T-Minus 1 Day: A Progress Report

In these days before the book comes out - tomorrow! - there have been some wonderful write-ups about the book. Just thought I should note them here. Kent Bottles wrote a piece titled "Check Lists and Decision Trees" that mulled whether structures like a decision tree can help people negotiate the huge information dumps that come with data-driven medicine. Besides the flattering proximity to Atul Gawande's book, Bottles was generous in grasping the fact that I'm not claiming a decision-tree paradigm depends solely on rational decision making (which is inevitably unrealistic) but that I'm trying to find a way to bring our rational capacity together with our emotional needs - and therein lies better healthcare.

Brian Ahier wrote a terrific post on O'Reilly Radar, largely about the book. Riffing off one of my set phrases - it's data, not drugs - Brian - who's not only a health IT expert and blogger but also a member of his city council - nailed the promise and riddle of turning to a data-intensive model for healthcare. As he puts it, "Putting the patient at the center of healthcare and creating a strategy to process all of health data available today is a great start towards meaningful healthcare reform." I was especially glad that Brian recognized the flexibility of my three principles for patient-centric health: Early is better than late; Let data do the work; and Openness is a powerful thing.

And Susannah Fox of the Pew Center lobbed a characteristically provocative take recently on e-patients.net. Her take: that the book could be retitled What to Expect When Your Expecting a Long Life. (Fine with me; those What to Expect books are huge!). In addition to the flattering notion that the Decision Tree compelled Susannah - a longtime health expert - to rethink her own health decisions, she astutely recognizes that I'm not just calling for self-tracking gadgets and gizmos - I'm really arguing that we should use whatever tools we have, including messaging from the FDA and other official bodies - to make health information clearer and more personalized.

It's very heartening to me that three people who constitute experts in the field all seem to think the book is in tune with their own knowledge - that the notes are right, and that the composition is in the right key. My hope, of course, is that the book will also find a larger, less-expert audience, but my hunch is that unless I convince the experts, the lay audience won't be there. If these three are any indication, I'm on the right track.

Lastly, I want to address some Twitter kibbitzing that these ideas are simplistic, naive, or somehow dangerous. I take some assurance that so far, this chatter comes from people who haven't read the book - because the book itself goes to great lengths to explore both the promise as well as the perils and challenges of engaging in patient-centric healthcare (challenging both for the patient and the system). There is ample evidence presented in the book; the bibliography alone runs to 15 pages. Of course, I'll answer this head-on when I have the chance. But broadly, I'll offer this:

There is hope in the book, yes; there is a simplicity to the idea, indeed - but naive or simplistic it is not.