Uncaring How the culture of medicine kills doctors & patients

Robert Pearl

Book - 2021

"The spread of COVID-19 has brought the lives of doctors into sharper focus than ever before. We now see how the daily work of making important, even life-and-death decisions is frequently made harder. Hospitals and medical offices face budget problems, the influence of big pharmaceutical and insurance companies, as well as stress and long hours and massive amounts of bureaucracy and paperwork. And that was before the pandemic. As we engage in a public debate about the appropriate role of government, technology, big pharma and insurance companies in our health care, we've paid little attention to what it actually feels like to be a doctor. This simple ingredient -- medical culture -- argues for a simpler and more humane health car...e policy. And it also signals that necessary change must be made with care and attention. Saying thank you and applauding out the window for their life-saving work during the pandemic won't be enough. If we don't take care of our doctors, they can't take care of us. In this important book, Robert Pearl -- the former CEO of the Permanente Medical Group and a Stanford professor -- argues for the importance of culture to the future of medicine. No matter who is president, or how our laws change, his book makes it obvious that we can no longer afford to ignore it"--

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Subjects
Published
New York : PublicAffairs 2021.
Language
English
Main Author
Robert Pearl (author)
Edition
First edition
Physical Description
viii, 379 pages ; 25 cm
Bibliography
Includes bibliographical references (pages 339-365) and index.
ISBN
9781541758278
  • Introduction
  • Part 1. Diagnosing Physician Culture
  • Chapter 1. Bloodletting, Handwashing, and Gorilla Watching
  • Chapter 2. A First Look at Physician Culture
  • Chapter 3. Heroes and Fools
  • Chapter 4. A Two-Part History of Today's Physician Culture
  • Chapter 5. The People v. Physician Culture
  • Part 2. The Physician's Pain
  • Chapter 1. Did We Kill One of Our Own?69
  • Chapter 2. The Rise of Burnout, the Rebirth of Moral Injury
  • Chapter 3. The Problem with Prestige
  • Chapter 4. How the Mighty Fell
  • Chapter 5. Doctors and Self-Determination Theory
  • Chapter 6. Bored Stiff
  • Part 3. Helping Or Harming Patients?
  • Chapter 1. Quality Isn't a Given
  • Chapter 2. A Tale of Two Emergencies
  • Chapter 3. Human Shields
  • Chapter 4. The Real Price of Rx
  • Chapter 5. A Great Inconvenience
  • Chapter 6. The Language Barrier
  • Chapter 7. Impersonalized Medicine
  • Chapter 8. The Truth Is Complicated
  • Chapter 9. The Doctor's Double Standard
  • Part 4. The Social Ladder
  • Chapter 1. A Culture Without Answers
  • Chapter 2. On Death and Dying
  • Chapter 3. The Young and the Breathless
  • Chapter 4. Colorblind
  • Chapter 5. Does Sex Matter?
  • Chapter 6. Discomfort with Difference
  • Chapter 7. The Last Straw
  • Part 5. The Evolution of Physician Culture
  • Chapter 1. Economic Desperation
  • Chapter 2. Between Scylla and Charybdis
  • Chapter 3. Two Paths, Both Fraught with Peril
  • Chapter 4. Denial, Anger, Bargaining, and Depression
  • Chapter 5. Acceptance and the Five Cs of Cultural Change
  • Chapter 6. The Virtues of Being Difficult
  • Chapter 7. Medicine: A Love Story
  • Acknowledgments
  • Bibliography
  • Index
Review by Kirkus Book Review

The former CEO of the Permanente Medical Group takes readers into the world that shapes the medical practitioner's mindset and lays out necessary changes for a broken system. By the early 2000s, the U.S. health care system, once a global leader, had become the most expensive and least effective in the developed world. Of course, Covid-19 has only exacerbated the situation. Among the number of factors that have led to our current state of affairs--a situation that implicates everyone from hospital administrators to insurers, regulators, and pharmaceutical giants--Pearl singles out for examination the flawed culture that guides doctors in their practice. Physician culture, writes the author, "elevates intervention over prevention," resulting in a lack of effective treatment for chronic killers such as diabetes, obesity, hypertension, and heart disease. In a brightly delineated--and highly disturbing--dissection, Pearl lays out the rituals, rules, and beliefs that often isolate physicians from their colleagues and their patients. The foundation of the culture may rest on concepts of healing, resilience, and artistry, but it also breeds a hierarchical sense of individual exceptionalism, heroism, and invincibility. This entitlement and autonomy often clash with the implementation of advanced diagnostic technology, undercutting the doctor's sense of status and control. In this new environment, characterized by long hours, lowered pay, diminished decision-making, and erasure of prestige, more and more physicians are experiencing burnout. Pearl sensibly advocates a coevolution of these two streams, taking advantage of a doctor's experience and independent judgement while tapping into the structural and scientific changes in medical practice. Incorporating peer-reviewed research, personal experience, and anecdotal evidence, the author excoriates overtesting and overprescribing as well as institutionalized racism within the medical community, and he advocates for "broadly available, prepaid, integrated, high-quality healthcare," a system that is open to change, collaboration, and "safe, effective, patient-centered, timely, efficient, and equitable" care. In a well-documented, panoramic narrative, an insider demystifies what makes many doctors tick. Copyright (c) Kirkus Reviews, used with permission.

Copyright (c) Kirkus Reviews, used with permission.