Uncaring: How the Culture of Medicine Kills Doctors and Patients

Uncaring: How the Culture of Medicine Kills Doctors and Patients

by Robert Pearl MD


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Doctors are taught how to cure people. But they don’t always know how to care for them.

Hardly anyone is happy with American healthcare these days. Patients are getting sicker and going bankrupt from medical bills. Doctors are burning out and making dangerous mistakes. Both parties blame our nation’s outdated and dysfunctional healthcare system. But that’s only part of the problem.

In this important and timely book, Dr. Robert Pearl shines a light on the unseen and often toxic culture of medicine. Today’s physicians have a surprising disdain for technology, an unhealthy obsession with status, and an increasingly complicated relationship with their patients. All of this can be traced back to their earliest experiences in medical school, where doctors inherit a set of norms, beliefs, and expectations that shape almost every decision they make, with profound consequences for the rest of us.

Uncaring draws an original and revealing portrait of what it’s actually like to be a doctor. It illuminates the complex and intimidating world of medicine for readers, and in the end offers a clear plan to save American healthcare.

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Product Details

ISBN-13: 9781541758278
Publisher: PublicAffairs
Publication date: 05/18/2021
Pages: 400
Sales rank: 70,354
Product dimensions: 6.10(w) x 9.40(h) x 1.30(d)

About the Author

Dr. Robert Pearl is the former CEO of The Permanente Medical Group. Named one of Modern Healthcare's 50 most influential physician leaders, Pearl is a clinical professor of plastic surgery at Stanford University School of Medicine and is on the faculty of the Stanford Graduate School of Business, where he teaches courses on strategy and leadership, and lectures on information technology and health care policy. He is the author of the Washington Post bestseller Mistreated, hosts the popular podcast Fixing Healthcare, publishes a newsletter with over 10,000 subscribers, and is a regular contributor to Forbes. He has been featured on CBS This Morning, CNBC, NPR, and in TIME, USA Today and Bloomberg News, and is a frequent keynote speaker at healthcare and medical technology conferences.

Table of Contents

Introduction 1

Part 1 Diagnosing Physician Culture

Chapter 1 Bloodletting, Handwashing, and Gorilla Watching 13

Chapter 2 A First Look at Physician Culture 24

Chapter 3 Heroes and Fools 30

Chapter 4 A Two-Part History of Today's Physician Culture 35

Chapter 5 The People v. Physician Culture 50

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 81

Chapter 3 The Problem with Prestige 90

Chapter 4 How the Mighty Fell 99

Chapter 5 Doctors and Self-Determination Theory 104

Chapter 6 Bored Stiff 114

Part 3 Helping Or Harming Patients?

Chapter 1 Quality Isn't a Given 123

Chapter 2 A Tale of Two Emergencies 127

Chapter 3 Human Shields 133

Chapter 4 The Real Price of Rx 141

Chapter 5 A Great Inconvenience 149

Chapter 6 The Language Barrier 155

Chapter 7 Impersonalized Medicine 161

Chapter 8 The Truth Is Complicated 169

Chapter 9 The Doctor's Double Standard 177

Part 4 The Social Ladder

Chapter 1 A Culture Without Answers 187

Chapter 2 On Death and Dying 191

Chapter 3 The Young and the Breathless 206

Chapter 4 Colorblind 219

Chapter 5 Does Sex Matter? 230

Chapter 6 Discomfort with Difference 237

Chapter 7 The Last Straw 252

Part 5 The Evolution of Physician Culture

Chapter 1 Economic Desperation 263

Chapter 2 Between Scylla and Charybdis 271

Chapter 3 Two Paths, Both Fraught with Peril 277

Chapter 4 Denial, Anger, Bargaining, and Depression 289

Chapter 5 Acceptance and the Five Cs of Cultural Change 295

Chapter 6 The Virtues of Being Difficult 312

Chapter 7 Medicine: A Love Story 322

Acknowledgments 335

Bibliography 339

Index 367

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