
Healthcare From The Trenches: An Insider Account of the Complex Barriers of U.S. Healthcare from the Providers and Patients’ Perspective, ISBN 978-0-57868-099-6 (Paperback) $19.97, AISN B088PSH2RL (eBook) $2.99, 2020, Badia Hand to Shoulder, 465 pages, available at Amazon.