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Mistreated: Why We Think We're Getting Good Health Care -- and Why We're Usually Wrong
The biggest problem in American health care is us
Do you know how to tell good health care from bad health care? Guess again. As patients, we wrongly assume the "best" care is dependent mainly on the newest medications, the most complex treatments, and the smartest doctors. But Americans look for health-care solutions in the wrong places. For example, hundreds of thousands of lives could be saved each year if doctors reduced common errors and maximized preventive medicine.
For Dr. Robert Pearl, these kinds of mistakes are a matter of professional importance, but also personal significance: he lost his own father due in part to poor communication and treatment planning by doctors. And consumers make costly mistakes too: we demand modern information technology from our banks, airlines, and retailers, but we passively accept last century's technology in our health care.
Solving the challenges of health care starts with understanding these problems. Mistreated explains why subconscious misperceptions are so common in medicine, and shows how modifying the structure, technology, financing, and leadership of American health care could radically improve quality outcomes. This important book proves we can overcome our fears and faulty assumptions, and provides a roadmap for a better, healthier future.
Do you know how to tell good health care from bad health care? Guess again. As patients, we wrongly assume the "best" care is dependent mainly on the newest medications, the most complex treatments, and the smartest doctors. But Americans look for health-care solutions in the wrong places. For example, hundreds of thousands of lives could be saved each year if doctors reduced common errors and maximized preventive medicine.
For Dr. Robert Pearl, these kinds of mistakes are a matter of professional importance, but also personal significance: he lost his own father due in part to poor communication and treatment planning by doctors. And consumers make costly mistakes too: we demand modern information technology from our banks, airlines, and retailers, but we passively accept last century's technology in our health care.
Solving the challenges of health care starts with understanding these problems. Mistreated explains why subconscious misperceptions are so common in medicine, and shows how modifying the structure, technology, financing, and leadership of American health care could radically improve quality outcomes. This important book proves we can overcome our fears and faulty assumptions, and provides a roadmap for a better, healthier future.
336 pages, Hardcover
Published May 2, 2017
91 people are currently reading
1114 people want to read
About the author
Robert Pearl
3 books19 followersRobert Pearl, MD is a healthcare leader, author, educator, columnist and podcaster. For 18 years, he served as CEO of The Permanente Medical Group (Kaiser Permanente). He is also former president of The Mid-Atlantic Permanente Medical Group. In these roles he led 10,000 physicians, 38,000 staff and was responsible for the nationally recognized medical care of 5 million Kaiser Permanente members on the west and east coasts.
He is a clinical professor of plastic surgery at Stanford University School of Medicine and on the faculty at the Stanford Graduate School of Business, where he teaches courses on healthcare strategy, technology, and leadership. Pearl is board certified in plastic and reconstructive surgery, receiving his medical degree from Yale, followed by a residency in plastic and reconstructive surgery at Stanford University.
He's the author of three books: "Mistreated: Why We Think We're Getting Good Healthcare—And Why We're Usually Wrong," a Washington Post bestseller (2017); "Uncaring: How the Culture of Medicine Kills Doctors & Patients," a Kirkus star recipient (2021); and his newest book "ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine" (April 2024). All profits from sales of his books go to Doctors Without Borders.
He is a LinkedIn "Top Voice" in healthcare and host of the popular podcasts Fixing Healthcare and Medicine: The Truth. He publishes two monthly healthcare newsletters reaching 50,000+ combined subscribers. A frequent keynote speaker, Pearl has presented at The World Healthcare Congress, the Commonwealth Club, TEDx, HLTH, NCQA Quality Talks, the National Primary Care Transformation Summit, American Society of Plastic Surgeons, and international conferences in Brazil, Australia, India, and beyond.
Dr. Pearl's insights on generative AI in healthcare have been featured in Associated Press, USA Today, MSN, FOX Business, Forbes, Fast Company, WIRED, Global News, Modern Healthcare, Medscape, Medpage Today, AI in Healthcare, Doximity, Becker's Hospital Review, the Advisory Board, the Journal of AHIMA, and more.
He is a clinical professor of plastic surgery at Stanford University School of Medicine and on the faculty at the Stanford Graduate School of Business, where he teaches courses on healthcare strategy, technology, and leadership. Pearl is board certified in plastic and reconstructive surgery, receiving his medical degree from Yale, followed by a residency in plastic and reconstructive surgery at Stanford University.
He's the author of three books: "Mistreated: Why We Think We're Getting Good Healthcare—And Why We're Usually Wrong," a Washington Post bestseller (2017); "Uncaring: How the Culture of Medicine Kills Doctors & Patients," a Kirkus star recipient (2021); and his newest book "ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine" (April 2024). All profits from sales of his books go to Doctors Without Borders.
He is a LinkedIn "Top Voice" in healthcare and host of the popular podcasts Fixing Healthcare and Medicine: The Truth. He publishes two monthly healthcare newsletters reaching 50,000+ combined subscribers. A frequent keynote speaker, Pearl has presented at The World Healthcare Congress, the Commonwealth Club, TEDx, HLTH, NCQA Quality Talks, the National Primary Care Transformation Summit, American Society of Plastic Surgeons, and international conferences in Brazil, Australia, India, and beyond.
Dr. Pearl's insights on generative AI in healthcare have been featured in Associated Press, USA Today, MSN, FOX Business, Forbes, Fast Company, WIRED, Global News, Modern Healthcare, Medscape, Medpage Today, AI in Healthcare, Doximity, Becker's Hospital Review, the Advisory Board, the Journal of AHIMA, and more.
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Displaying 1 - 30 of 38 reviews
August 23, 2017
Modern healthcare needs to return to a system where the health and well being of the patient comes first. Doctors and patients alike are in a vice grip from insurance companies who dictate everything from which prescriptions can be prescribed to which medical procedures are deemed necessary. Healthcare is not a commodity and not a privilege. It is a basic human right and treating patients like paychecks instead of people is the fundamental problem with modern healthcare in the U.S. An excellent read.
"In today's health care system ruled as it is by economics, there is no "billing code" physicians can use for the time they spend comforting a family or holding a patients hand when death is inevitable. Doctors get paid for intervening, not for moments of compassion. Today, the insurance reimbursement system dictates how care is delivered. It has eroded personal relationships, devalued empathy and kindness, and undermined the very mission and commitment that led most doctors to practice medicine in the first place."
"In today's health care system ruled as it is by economics, there is no "billing code" physicians can use for the time they spend comforting a family or holding a patients hand when death is inevitable. Doctors get paid for intervening, not for moments of compassion. Today, the insurance reimbursement system dictates how care is delivered. It has eroded personal relationships, devalued empathy and kindness, and undermined the very mission and commitment that led most doctors to practice medicine in the first place."
May 28, 2017
Incredibly insightful and holistic accounting of the failings of America's health care system, and also a really depressing read, because I came away with a sense that the problems are so formidable, they'll never be fixed.
February 17, 2018
I’m only on page 20 so far, and already I’m seeing, you’d best not go into a hospital without someone there with you to pay attention and see to it that you’re properly cared for. The doctors and staff are far too busy to get it right every time. He says that doctors forget to wash their hands between patients 1/3 of the time. Whoa! No wonder there are so many infections in hospitals. Apparently, you are more likely to die of an infection than a heart attack or stroke during or after a hospital visit.
To be passive, and assume the doctor and staff know what is best could be the death of you.
“The human body maintains a delicate balance between too much and too little of just about everything it needs. A healthy body, one with just the right balance, operates with clockwork precision, bringing oxygen, nutrients, and infection-fighting cells to tissues and organs with each beat of the heart. But it remains, always, a delicate system. With not enough liquid, blood pressure begins to fall, kicking the heart into overdrive as it struggles to push sufficient blood to vital organs. With too much liquid, fluid backs up. Like a clogged pipe, the lungs flood, swelling the feet and reducing the flow of oxygen to the heart and eventually the brain.
Our bodies walk a perpetual fine line.”
I find it disheartening that traditional medicine pretty much memorizes a list of illnesses and a looong list of medical procedures to run on patients who they suspect have these illnesses. They get in trouble if they act outside the box that has been drilled into them. If you die (or suffer extra) after they follow standard-operating procedure, all is well for them.
“But without the revenue from patient complications, many hospitals would teeter on bankruptcy. A recent study found that privately insured surgical patients with one or more complications provided hospitals with a 330 percent higher profit margin than those who had none.”
How many of us don’t know someone who after their initial problem developed something like pressure ulcers (bedsores), pneumonia, and hospital-acquired infections?
This book is an eye-opener.
“What’s most puzzling is why patients are willing to accept so much less from health care than from just about any other industry.
We put our faith in others so as to manage our otherwise immobilizing fears, and in doing so, we have become reluctant to question our healers.”
“ProPublica, an independent nonprofit newsroom first built its impressive “Dollars for Docs” database in 2010 and has since tracked more than $4 billion in disclosed payments. The site will show you which doctors are the biggest recipients of drug-company money and how much they receive—with some individuals raking in millions of dollars.
Ask doctors why they appear in a pharmaceutical “open payments” register, and they’ll likely deny any relationship between the perks they get and the drugs they prescribe. They’ll naively talk about how they provide invaluable expertise that leads to better medical outcomes. You can be certain that’s not how drug and medical-device companies view the relationship.
Pharmaceutical companies don’t align with individual doctors because they provide superior care or medical expertise. The do it because these doctors prescribe more of their products and recommend them to their colleagues.
Drug reps provide doctors with food, flattery, and friendship, while their companies lure physicians with offers of lavish trips, dinners, and the opportunity to participate in industry talks that come with a handsome honorarium for their trouble.
These relationships create conflicts of interest that cloud clinical judgment. For the drug company, the influence is calculated and measured in terms of “return on investment.”
Doctors on the receiving end understand that these perks will disappear as soon as they begin to prescribe competing product.
Sunshine Act – pharmaceutical and medical-device companies are now required by law to release details of their payments to doctors and US teaching hospitals. By going online, you can find out whether your doctor is one of them.”
The pharmaceutical companies have lobbyists in D.C. and they’ve gotten laws passed that prohibit our government from negotiating on our behalf for lower drug costs. The laws prohibit the president from doing anything that will lower our drug costs. That is how rich and powerful the pharmaceutical companies are.
Somewhere I heard that they want to start getting their hands in the vitamin/herb business to supposedly regulate it so we’ll get what we think we’re getting, but it is really just to get rid of their competition for their over-priced drugs. That is also why they don’t want anyone getting drugs from Canada, and not because Canada has poison in their medicine.
“Fifteen minutes of exercise a day could reduce a person’s mortality risk by 14% and increase life expectancy by three years. Thirty minutes of exercise five days a week will save the average American $2,500 a year in medical expenses.”
“Avastin, a medication approved for cancer treatment. It slows the growth of new blood vessels that feed tumors. A while back, a thoughtful group of ophthalmologists recognized that if this drug could limit blood-vessel proliferation to stop tumor growth, it might also be useful in slowing a medical problem called wet macular degeneration, a chronic eye disease that blurs vision and leads to blindness, particularly in older patients. It happens because of an overgrowth of abnormal blood vessels in the back of the eye.
The ophthalmologists were injecting a very small dose of Avastin in their macular-degeneration patients with excellent clinical results and an average cost per treatment of about $60.
Genentech, the manufacturer of Avastin, recognized the same opportunity at about the same time as the ophthalmologists. But instead of seeking FDA approval of Avastin for wet macular degeneration, Genentech created Lucentis, a drug with a biologically active component identical to Avastin. Once Genentech received FDA approval for Lucentis, it priced the drug at $2,300 a dose and tried to prohibit ophthalmologists (or anyone else with a low-cost solution) from obtaining or administering the much cheaper option, Avastin.
Ophthalmologists were outraged. Not surprisingly, when the National Eye Institute tested Lucentis against Avastin, it found essentially no difference for a drug priced nearly forty times higher.”
I'd recommend reading this book. It helps you form a more realistic view of what you're getting in the medical field.
Doctors are a necessary part of life, but they do make mistakes. You can't just hand yourself over trusting as a baby. You have to pay attention and monitor your own body. No one other person is going to remember every little thing about you especially someone who sees you for fifteen minutes every few months. You're responsible for you.
To be passive, and assume the doctor and staff know what is best could be the death of you.
“The human body maintains a delicate balance between too much and too little of just about everything it needs. A healthy body, one with just the right balance, operates with clockwork precision, bringing oxygen, nutrients, and infection-fighting cells to tissues and organs with each beat of the heart. But it remains, always, a delicate system. With not enough liquid, blood pressure begins to fall, kicking the heart into overdrive as it struggles to push sufficient blood to vital organs. With too much liquid, fluid backs up. Like a clogged pipe, the lungs flood, swelling the feet and reducing the flow of oxygen to the heart and eventually the brain.
Our bodies walk a perpetual fine line.”
I find it disheartening that traditional medicine pretty much memorizes a list of illnesses and a looong list of medical procedures to run on patients who they suspect have these illnesses. They get in trouble if they act outside the box that has been drilled into them. If you die (or suffer extra) after they follow standard-operating procedure, all is well for them.
“But without the revenue from patient complications, many hospitals would teeter on bankruptcy. A recent study found that privately insured surgical patients with one or more complications provided hospitals with a 330 percent higher profit margin than those who had none.”
How many of us don’t know someone who after their initial problem developed something like pressure ulcers (bedsores), pneumonia, and hospital-acquired infections?
This book is an eye-opener.
“What’s most puzzling is why patients are willing to accept so much less from health care than from just about any other industry.
We put our faith in others so as to manage our otherwise immobilizing fears, and in doing so, we have become reluctant to question our healers.”
“ProPublica, an independent nonprofit newsroom first built its impressive “Dollars for Docs” database in 2010 and has since tracked more than $4 billion in disclosed payments. The site will show you which doctors are the biggest recipients of drug-company money and how much they receive—with some individuals raking in millions of dollars.
Ask doctors why they appear in a pharmaceutical “open payments” register, and they’ll likely deny any relationship between the perks they get and the drugs they prescribe. They’ll naively talk about how they provide invaluable expertise that leads to better medical outcomes. You can be certain that’s not how drug and medical-device companies view the relationship.
Pharmaceutical companies don’t align with individual doctors because they provide superior care or medical expertise. The do it because these doctors prescribe more of their products and recommend them to their colleagues.
Drug reps provide doctors with food, flattery, and friendship, while their companies lure physicians with offers of lavish trips, dinners, and the opportunity to participate in industry talks that come with a handsome honorarium for their trouble.
These relationships create conflicts of interest that cloud clinical judgment. For the drug company, the influence is calculated and measured in terms of “return on investment.”
Doctors on the receiving end understand that these perks will disappear as soon as they begin to prescribe competing product.
Sunshine Act – pharmaceutical and medical-device companies are now required by law to release details of their payments to doctors and US teaching hospitals. By going online, you can find out whether your doctor is one of them.”
The pharmaceutical companies have lobbyists in D.C. and they’ve gotten laws passed that prohibit our government from negotiating on our behalf for lower drug costs. The laws prohibit the president from doing anything that will lower our drug costs. That is how rich and powerful the pharmaceutical companies are.
Somewhere I heard that they want to start getting their hands in the vitamin/herb business to supposedly regulate it so we’ll get what we think we’re getting, but it is really just to get rid of their competition for their over-priced drugs. That is also why they don’t want anyone getting drugs from Canada, and not because Canada has poison in their medicine.
“Fifteen minutes of exercise a day could reduce a person’s mortality risk by 14% and increase life expectancy by three years. Thirty minutes of exercise five days a week will save the average American $2,500 a year in medical expenses.”
“Avastin, a medication approved for cancer treatment. It slows the growth of new blood vessels that feed tumors. A while back, a thoughtful group of ophthalmologists recognized that if this drug could limit blood-vessel proliferation to stop tumor growth, it might also be useful in slowing a medical problem called wet macular degeneration, a chronic eye disease that blurs vision and leads to blindness, particularly in older patients. It happens because of an overgrowth of abnormal blood vessels in the back of the eye.
The ophthalmologists were injecting a very small dose of Avastin in their macular-degeneration patients with excellent clinical results and an average cost per treatment of about $60.
Genentech, the manufacturer of Avastin, recognized the same opportunity at about the same time as the ophthalmologists. But instead of seeking FDA approval of Avastin for wet macular degeneration, Genentech created Lucentis, a drug with a biologically active component identical to Avastin. Once Genentech received FDA approval for Lucentis, it priced the drug at $2,300 a dose and tried to prohibit ophthalmologists (or anyone else with a low-cost solution) from obtaining or administering the much cheaper option, Avastin.
Ophthalmologists were outraged. Not surprisingly, when the National Eye Institute tested Lucentis against Avastin, it found essentially no difference for a drug priced nearly forty times higher.”
I'd recommend reading this book. It helps you form a more realistic view of what you're getting in the medical field.
Doctors are a necessary part of life, but they do make mistakes. You can't just hand yourself over trusting as a baby. You have to pay attention and monitor your own body. No one other person is going to remember every little thing about you especially someone who sees you for fifteen minutes every few months. You're responsible for you.
April 9, 2022
This book looked really interesting from the cover (and the Malcolm Gladwell quote on it!), but I was disappointed. Some of that disappointment may have been a misalignment of my hopes for the book and the intentions of the author. For example, I didn't really enjoy the section on the Affordable Care Act. It was focused on the past rather than future possibilities, and it already felt outdated (there was a lot of speculation on what President Trump might do). I also didn't really care about the details of people's personal lives (for example, what in Obama's past led him to care so deeply about health care reform), although for some people those parts of the book might be really interesting.
A bigger problem I have with the book is that I thought the author was overly simplistic and illogical in his thinking. Because of this, I disagreed with many of his conclusions and recommendations.
One example he gives in the book is contrasting two women who both had hand surgery and both died. Pearl says, "Both of these surgeons will fail to ask a crucial question. These omissions will cost each woman her life." He consistently suggests that the two doctors' "mistakes" are similar and implies that they were the cause of both women's deaths. I strongly disagree!
One surgeon directly caused a woman's death by administering medication that caused her heart to stop. It was a tragic accident, and the surgeon could have gathered more information before the surgery that probably would have prevented the death. The second surgeon successfully treated a woman's carpal tunnel syndrome. The woman died a few years later of colon cancer. The supposed "mistake" that the surgeon made was not referring the woman for a colonoscopy, which supposedly would have saved her life. Pearl claims that these two situations were "equally negligent, as both were preventable."
I just can't agree with his conclusion! I actually find this to be one of the problems with the current health care system - doctors are required to check all the "prevention" boxes instead of focusing on patients' actual requests. It overwhelms everyone. Should we require everyone who gets surgery for carpal tunnel syndrome to get a colonoscopy? Of course, it wouldn't just be a colonoscopy - they'd also have to have a battery of tests for every possibly preventable issue, from high blood pressure to elevated liver enzymes. What if the patient declines? (The author seems to assume that patients would not decline. I don't think he even knows whether the second surgeon recommended a colonoscopy - he just knows that the patient didn't get one, so he has decided that the surgeon was negligent.) Some people avoid the doctor because every time they go, they have to sit through a list of recommendations to lose weight, stop smoking, get a variety of tests, get their flu shot, etc., when all they wanted was to get their sprained ankle examined. I'm not saying that doctors shouldn't discuss preventive medicine with their patients. I just think that if we call it "negligent" for a hand surgeon not to send his patient for a colonoscopy, we're overshooting the problem.
Pearl ultimately gave his recommendation of "four pillars of transformation," but I thought he didn't think them through in a nuanced way. For example, he pushed for health care to be "prepaid, moving away from pay-for-volume toward paying for value and superior outcomes." I see his argument for this, but it seems like prepaying would incentivize providers to deny care, just as the current system encourages them to provide unneeded care. He didn't address this obvious issue. Health care solutions are complex, and every solution causes new problems. The only problem he seemed to think about was that the "legacy players" wouldn't like his solutions. I would take his recommendations more seriously if he seemed to have considered the potential negatives.
He also seemed to overestimate the impact of some of his ideas on the health care system. One of his "pillars" was about modernizing technology in the way patients and doctors make appointments and access records. The book was written before the pandemic, but now that we can all make online medical appointments, I haven't been experiencing my health care as improved. Online appointments are a convenience sometimes, but they don't do much to address the major systemic problems in our health care system. Electronic records are a little more helpful, I believe, but they seem to have led to my doctors spending a lot of appointment time staring at the computer instead of listening to me. I don't think they're delivering the major improvements that Pearl anticipated.
As I was reading I kept waiting for thoughtful, clearly explained ideas for improving the problems Pearl was describing in our health care system. I found those to be few and far between. There are a lot of interesting stories and examples of flaws in the current system, but I got frustrated at what I perceive as inadequate and possibly counterproductive solutions suggested in the book.
A bigger problem I have with the book is that I thought the author was overly simplistic and illogical in his thinking. Because of this, I disagreed with many of his conclusions and recommendations.
One example he gives in the book is contrasting two women who both had hand surgery and both died. Pearl says, "Both of these surgeons will fail to ask a crucial question. These omissions will cost each woman her life." He consistently suggests that the two doctors' "mistakes" are similar and implies that they were the cause of both women's deaths. I strongly disagree!
One surgeon directly caused a woman's death by administering medication that caused her heart to stop. It was a tragic accident, and the surgeon could have gathered more information before the surgery that probably would have prevented the death. The second surgeon successfully treated a woman's carpal tunnel syndrome. The woman died a few years later of colon cancer. The supposed "mistake" that the surgeon made was not referring the woman for a colonoscopy, which supposedly would have saved her life. Pearl claims that these two situations were "equally negligent, as both were preventable."
I just can't agree with his conclusion! I actually find this to be one of the problems with the current health care system - doctors are required to check all the "prevention" boxes instead of focusing on patients' actual requests. It overwhelms everyone. Should we require everyone who gets surgery for carpal tunnel syndrome to get a colonoscopy? Of course, it wouldn't just be a colonoscopy - they'd also have to have a battery of tests for every possibly preventable issue, from high blood pressure to elevated liver enzymes. What if the patient declines? (The author seems to assume that patients would not decline. I don't think he even knows whether the second surgeon recommended a colonoscopy - he just knows that the patient didn't get one, so he has decided that the surgeon was negligent.) Some people avoid the doctor because every time they go, they have to sit through a list of recommendations to lose weight, stop smoking, get a variety of tests, get their flu shot, etc., when all they wanted was to get their sprained ankle examined. I'm not saying that doctors shouldn't discuss preventive medicine with their patients. I just think that if we call it "negligent" for a hand surgeon not to send his patient for a colonoscopy, we're overshooting the problem.
Pearl ultimately gave his recommendation of "four pillars of transformation," but I thought he didn't think them through in a nuanced way. For example, he pushed for health care to be "prepaid, moving away from pay-for-volume toward paying for value and superior outcomes." I see his argument for this, but it seems like prepaying would incentivize providers to deny care, just as the current system encourages them to provide unneeded care. He didn't address this obvious issue. Health care solutions are complex, and every solution causes new problems. The only problem he seemed to think about was that the "legacy players" wouldn't like his solutions. I would take his recommendations more seriously if he seemed to have considered the potential negatives.
He also seemed to overestimate the impact of some of his ideas on the health care system. One of his "pillars" was about modernizing technology in the way patients and doctors make appointments and access records. The book was written before the pandemic, but now that we can all make online medical appointments, I haven't been experiencing my health care as improved. Online appointments are a convenience sometimes, but they don't do much to address the major systemic problems in our health care system. Electronic records are a little more helpful, I believe, but they seem to have led to my doctors spending a lot of appointment time staring at the computer instead of listening to me. I don't think they're delivering the major improvements that Pearl anticipated.
As I was reading I kept waiting for thoughtful, clearly explained ideas for improving the problems Pearl was describing in our health care system. I found those to be few and far between. There are a lot of interesting stories and examples of flaws in the current system, but I got frustrated at what I perceive as inadequate and possibly counterproductive solutions suggested in the book.
December 29, 2021
The pandemic ruined nonfiction for me for a while. I tried on several occasions to pick this up, but a circa-2017 analysis of the problems in the U.S. healthcare system seemed too depressing when a novel virus was demolishing it in 2020 and 2021. Now having finished this, the chapters develop a compelling story: (1) What is wrong? (2) Why is this problem unique to the U.S.? (3) What do we do to fix it? Even though the world seems to have changed dramatically in the last couple of years, this remained a disturbingly relevant book.
(1) What is wrong? covered a reliance on paper records, an inability to access consistent information, lack of prevention/early interventions, and billing according to individual tests/operations rather than outcomes. But the main point that Pearl would focus on for the remainder of the book was how operational issues in the healthcare setting exist to the detriment of health—more on this later.
(2) Why does the U.S. have this problem when no other country seems to? was worth mentioning, but the overwhelming answer is that the U.S. is completely backwards compared to how the rest of the world does healthcare, and appears to be paying the price for it. Pearl wanted to address this, and seemed optimistic that solutions exist without invoking a single-payer system.
(3) How do we fix it? As a health informatics Ph.D. student, this was partly inspiring and partly terrifying. Most of Pearl's recommendations are related to technology and healthcare. Being facetious: if only we had "Uber for Healthcare" then these problems would be solved. We see from part (2) that countries with socialized medicine seem to provide better outcomes for their citizens (with some caveats: smaller and more homogenous populations, etc.). It's suggested in (1) and (3) that technology is both the problem and the solution. A natural question should be: what does technology adoption and hospital communication look like in these places? Are countries with socialized medicine technological utopias, or paper-based hellscapes, or somewhere comparable to the U.S.? This is critical to understanding whether the proposed interventions are valid. Consider starting with: a "troubled system" + "technology" vs. a "good system" + "technology." It's not obvious how the unknown component "technology" will make the two equivalent. The argument seems to assume that "technology" will provide an exponential return on investment that dwarfs everything else in the equation.
So to recap: I really enjoyed reading this, but it's hard to not be skeptical about the conclusions. The problems this addressed kept reminding me of an argument that Rutger Bregman made in Utopia for Realists . Bregman gave "universal basic income" as an example where nations with capitalist economies conclude to use a policy that looks like socialism but is reached through a different logic. In any society there is a common set of problems that people want resolved (i.e., ending poverty), but Bregman suggests that hypothetical capitalist and socialist societies can each reach the same fixed point: "give people money" via different modes of reasoning. Dr. Pearl seems optimistic that we can solve the U.S. healthcare problem through policy adjustments and technology, but it's unclear how this would resolve "U.S. citizens not believing healthcare is a right" and "private control of lifesaving medications." The problem that society needs to resolve is: "provide a healthy life to its citizens," but the fixed point still sounds like it needs to be "give people healthcare."
(1) What is wrong? covered a reliance on paper records, an inability to access consistent information, lack of prevention/early interventions, and billing according to individual tests/operations rather than outcomes. But the main point that Pearl would focus on for the remainder of the book was how operational issues in the healthcare setting exist to the detriment of health—more on this later.
(2) Why does the U.S. have this problem when no other country seems to? was worth mentioning, but the overwhelming answer is that the U.S. is completely backwards compared to how the rest of the world does healthcare, and appears to be paying the price for it. Pearl wanted to address this, and seemed optimistic that solutions exist without invoking a single-payer system.
(3) How do we fix it? As a health informatics Ph.D. student, this was partly inspiring and partly terrifying. Most of Pearl's recommendations are related to technology and healthcare. Being facetious: if only we had "Uber for Healthcare" then these problems would be solved. We see from part (2) that countries with socialized medicine seem to provide better outcomes for their citizens (with some caveats: smaller and more homogenous populations, etc.). It's suggested in (1) and (3) that technology is both the problem and the solution. A natural question should be: what does technology adoption and hospital communication look like in these places? Are countries with socialized medicine technological utopias, or paper-based hellscapes, or somewhere comparable to the U.S.? This is critical to understanding whether the proposed interventions are valid. Consider starting with: a "troubled system" + "technology" vs. a "good system" + "technology." It's not obvious how the unknown component "technology" will make the two equivalent. The argument seems to assume that "technology" will provide an exponential return on investment that dwarfs everything else in the equation.
So to recap: I really enjoyed reading this, but it's hard to not be skeptical about the conclusions. The problems this addressed kept reminding me of an argument that Rutger Bregman made in Utopia for Realists . Bregman gave "universal basic income" as an example where nations with capitalist economies conclude to use a policy that looks like socialism but is reached through a different logic. In any society there is a common set of problems that people want resolved (i.e., ending poverty), but Bregman suggests that hypothetical capitalist and socialist societies can each reach the same fixed point: "give people money" via different modes of reasoning. Dr. Pearl seems optimistic that we can solve the U.S. healthcare problem through policy adjustments and technology, but it's unclear how this would resolve "U.S. citizens not believing healthcare is a right" and "private control of lifesaving medications." The problem that society needs to resolve is: "provide a healthy life to its citizens," but the fixed point still sounds like it needs to be "give people healthcare."
May 23, 2018
Edward Fisher
In Mistreated: Why We Think We’re Getting Good Healthcare—And Why We’re Usually Wrong, the author, Dr. Robert Pearl MD, explains to the readers just why that happens. Dr. Pearl is a board-certified plastic and reconstructive surgeon; he got his MD from Yale University School of Medicine, and did his Residency in Plastic and Reconstructive Surgery at Stanford University School of Medicine. Dr. Pearl was the CEO of Kaiser Permanente Medical Group from 1999 to 2017, Americas largest medical group, leading over 10,000 practicing physicians, and 4 million Kaiser members. Dr. Pearl is currently a Clinical Professor of Plastic Surgery at Stanford University School of Medicine, and a professor at Stanford University Graduate School of Business, having taught at Harvard Medical School, Duke, and UC Berkeley. Pearl has countless articles in Forbes Magazine, including interviews with very influential Forbes publishers like Malcolm Gladwell. He was recently named one of Modern Healthcare’s 50 most influential physician leaders and has spoken on the news for Time, ABC News, USA Today, and NPR. Basically, he’s a god.
Pearl jumps right into the book with what we find out to be the reason that he went into medicine—his father was found unconscious one morning—for an infection that metastasized from his lungs into his entire body. We are described the surroundings of the inside of an ICU, and Jack Pearl, DDS, has an endotracheal tube into his lungs. He is in septic shock, and Robert and Ron Pearl, (brothers, Jack’s sons, both MD’s), are well aware of the life-threatening condition that their father is in, though it remains a mystery: how did he get here? Eventually, it is explained that Jack Pearl was diagnosed with a hemolytic anemia; he killed too many of his red blood cells, deeming him very weak. (This was in his sixties). After many transfusions, there were not very many options left other than a splenectomy. (Removal of the spleen). This fixed it! Yay! But that was many years ago. Today, he was in septic shock because of a pneumococcal infection, something that he would have been very susceptible to getting without a spleen. After the splenectomy, he should have gotten a pneumococcal vaccination. His doctors all obviously knew this, but he had two sets of doctors. The ones in Florida, who had diagnosed the hemolytic anemia, and the ones in New York, who had performed the splenectomy. Both sets were under the safe impression that the other set had given the pneumococcal vaccine, when in fact, neither had. Then the lens zooms out to the outside of the hospital, where the physicians of Stanford’s Medical Center are eating lunch, and where it is sunny and bright out. For everyone else, this is just another day, but for the Pearls, it’s the first time that they are on the wrong end of the patient—doctor spectrum. In January of 2003, a couple days after being moved from a hospital to a skilled-nursing home, Jack Pearl died, in his sleep, at 83 years old.
Robert Pearl diagnosed the American medical system as critically ill: burned out, tired, and sometimes depressed physicians; and several, billion-dollar pharmaceutical companies who do not fear public backlash when they raise prices by 5,000%, and of course: unaffordable health care costs that are rising twice as fast as America can pay them off, are what contributed towards the doctors not using an electronic system to input patient data; patient data of arguable the most influential physician family in the world; and the easily preventable premature death of one of those doctors and family members.
Dr. Pearl’s book has countless strengths, but there is one extremely prominent one—the personal connection that Pearl portrays between himself and his father—and that personal connection Pearl manages to establish throughout the book to the readers. Dr. Pearl’s father is portrayed in a way that it is very hard not to love him: he was raised by parents who immigrated to America from Belarus, went to dental school, and he volunteered to be paratroop in World War II, surviving D-Day, and led an elaborate escape mission from a Nazi camp. But no, he is not alive today to tell those stories, because he died 15 years ago, when he should have died in over three years—in the future—once he reached a hundred, which he probably would have, if it wasn’t for the physician-made medical error, that had cost Jack Pearl the last 20 years of, and the conclusion of, his life. Robert Pearl manages to do what I have always seen to be impossible: make a factually inspired, medical journal-like, book, nonstop action: which in turn means that it is a very good read. How Pearl does this is through his father—a personal connection that suits both the readers and the author. Pearl mentions to us that “Death is no stranger to physicians. I have lost patients to cancer, infection, and trauma. Each death is painful. But to see someone die prematurely from a medical error or preventable problem is something else entirely, especially when that someone is your father” (Pearl, 11). This is just so completely true, and Pearl has managed to bond with the readers through the bond that he and his father had, making this book, almost personal, to almost every reader. I think that this book is just completely amazing.
Are there even any weaknesses to discuss? Well, to be honest, no, there aren’t. But, this book, amazing as it is, won’t particularly be enjoyed to the fullest by everyone. So, who is it for? Anyone over the age of, oh, say 14, with basic knowledge of mammalian bio and physiology. I wouldn’t recommend this book to anyone who is grossed out by gore, death, hospitals, etc. (medicine). Everyone else, ranging from freshmen in biology to practicing surgeons, can enjoy this book, thanks to the extraordinary knowledge, creativity, and compassion displayed by Dr. Robert Pearl, MD.
In my personal opinion, I think that Mistreated is truly an awesome book, because it encompasses the complete ideology of the American medical system. By combining the whole thing with his own life, Pearl manages to keep the readers completely intrigued throughout the entirety of the book, and although it is factual, non-fiction, and very informative: it’s nonstop action, just the right amount to keep you on the edge of your seat. I really loved the book—truly. I totally think that everyone who I mentioned earlier should, absolutely, read it.
In Mistreated: Why We Think We’re Getting Good Healthcare—And Why We’re Usually Wrong, the author, Dr. Robert Pearl MD, explains to the readers just why that happens. Dr. Pearl is a board-certified plastic and reconstructive surgeon; he got his MD from Yale University School of Medicine, and did his Residency in Plastic and Reconstructive Surgery at Stanford University School of Medicine. Dr. Pearl was the CEO of Kaiser Permanente Medical Group from 1999 to 2017, Americas largest medical group, leading over 10,000 practicing physicians, and 4 million Kaiser members. Dr. Pearl is currently a Clinical Professor of Plastic Surgery at Stanford University School of Medicine, and a professor at Stanford University Graduate School of Business, having taught at Harvard Medical School, Duke, and UC Berkeley. Pearl has countless articles in Forbes Magazine, including interviews with very influential Forbes publishers like Malcolm Gladwell. He was recently named one of Modern Healthcare’s 50 most influential physician leaders and has spoken on the news for Time, ABC News, USA Today, and NPR. Basically, he’s a god.
Pearl jumps right into the book with what we find out to be the reason that he went into medicine—his father was found unconscious one morning—for an infection that metastasized from his lungs into his entire body. We are described the surroundings of the inside of an ICU, and Jack Pearl, DDS, has an endotracheal tube into his lungs. He is in septic shock, and Robert and Ron Pearl, (brothers, Jack’s sons, both MD’s), are well aware of the life-threatening condition that their father is in, though it remains a mystery: how did he get here? Eventually, it is explained that Jack Pearl was diagnosed with a hemolytic anemia; he killed too many of his red blood cells, deeming him very weak. (This was in his sixties). After many transfusions, there were not very many options left other than a splenectomy. (Removal of the spleen). This fixed it! Yay! But that was many years ago. Today, he was in septic shock because of a pneumococcal infection, something that he would have been very susceptible to getting without a spleen. After the splenectomy, he should have gotten a pneumococcal vaccination. His doctors all obviously knew this, but he had two sets of doctors. The ones in Florida, who had diagnosed the hemolytic anemia, and the ones in New York, who had performed the splenectomy. Both sets were under the safe impression that the other set had given the pneumococcal vaccine, when in fact, neither had. Then the lens zooms out to the outside of the hospital, where the physicians of Stanford’s Medical Center are eating lunch, and where it is sunny and bright out. For everyone else, this is just another day, but for the Pearls, it’s the first time that they are on the wrong end of the patient—doctor spectrum. In January of 2003, a couple days after being moved from a hospital to a skilled-nursing home, Jack Pearl died, in his sleep, at 83 years old.
Robert Pearl diagnosed the American medical system as critically ill: burned out, tired, and sometimes depressed physicians; and several, billion-dollar pharmaceutical companies who do not fear public backlash when they raise prices by 5,000%, and of course: unaffordable health care costs that are rising twice as fast as America can pay them off, are what contributed towards the doctors not using an electronic system to input patient data; patient data of arguable the most influential physician family in the world; and the easily preventable premature death of one of those doctors and family members.
Dr. Pearl’s book has countless strengths, but there is one extremely prominent one—the personal connection that Pearl portrays between himself and his father—and that personal connection Pearl manages to establish throughout the book to the readers. Dr. Pearl’s father is portrayed in a way that it is very hard not to love him: he was raised by parents who immigrated to America from Belarus, went to dental school, and he volunteered to be paratroop in World War II, surviving D-Day, and led an elaborate escape mission from a Nazi camp. But no, he is not alive today to tell those stories, because he died 15 years ago, when he should have died in over three years—in the future—once he reached a hundred, which he probably would have, if it wasn’t for the physician-made medical error, that had cost Jack Pearl the last 20 years of, and the conclusion of, his life. Robert Pearl manages to do what I have always seen to be impossible: make a factually inspired, medical journal-like, book, nonstop action: which in turn means that it is a very good read. How Pearl does this is through his father—a personal connection that suits both the readers and the author. Pearl mentions to us that “Death is no stranger to physicians. I have lost patients to cancer, infection, and trauma. Each death is painful. But to see someone die prematurely from a medical error or preventable problem is something else entirely, especially when that someone is your father” (Pearl, 11). This is just so completely true, and Pearl has managed to bond with the readers through the bond that he and his father had, making this book, almost personal, to almost every reader. I think that this book is just completely amazing.
Are there even any weaknesses to discuss? Well, to be honest, no, there aren’t. But, this book, amazing as it is, won’t particularly be enjoyed to the fullest by everyone. So, who is it for? Anyone over the age of, oh, say 14, with basic knowledge of mammalian bio and physiology. I wouldn’t recommend this book to anyone who is grossed out by gore, death, hospitals, etc. (medicine). Everyone else, ranging from freshmen in biology to practicing surgeons, can enjoy this book, thanks to the extraordinary knowledge, creativity, and compassion displayed by Dr. Robert Pearl, MD.
In my personal opinion, I think that Mistreated is truly an awesome book, because it encompasses the complete ideology of the American medical system. By combining the whole thing with his own life, Pearl manages to keep the readers completely intrigued throughout the entirety of the book, and although it is factual, non-fiction, and very informative: it’s nonstop action, just the right amount to keep you on the edge of your seat. I really loved the book—truly. I totally think that everyone who I mentioned earlier should, absolutely, read it.
July 10, 2017
Heartfelt, insightful view of what's wrong with and how to fix America's healthcare system from CEO of Permanente Medical Group. Hint: it's all about cost and quality of care delivery. I wrote about it here: https://www.gsb.stanford.edu/insights... and here: https://www.strategy-business.com/art...
July 3, 2019
A nonfiction book by a doctor and the CEO of Kaiser about all that ails our (the USA's) health care system. (Put that way, it's amazing it's not 100,000 pages long.)
This is an important book chock full of info, on topics from health insurance, the ACA (Affordable Care Act), different potential ways to structure health care delivery systems, and the emerging financial sinkhole that we are stuck in regarding health care costs.
The author states that the U.S. is stuck between a rock and a hard place in terms of health care's spiraling costs. The costs will soon outpace GDP at a rate that will be unsustainable. We will collapse under the health care problem's weight if costs continue to grow at their current rate.
He said something that astounded me (but could be true): that people in other countries with universal health care systems view health care as a fundamental human right, while here in the U.S. with (prior to ACA) no universal health care, we view it as something you need to earn. But why should you have to earn something that applies to 100% of us (the care of a body)? Maybe because the occasional rare person actually lives their whole life without needing a doctor...? But what about their vaccinations, for example?
So much to learn and think about in this book. Just one last thing which I think is particularly important: we obsess about finding the "best doctor" so much. But he said don't worry about an individual doctor's talents: you need to find doctors that have 1) the support of a good IT system, 2) are surrounded by a good team, 3) adherence to national guidelines, and 4) how often this doctor has performed a particular procedure. Those items are most important--not what your friends, family and co-workers think about a doctor's bedside manner or whatever.
This is an important book chock full of info, on topics from health insurance, the ACA (Affordable Care Act), different potential ways to structure health care delivery systems, and the emerging financial sinkhole that we are stuck in regarding health care costs.
The author states that the U.S. is stuck between a rock and a hard place in terms of health care's spiraling costs. The costs will soon outpace GDP at a rate that will be unsustainable. We will collapse under the health care problem's weight if costs continue to grow at their current rate.
He said something that astounded me (but could be true): that people in other countries with universal health care systems view health care as a fundamental human right, while here in the U.S. with (prior to ACA) no universal health care, we view it as something you need to earn. But why should you have to earn something that applies to 100% of us (the care of a body)? Maybe because the occasional rare person actually lives their whole life without needing a doctor...? But what about their vaccinations, for example?
So much to learn and think about in this book. Just one last thing which I think is particularly important: we obsess about finding the "best doctor" so much. But he said don't worry about an individual doctor's talents: you need to find doctors that have 1) the support of a good IT system, 2) are surrounded by a good team, 3) adherence to national guidelines, and 4) how often this doctor has performed a particular procedure. Those items are most important--not what your friends, family and co-workers think about a doctor's bedside manner or whatever.
July 25, 2017
This is a book everyone should read. I only hope that the author's ideas for making healthcare better come to fruition in the very near future.
July 18, 2017
I believe in the Permanente Medical Group and the approach to treatment. Robbie Pearl is the CEO of the Group. It's a good summary of the underlying principles of this way to deliver better healthcare.
But the first part of the book tries to tie psychological concepts to the current problems with heatlhcare and just doesn't make much sense as an underlying theory. The second part of the book is absolutely right in the description of the advances of the Affordable Care Act and the "prescription" for improving healthcare delivery. Worth reading, especially for this.
The book also weaves together many patient stories that are very engaging and inspiring.
But the first part of the book tries to tie psychological concepts to the current problems with heatlhcare and just doesn't make much sense as an underlying theory. The second part of the book is absolutely right in the description of the advances of the Affordable Care Act and the "prescription" for improving healthcare delivery. Worth reading, especially for this.
The book also weaves together many patient stories that are very engaging and inspiring.
October 12, 2018
The patient stories make this an easy and engaging read, considering how complex the subject matter is. Unfortunately, as with all the other books I've read about this (T.R. Reid's book, Wendell Potter's book, Marty Makary's book, Elisabeth Rosenthal's book), the news on both quality and cost of our current health care is grim. This book is a strong argument in favor of fully integrated health care with strong enforcement of best practices and care coordination. I.e. single-payer with strict oversight and provider accountability.
If we want change, as we definitely should, we patients will have to make it happen. Against stiff resistance from everyone in the system, including our own doctors. And in the meantime, we can't even trust medical professionals to wash their hands when they should. Nor to give us advice that is in our best interests when those best interests diverge from their own.
Dr. Pearl wrote this book because his much-loved father died due to a medical oversight. None of his doctors made sure he got a vaccine that he should have received when his spleen was surgically removed. It seems to me that until the system changes the only way we can be safe from such errors is to research our own medical conditions so exhaustively that we can correct the professionals(!) And I can't think of any way to be safe from unwashed hands without being rude to the very people you hope will help you.
One important thing I learned from this book bears special mention: we should all educate ourselves about sepsis. Apparently doctors are reluctant to treat it aggressively as early as they should (before the patient goes into crisis) because the treatment can kill. But NOT treating it aggressively leads to death far more often than the treatment would. The problem is, doctors find it much easier to tell loved ones sepsis killed the patient than to say their treatment did so.
If we want change, as we definitely should, we patients will have to make it happen. Against stiff resistance from everyone in the system, including our own doctors. And in the meantime, we can't even trust medical professionals to wash their hands when they should. Nor to give us advice that is in our best interests when those best interests diverge from their own.
Dr. Pearl wrote this book because his much-loved father died due to a medical oversight. None of his doctors made sure he got a vaccine that he should have received when his spleen was surgically removed. It seems to me that until the system changes the only way we can be safe from such errors is to research our own medical conditions so exhaustively that we can correct the professionals(!) And I can't think of any way to be safe from unwashed hands without being rude to the very people you hope will help you.
One important thing I learned from this book bears special mention: we should all educate ourselves about sepsis. Apparently doctors are reluctant to treat it aggressively as early as they should (before the patient goes into crisis) because the treatment can kill. But NOT treating it aggressively leads to death far more often than the treatment would. The problem is, doctors find it much easier to tell loved ones sepsis killed the patient than to say their treatment did so.
January 25, 2023
I had the pleasure of attending a conference where Robert Pearl spoke several years ago, which is where I received my copy of the book. It is so very "me" that I was excited to read it, but like many books I acquire, I didn't get to it right away. Or for years. I finally sat down with it this month and devoured it.
I give you that backstory because it explains that my complaint with this book has to do with it already being out of date. "In fact, the half-life of medical knowledge is now estimated to be five to seven years, meaning that half of what we learned five, six, or seven years ago is now understood to be wrong." While this clearly isn't meant to refer to the book, reading a five year old book about the medical profession written before the Trump administration and before the Covid pandemic has a similar effect. Chapters involving electronic records and telehealth no longer have the same pushback they did in 2017.
But you know what? The main idea of the book still rings as true in 2023 as it did in 2017. The healthcare system in this country definitely still has yet to focus on the patients themselves, and the patients don't seem to be aware of the ways in which they are lacking. When I was in law school I had a professor who also worked with doctors in developing practices that increased patient advocacy. Most of my work in law dealt with discussions with doctors over the choices they made and whether they were done because it was standard or the best interest of the patient.
In my current position I often speak up on behalf of the member experience which can easily be overlooked when healthcare is treated more like a business than a healing institution. And Pearl points out that it isn't even treated as other businesses are treated, given leeway where other industries have been reigned in.
Pearl presents wonderful insight into the ways in which the current system fails us, and suggestions which would lead to a revolution in the ways we receive care.
I give you that backstory because it explains that my complaint with this book has to do with it already being out of date. "In fact, the half-life of medical knowledge is now estimated to be five to seven years, meaning that half of what we learned five, six, or seven years ago is now understood to be wrong." While this clearly isn't meant to refer to the book, reading a five year old book about the medical profession written before the Trump administration and before the Covid pandemic has a similar effect. Chapters involving electronic records and telehealth no longer have the same pushback they did in 2017.
But you know what? The main idea of the book still rings as true in 2023 as it did in 2017. The healthcare system in this country definitely still has yet to focus on the patients themselves, and the patients don't seem to be aware of the ways in which they are lacking. When I was in law school I had a professor who also worked with doctors in developing practices that increased patient advocacy. Most of my work in law dealt with discussions with doctors over the choices they made and whether they were done because it was standard or the best interest of the patient.
In my current position I often speak up on behalf of the member experience which can easily be overlooked when healthcare is treated more like a business than a healing institution. And Pearl points out that it isn't even treated as other businesses are treated, given leeway where other industries have been reigned in.
Pearl presents wonderful insight into the ways in which the current system fails us, and suggestions which would lead to a revolution in the ways we receive care.
March 10, 2022
This book takes a psychological, political, statistical, and financial perspective of why US health care is bad. While I agree with most points made by the author, some parts of the book were potentially biased of the authors insurance network he is the CEO of.
Also, if you hate politics (like me), this book is not for you as about 1/3 of it is in depth political talk, as well as laws/regulations that were a little tedious to read.
The points of psychological reasons we do certain things and the case studies/stories of patients were the best part of the book.
My biggest complaint overall was how repetitive certain points were made; ex. he mentioned how all physicians should integrate technology into their practice to have better communication which would lead to better health care. While I agree with this statement, he reiterated this statement what felt like 1000 times in different words; almost like a high schooler trying to get their page count for an essay but not having much to say.
I was very excited for this book but it was my slowest read so far. I enjoyed about 1/2 of it so I give it 3/5. But this book is not going to be for you if you’re not into politics and law/regulations of the US.
Also, if you hate politics (like me), this book is not for you as about 1/3 of it is in depth political talk, as well as laws/regulations that were a little tedious to read.
The points of psychological reasons we do certain things and the case studies/stories of patients were the best part of the book.
My biggest complaint overall was how repetitive certain points were made; ex. he mentioned how all physicians should integrate technology into their practice to have better communication which would lead to better health care. While I agree with this statement, he reiterated this statement what felt like 1000 times in different words; almost like a high schooler trying to get their page count for an essay but not having much to say.
I was very excited for this book but it was my slowest read so far. I enjoyed about 1/2 of it so I give it 3/5. But this book is not going to be for you if you’re not into politics and law/regulations of the US.
August 26, 2021
Heard Dr Pearl in an interview on NPR talking about his new book Uncaring. I found this one while waiting for a hold from the library. It is a must read for anyone interested in American healthcare . In it he gives a very thorough description of the ACA, how it was meant to work and how it has become mired down in the politics of bickering partisanship. He begins the book with a description of his Father's death from Sepsis, and how having two sons and a brother who were doctors didn't save him. It made me look at some aspects of healthcare in the past and realize that there was a lot more to the story than we realized. Scurvy for instance in the history book always seemed to have been solved quickly, usually in one paragraph in our school textbooks but in reality it took nearly 300 years to get from its discovery by doctors and the cure of carrying lime juice on long sea voyages. In the meantime many seamen lost their lives from this easily preventable disease.
July 15, 2017
Excellent story of what's wrong with healthcare
I enjoyed reading the book and although a lot of the information is known to most physicians, there were plenty of examples to motivate one to look deeper into the "4 pillars of transformation" and understand the necessity and contribution of each of them with emphasis on the most critical one of growing physician leadership. Health care as portrayed in this book is a "team sport" and physicians historically have known how to captain but not necessarily how to lead or be "an integral part of the team." I believe this book will appeal to everyone who is touched by healthcare in this country which means the whole nation including as nicely articulated in the book, the "legacy players."
I enjoyed reading the book and although a lot of the information is known to most physicians, there were plenty of examples to motivate one to look deeper into the "4 pillars of transformation" and understand the necessity and contribution of each of them with emphasis on the most critical one of growing physician leadership. Health care as portrayed in this book is a "team sport" and physicians historically have known how to captain but not necessarily how to lead or be "an integral part of the team." I believe this book will appeal to everyone who is touched by healthcare in this country which means the whole nation including as nicely articulated in the book, the "legacy players."
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March 19, 2020It’s no secret that the American healthcare system is broken. While there have been great advances in healthcare that saves lives and improves the quality of lives for so many people, it is still broken. The problem is that we can’t take a step back and fix it because it’s still saving lives every day. Mistreated: Why We Think We’re Getting Good Health Care—and Why We’re Usually Wrong walks through the details of our healthcare system from blind spots and misperception to motivations that are out of alignment with what’s best for the public.
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September 14, 2017
Anyone who is interested in the state of the health care situation in our country - which should be about everyone - should read this book. It is written by a very well qualified individual. The author illustrates his points with stories from peoples' experiences to make his points. He makes it clear that our misperceptions about how good the U.S. health care system is really color why it is hard to change the status quo. Add to this the stupid way the health insurance payment system has been structured, and lobbying payoffs to our elected officials and you have a big mess. He makes a lot of good points on how we can get to a better place - if anyone will listen.
October 11, 2017
This is an excellent look at how and why our health care system operates as it does and why and how to change that. We need a system that is connected, technologically competent, and coordinated. We need a system that pays more attention to errors of omission and doesn't base physician salary on the number of services performed. The book deftly intersperses anecdotes of the author - as a doctor, medical leader, and family member - with expert professional knowledge and a straightforward style.
Even if you are already well versed in this universe, you will still be left (as I was) wondering why we are still mired in an outdated, ineffective, and stubborn system.
Even if you are already well versed in this universe, you will still be left (as I was) wondering why we are still mired in an outdated, ineffective, and stubborn system.
November 25, 2017
A very well done, workmanlike discussion of the choices we face to provide good healthcare, and how we got here. In interesting ways, it updates Starr's Social Transformation of Medicine in America - first, by filling in the decades since Starr published. More interestingly, where Starr looked at the medical community in terms of social and economic trends, Pearl looks at it in terms of motivators, biases, and patient / physician / system psychology.
If you haven't been immersed in the policy, politics, business, and conflicts in healthcare for the past 10 years, this is a great overview of where we are, and a good discussion of where we can go.
If you haven't been immersed in the policy, politics, business, and conflicts in healthcare for the past 10 years, this is a great overview of where we are, and a good discussion of where we can go.
September 24, 2017
I have an interest in healthcare because of my career but this book is written in common enough language for anyone to understand it. The author begins the book with a story of how he lost his father due to medical neglect. He talks at length about how our system, though very expensive in the US is not the best and explains why. Especially interesting are the chapters on the ACA. Worth reading for all of us who are interested in better and more efficient health care.
August 20, 2018
For anyone looking to educate yourself on the issues in the American health care system, this should be your first stop.
The subject is complex which makes it a challenging read, but Pearl managed to write a highly readable book on a topic that could have been easily too dry to be palpable. Good book for anyone regardless of how acquainted you are on the subject, professionals and patients alike. Written very recently, with references to the 2016 election.
The subject is complex which makes it a challenging read, but Pearl managed to write a highly readable book on a topic that could have been easily too dry to be palpable. Good book for anyone regardless of how acquainted you are on the subject, professionals and patients alike. Written very recently, with references to the 2016 election.
July 23, 2018
I think everyone who uses medical care in the US should read this. I already knew some of this but many sections really helped me understand what was intended with the ACA, what will we keep and what will we lose. The problems with medical care in America starkly demonstrated with data and possible solutions.
November 7, 2018
If you're someone who even casually follows health care and its social /economic/political implications in the U.S., then there's not much new here, but it's probably still worth the read. Or listen to the audiobook (which is what I did and I'm too lazy to add the edition) although the reader of the audiobook is not the author and his cadence was annoying to me.
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September 25, 2019Pearl argues that cost, driven by the delivery system, is the problem. His solution is "integration (both horizontally within specialties and vertically between primary care and specialty care and outpatient and inpatient), capitation (prepayment), modern technology (comprehensive electronic health record, secure e-mail and video) and physician leadership."
July 4, 2020
An absolute must-read for any individual electing a profession related in any way to healthcare.
As a student looking ahead to a career in medicine and psychiatry, this opened my eyes to how ineffective our current system is. It lit a fire in my belly for reform and revolution, and I hope even the casual reader understands the implications of this for their own lives.
As a student looking ahead to a career in medicine and psychiatry, this opened my eyes to how ineffective our current system is. It lit a fire in my belly for reform and revolution, and I hope even the casual reader understands the implications of this for their own lives.
October 4, 2021
Thank you, Dr. Pearl!
There is so much low-hanging fruit in America’s dysfunctional, disjointed, overpriced medical patchwork, and Dr. Pearl does a great job of shining a light on problems and pointing to solutions with human stories.
There is so much low-hanging fruit in America’s dysfunctional, disjointed, overpriced medical patchwork, and Dr. Pearl does a great job of shining a light on problems and pointing to solutions with human stories.
September 24, 2017
Interesting book on US healthcare in 2016/2017. Good perspective on the healthcare industry, though at times it sounds like an ad for Kaiser.
November 9, 2019
The most upset a book has ever made me. But this is a must read.
January 21, 2020
Doctors have become today's used car salesmen. Buyer beware.
January 20, 2022
Redundant. If you're new to the topic, this is great and informative. If you're a disabled person, it's just retraumatizing
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