Uncaring: How the Culture of Medicine Kills Doctors and Patients

by Robert Pearl

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 Both parties blame our nation’s outdated and dysfunctional healthcare system.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.

Genres: Medicine, Nonfiction, Health Care, Medical, Science, Health, Audiobook

Audible Audio

Published May 18, 2021

About the author

Robert 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.

Reviews

[Rennie · Rating 4 out of 5]

This was excellent. There is so much wrong in the US healthcare system and it’s hurting both patients and physicians. The biggest problem that gets its tentacles into just about everything else is physician culture, as Pearl identifies it.

I learned so much from this book, and it was beautifully written. Actually I was surprised how lovely and eloquent the writing was as some other doctor-written books I’ve read had completely different, much more clinical styles. Pearl has that gift of knowing when to stick to data and statistics and when to tell a particularly moving and insightful anecdote or bit of history. This is a very necessary book, especially coming at the time it does - Pearl uses Covid-19 examples to show how a crisis can bring out the best and the worst, and there’s a lot of warning about what needs to change going forward, as we face huge economic difficulties and an overburdened healthcare system.

This is all a mess but I’m glad to understand more of it, and Pearl seems optimistic. We have wonderfully compassionate, caring, and well trained doctors, but we need better systems, infrastructure, and physician culture to actually have the best care outcomes and avoid errors as well as burnout and depression among clinicians.

[Beth]

Pearl has some good insights. First, he argues America should've gone with Roosevelt's national healthcare reform plan in 1932. "Anchored by a prepaid reimbursement model and a more integrated approach to care delivery...A prepaid system would have led to generations of doctors to practice in group settings where excellent care depends on teamwork, interspecialty collaboration, and communication across the entire health system." It's fairly well known physicians are bogged down by billing their services to various different insurances, coded in the way those insurances will accept. He argues this would remove the incentive for doctors to overtest, overtreat, and overcharge.

What I've just quoted is from the end of the book in his like ten takeaways section. Earlier, he argues that people with migraines get overtreated with MRIs and CT scans when statistically doctors are no more likely to find something when compared to a randomly selected group of people. As someone who's had an MRI and EEG for migraines, ya, it was a waste of time! When I consider how we can more effectively treat people, this is the boots on the ground type of stuff I really appreciated from Pearl. Not only as a doctor but someone with a big picture view of healthcare.

This book, though, is about physician culture. There are some alarming things. High suicide rates for the profession. Specialty doctors treated better in the physician hierarchy when research shows adding more family doctors to a population has a more significant impact on lowering heart disease and cancer rates than specialists.

I think what I wanted more out of this book is something that really challenged doctors and pushed for stronger reforms in medicine. Although, maybe it challenges them enough because I've already seen one doctor on here really pressed by the tone of this book even though he agreed with its contents. Anyway, interesting book, but I wanted Pearl to be more ideologically in line with a book like Health Justice Now by Timothy Faust.

[Lynn · Rating 3 out of 5]

Book by a doctor discussing how the change in healthcare over the years has changed the profession. He also goes over why doctors resist public options for healthcare and why it’s an advantage to them to change. The book has a lot to go over but the story is so grim. The last chapter is about the author’s life story and why he chose medicine. He also writes how he loves it. But the chapter seems forced and tacked in probably at the urging of a publisher. It’s a downer.

[Anisha Mulumudi · Rating 4 out of 5]

guys i can’t believe i finished this book, i rly took me 3 months but don’t let that fool you it is quite excellent. pearl makes an excellent argument and truly lays it all out there to see: physician culture is founded in excellence, but that excellence can quickly turn to negligence.

reading this while applying to med school was ultra important and really reframed my perspective of medicine. it totally affirmed to me all the things about doctors being ego maniacs and how that genuinely hurts patients in every possible way. it also reminded me that there are people out there who recognize and despise this too, and care less about being hero and will help without thanks.

while the points are excellent, i think he’s not the greatest writer in the world. was i entertained? sure. was i engaged? yes. but the continuous formula of providing a tangentially related metaphor at the beginning of a chapter gets boring after the 50th time. sorry! i’m hater and i am going to hate

[Michael · Rating 2 out of 5]

I have to say this was a challenging read. Pearl is a physician and the former CEO of Kaiser Permanente, one of the most successful insurance agencies in the US. He has written a critique of physician culture that is hard hitting and honest. That being said, I have some serious concerns with the tone of this book, rather than most of the facts. First of all, the cover, title and subtitle of this book are gratuitous. The subtitle reads "how the culture of medicine kills doctors and patients". As an author, you are responsible for your title and this one gives away a willingness to be sensational. Secondly as the CEO of an insurance company, I suppose it is not surprising that Pearl comes off as patronizing towards physicians. Pearl sees all the solutions for health care as coming from above physicians from government or corporate agencies, or from patients applying pressure on physicians. He seems completely to have dismissed that physicians themselves could grow, mature and organize themselves and their community in a different way. This book won't help this cause, as it does not seem written for physicians, but about physicians. As a physician myself, I found the tone of the book to be condescending towards our community. That being said, Pearl's observations are not incorrect. His facts are not incorrect. His love of medicine seems authentic, but his tone towards his fellow physicians is out of joint and patronizing. This is a fatal flaw, and although one should not judge a book by it's cover, in this instance... the cover gives it away.

[Andrew House · Rating 5 out of 5]

Would definitely put this in my “essential reads for physicians” list. Good for general public as well although some of it may come across as unfamiliar and complex. Some of it was eye opening and even hurtful to read as a physician but it was all truth.

[Heather · Rating 3 out of 5]

After reading this, I feel like I can have some empathy for my doctors. The last chapter has questions you can ask doctors, which is really helpful. However, I couldn't help thinking while reading that it's very difficult to step outside of your own culture and critique it. So I'm taking the info with a grain of salt.

[Donna Hines (The Secret Book Sleuth) · Rating 3 out of 5]

I'm not sure if it's wise to base a change in the healthcare system solely upon a physician's advice but here we go.
Uncaring is about the health care system and everything that it faces today and in the coming days ahead especially among unchartered territory with the opiod crisis, pandemic, Covid virus, and dare I say even women's care with regard to hysterectomies.
What I can tell you having extensive knowledge on this subject matter and having just read an article about fake nursing diplomas in Florida is that our system is truly flawed to the point it's completely broken. https://www.cbsnews.com/news/fake-nur...
Not only this but I'm seeing personally more and more less qualified individuals rather than MD/DO we have PA-C's with 2 yrs. rather than 4 required.
This would be fine for routine care but not in emergency settings or extensive care/hospice situations.
Not long ago I went to the ER for asthma/COPD/chronic bronchitis (labeled acute for over 30 yrs.) and 21 yrs pneumonia to have my lungs tested. I needed an albuterol inhaler- a basic prescription- yet, the doctor couldn't prescribe as her credentials weren't even on file yet with the state and the nurse practicioner had to sign off for an inhaler.
I had another situation in which these younger doctors treat patients poorly. So much so that they look to 'label' individuals within 5 minutes of a first meeting in their office. This is not only risky but wrong and can in many cases lead to issues for the patient especially those with mental issues.
Not just this but I've noticed a significant increase in distribution of narcotics for the most minor complaint of pain. Oxycoton, anxiety meds, and more are giving out like candy at the slightest sign and it's sad because these are heavy narcotics that shouldn't be issued unless for the most serious cases.
Furthermore, doctors simply aren't listenting to patients concerns and addressing them fully. I'm someone with a history of medical issues and have attempted to address them over the last 30 plus years but sadly if you walk into a doctor's office and they ask your medical problems and you spew off a laundry list --well, trust me the negative labels will be attached for those rushed on time and patience.
It's sad because my mother is a retired RN-OBGYN who saved my life and that of my son along with countless others. The constant worry over medical malpractice lawsuits today is hampering the efforts of our nurses. The constant need to provide patient care and HIPA laws are causing confusion among many. The monopolies in our system and the ever changing profit over people is a constant in the insurance industry.
When I read this book and the questions posed I had to chuckle. I would never be able to go into a doctor's office and ask if he participated in drug trials or whether he received kickbacks from drug companies for promotion. I'd be content if he/she simply showed an ounce of interest much less remorse for misdiagnosis.
Allow me to showcase some more personal examples. I'm prediabetic, overweight, have just overcome herniated disc extrusion w temporary paralysis in both legs after a successful hysterecomy (robotic laproscopic/bilateral salpingo oophorectomy) with all ovaries, fallopian tubes, filsher clips and more removed. I had over 40 fibroids removed, I had beginning stages of endometriosis, it was told that my uterus was so enlarged they had to rip my vagina and seucher to remove (8x normal size/2x normal weight). I was initially told I had just 4 uterine fibroids, with my heavy menses, and my microcytic hypochromic anemia requiring b12/iron injections.
Thankfully, I had a surgeon who really was fantastic but shortly after my robotic laproscopic hysterectomy he left our facility and moved. I was never notified until 2 months later. I was needless to say devastated. I had to call his new hospital to try to learn if he was on their roster. Thankfully, he was but this basic information isn't something they normally even share.
Our healthcare is so awful that I've had times were I was sent home like this past time from an ER without even knowing the full extent of my illness. February 10th 2023, my dad passed away at 418 am. I went to ER at 10am-244 pm. Discharged w/o nasal swab results via PCR as just pneumonia from chest x-ray. Upon review of my medical file online I learned I had sepsis and Covid pneumonia as well as sinus tach. Imagine having 3 kids as a single mom and going to ER for IV treatment and receiving nothing but a can of ginger ale after being there all day while being told you'll be provided a meal soon. Imagine reading your file online and learning nothing was correct in terms of the information or situation at hand that day. Not the family history, not past medical history, not even the current stats. I was asked upon ER entry why I didn't go to primary. I explained because I have a history of passing out/lightheadedness/dyspnea as well as history of asthma, chronic bronchitis, pneumonia, copd, and more as a nonsmoker from factory work in which I breathed diesel fumes from loading docks without proper ventilation. Imagine not even getting called same day to be told you had Covid but learning about it online & getting a state text the next day.
Imagine being told you're anxious or that your hyperventilating when in reality you passed an EKG with sinus tachycardia every single hospital visit because you can't breathe. Imagine if you casually mention during said ER visit that your dad had passed and rather than treat the obvious illness with Covid Pneumonia, coughing, wheezing, dizziness, and more you instead offer anxiety meds aka zanax without doing any kind of evaluation on a first time visit within a few minutes together?
Our healthcare is not in the business to be psychologists they are in the business to be doctors and treat symptoms present not in making up symptoms for the ability to provide more meds to patients that do not need them.
Not everyone who loses a parent is anxious. Many like myself normally talk loud and if you're from NE PA you'll talk fast. This is my normal. My dad worked in the Navy during Cold War on air jets and during his end stage he was unable to hear. We had to always raise our voices with his hearing aids. Why do doctors assume without ever asking? This is my concern.
It's so sad to see how far our healthcare system has decreased and it concerns me how much worse will it get.
Being charged over $800 for a wart removal tube medication that cost $10 at CVS? Being provided care always with a PA-C without being seen by an actual Doctor of Medicine.
It's very scary as I have a son with vater syndrome. He's to have been medically disabled for life. He was physically/developmentally impaired with speech/reading comprehension yet our government SSI/SSP removed him at 18 yo. because hand-outs are seen negatively.
Lets also just say that I know someone who filed disability and couldn't get the aid not because she didn't need or qualify medically but because she owned too many assets while in extreme poverty, bankrupt, left homeless upon divorce, and without employment for nearly 20 years to raise her family.
We need immediate change especially for the impoverished dependent on Medicaid. I know personally that many times doctors would waste time in the waiting room knowing they were getting paid regardless of how long the patient stayed. I can also testify to improper procedures to treat medicaid like guinea pigs because of simply knowing they were covered financially.
My biggest concern is the doctors prescribing meds without conducting evaluations, based on first time assumptions, w/o past medical history or even patients concerns, while penalizing the pharmacy for filling said prescriptions. We have an opiod crisis in our nation and doctors aren't being held accountable.
We shouldn't treat patients as mere numbers but rather as intelligent individuals with hearts of gold.
I pray this can happen in my lifetime but I'm concerned we are already too far gone to return.

[Douglass Morrison · Rating 2 out of 5]

Why did I choose to read Dr. Robert Pearl’s book, Uncaring How the culture of medicine kills doctors and patients ?
• I wanted to learn more about the purported causes of doctors’: depression, anxiety, substance abuse, post-traumatic stress disorder, divorce, burnout, early retirement, and suicide.
• I wanted to learn about system issues versus individual choice issues in both doctors’ mental health problems, and healthcare quality, access, and costs.
• Doctors complain about too long work hours; too much time filling out forms; preauthorization; electronic medical record systems that are user-unfriendly for caregivers and patients; too little time per patient; too little remuneration; and too little appreciation. Do any or all, of these things really explain doctors’ burnout, depression, substance abuse, divorce, or suicide rates? How much do they matter relative to alternative causes such as individual life and career choices?
• I wanted to learn of the author’s views on the relative roles of physicians, physicians’ organizations, private insurers, pharmaceutical companies, hospital organizations, government payers like Medicare and Medicaid, lawyers, and patients in regard to healthcare: access, costs, and quality.
• I wanted to learn just who, or what, Dr. Pearl sees as uncaring, and deserving of blame.

What do I agree with Robert Pearl about, after reading Uncaring How the culture of medicine kills doctors and patients?
• Universal healthcare coverage is preferable to having large segments of our population with no access to healthcare; in terms of morality, access to care, overall outcomes, and costs.
• Fee-for-service payment models are for the most part, more expensive, less efficient, and less equitable than prepaid universal coverage.
• One can learn almost as much from antiheroes, who model behavior we do not wish to emulate, as from heroes, who model behavior we do wish to emulate. Similarly, we can learn a lot from reading books written by people with whom we disagree on one or more issues or themes.

With which of Robert Pearl’s theses do I take issue, after reading Uncaring How the culture of medicine kills doctors and patients?
• There is no monolithic physician culture. There are as many physician cultures (values, beliefs, ideals, rituals, ) as there are physicians.
• Physician culture begins to develop during medical school and training, long before the payment model (fee-for-service versus prepaid, universal) can begin to influence it.
• United States physicians’ culture is a subset of contemporary American culture, at a time when the liberal dreams of freedom, democracy, and capitalism are all under scrutiny, and disillusionment is widespread. The degree of disillusionment and its consequences is developed in Yuval Noah Harari’s book, 21 Ideas for the 21st Century.
• I think it is easier, and more practical for individual physicians to change their ideals and cultures than it is to change the entire United States healthcare system.
• There are many different systems of healthcare delivery and payment in the United States, not one monolith. Many physicians and some patients can choose from among the prepaid, quality care delivery models, and not necessarily settle for fee-for-service models. Perhaps, ‘voting with their feet’ (by doctors, nurses, and patients) would encourage and enhance the growth of the kinds of systems Dr. Pearl appears to favor.
• I think that the blame and shame tone of Pearl’s book, Uncaring How the culture of medicine kills doctors and patients, starting with the title and continuing throughout, is deliberately provocative. I presume that he chose it so as to market the sales of his books. I think it is counterproductive if what the author really wanted to do was to elicit the help of doctors, professional organizations, insurers, hospitals, and healthcare organizations in finding constructive and collaborative solutions to America’s healthcare problems.
• Accordingly, I give this book one of the lowest ratings (2 stars) I have ever given to a book into which I chose to put more than one hundred hours of study.

[Katie · Rating 4 out of 5]

Summary: Occasionally repetitive, but incredibly informative and interesting!

This is a book about the way physician culture contributes to the dysfunction of the American health care system. The author carefully acknowledges the heroic efforts that medical professionals make to save lives. However, he also notes that a preference for this kind of heroic work, causes healthcare workers to overlook the important but less flashy work of preventative medicine. It also leads doctors to believe they can be good at everything, although specialization leads to better patient outcomes. There are many other problems related to a focus on prestige and resistance to change as well.

Obviously, the information in this book is valuable to have as a patient. Even just reading the descriptions of physician culture started to give me some ideas of things to look for in a doctor. On top of that, the author has put together a collection of questions he suggests you ask your doctors. These seem especially helpful if you're looking to undergo a more serious procedure.

In addition to being useful, this was a fascinating insider look at this profession. It was incredible to read about how practicing medicine has changed over the past few decades and how doctors have reacted to that. Some of the darker, more anti-scientific elements of doctor culture were also really shocking.

I do have two small complaints with this book. One is that it sometimes became repetitive. I think the organization could have been better. Sometimes gimmicks, like writing one chapter as a court case against doctors and using analogies that are a bit of stretch, took away from the message. Second, the author was the CEO of Kaiser Permanente and sometimes this reads as an ad for them. To an extent, this makes sense. There are changes the author recommends, he was able to implement them at this company, and so they're an obvious example he can use to show his ideas working.

Despite these few small problems, I'd definitely recommend it. It was interesting reading and includes info every patient should have.This review was originally posted on Doing Dewey

[Trevor Diepenbrock · Rating 5 out of 5]

This is an excellent, albeit alarming book! As someone who will soon be matriculating to medical school, it was extremely eye-opening to learn about the shortcomings of the medical culture I will soon be entering. Dr. Pearl elegantly explains the issues with the current healthcare system and with the current physician culture. Rather than beating the dead horse that our current system is unsustainable, he tackles the issues with our current healthcare industry through a new lens.

The issues come from multiple directions, both from the systemic issues, but also by doctors who are fighting the wrong battles. Constant EHRs and data compiling is not exciting, but is necessary. However, systemic changes are needed (at the organizational level, inter-organizational level, or governmental level) to integrate EHRs to a common system. Physicians need to embrace sometimes painful changes in order to lead to better outcomes for patients as well as long-term benefits for physician well-being.

The current culture over-emphasizes physician autonomy (and thus no integration of care), wealth (leading to an excess of surprise medical bills, needless testing, and excessive end-of-life care that prolongs survival without the hope of recovery), and prestige (which contributes to the high rates of burnout). Many of the problems in physician culture emerge from its best aspects, so the nuances are very important.

Although this book is often hard to read due to it being somewhat of a downer, Dr. Pearl's detailing of physician culture is necessary and important. An excellent read I recommend for anyone finding themselves in a healthcare setting.

[Sara Broad · Rating 4 out of 5]

"Uncaring" by Robert Pearl is the author's personal experience as his experience in medicine as both a physician and former CEO of Kaiser Permanente. I wasn't sure how much to expect "Uncaring" would be colored by his former position as a healthcare CEO, but I found that this book provided a searingly honest book about many of the issues that are present in healthcare today. These issues are two-sided: the many reasons for physician burnout and job dissatisfaction and the impact this has on average people. Physician stress, the desire for more compensation through non-stop billing, and the insurance industry all make the healthcare experience for average people daunting, expensive, and risky. Pearl really sheds some interesting light on some of the causes of physician burnout, which could likely only be fixed through a systemic overhaul to which many doctors are resistant. This is a really interesting read, and it gave me some good ideas about how I can protect myself both physically and financially the next time I need healthcare.

[The DO]

Not exactly a title that makes you want to jump in, is it? But it’s worth it. I came across the book while reading a lengthy review of it by an osteopathic physician in a The Intima, a journal of narrative medicine.

There is certainly a surfeit of books, essays, podcasts, etc., decrying the broken healthcare system and the effect it’s having on physicians. What separates this one, in my opinion, is that while it rightly takes aim at the profiteers and business school graduates who have taken over medical care in this country, it also rightly takes physicians to task for their part in the ongoing debacle.

Read our entire review and see more book club selections on The DO!

[Rachel Gustafson · Rating 4 out of 5]

I loved this book, perhaps because I work in healthcare and it resonates so deeply with what I see happening in our industry. Dr. Pearl does an incredible job of describing the culture of medicine today and specifically addressing physician culture. He shares stories that are profound and at times heartbreaking. The content he covers as he examines physician culture is incredibly comprehensive, including addressing the impact of the pandemic. As I was reading, I was concerned that he wouldn’t outline any solutions- but the solution is culture change. I’ll be stewing on this one for awhile and sharing with colleagues.

[Adrianne · Rating 5 out of 5]

As someone going into medicine this story was incredibly informative, entertaining, and a bit shocking. The author, as a plastic surgeon and CEO of one of the largest medical groups in the country, provides a comprehensive yet extensive view on what he believes to be the downfall of American healthcare: physician culture. Everyone, especially patients and those who work in healthcare, feel the effects of this invisible force. I definitely plan to reread this book because the success of Pearl’s career and more importantly, his humanistic interactions and perspective offer a lot to our generation. I really hope we can take some of his sentiments seriously going forward.

[Robert Bogue]

It is not that they set out to be uncaring. Quite the opposite. Doctors, most of them anyway, got into medicine because of their concern for others. That’s what makes the fact that modern medicine, particularly in the United States, isn’t as good as it could or even should be for patients or doctors. In Uncaring: How the Culture of Medicine Kills Doctors and Patients, Robert Pearl pulls back the covers on the systems that drive our modern healthcare industry and what’s wrong with them.

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[Melissa Schild · Rating 5 out of 5]

I enjoyed this book written from a doctor's perspective. It brought to light many of the inner workings of the medical industry and how it is impacting doctors and patients alike. Written in the midst of the pandemic, Pearl brings a perspective that is balanced, practical, and insightful. His deep love for medicine is apparent as he shows the parts of the system that are inherently broken. The book in itself is one of hope for healthcare with sound suggestions on changing it for the better from the patient and doctor's perspective.

Super interesting read, not like what I would have chosen typically, but it was well written and easy to follow as a non-medical person.

[Connie Curtis · Rating 5 out of 5]

Written by a medical doctor, this is a brave and eye-opening book about how doctors feel about being doctors.

I don't understand how doctor culture promotes unhealthy living, but it certainly does when the doctor you see hasn't been asleep for 36 hours. I certainly don't want that one cutting into me or prescribing medicine! The idea that they do things just because they've always been done that way is so frustrating to me!

Read this book (or listen as I did). You won't be so quick to trust everything your doctor says or does. Use your head and learn.

[Kenneth E. Tepe, M.D. · Rating 5 out of 5]

Nicely done!

Exceptional treatment of the physician “culture,” which grants them superiority and infallibility while always knowing they can always help but not finally “fix“ human beings and are finally limited to doing the best they can, an all but impossible situation. He points out the harm of this paradigm to both physician and patient, managing not to “blame“ either one, and suggesting solutions. Fortunately, my agreement with most of his comments has allowed me to survive my many years of practicing medicine. This is an important book.

[Miguel · Rating 4 out of 5]

Good overview of the challenges that doctors face today. Personally interested in this to relate to a sibling in this position. Not as convinced by the author’s arguments for some of the structural issues that the overall US health system faces as these seem to be a bit off the mark and driven by his own experience being a C-level employee at Kaiser. But he’s definitely on solid footing documenting the pressures that doctors face today.

[george wakerlin · Rating 5 out of 5]

Energy

I personally benefited greatly from Robbie Pearl’s leadership of TPMG. Integrated, large group practice with emphasis on disease prevention, investment in proven advances in technology, and the creation of an environment focused on bringing out the best outcomes for patients was very rewarding. This book reflects the way forward for American healthcare.

[Jeffrey · Rating 4 out of 5]

Heavy emphasis on how great surgeons are and how much everyone envies them as written by a surgeon. But still manages to make great points about medicine, it culture and foibles within that culture and the cloak of brotherhood. And a good bit resonates, there is much we could do to improve.

[M · Rating 4 out of 5]

This was an informative read on the faults of physician culture. I think it did an excellent job presenting information, but around three quarters in, it just felt repetitive. Also, the very last chapter about the author’s passion for medicine felt very forced.

[Jarrett · Rating 4 out of 5]

Well describes some of the issues in medicine in the US today, although less emphasis placed on solutions.

[Kris Kemp · Rating 5 out of 5]

I found it to be a very good overview on how doctors think, the insurance conundrum, and how patients are treated.

[Allen Kirschenbaum · Rating 4 out of 5]

Well written with some very good points. Good discussion of what to look for in a doctor and medical system.

[Julia · Rating 4 out of 5]

Compelling, novel analysis of how flaws in physician culture cause the current cracks in our healthcare system.

[Lauren · Rating 3 out of 5]

Very informative book, but it was also very dense and heavy at times

[Parksy · Rating 4 out of 5]

Great overview of how physician culture impacts health care systems and care delivery.

[Arthur · Rating 3 out of 5]

An interesting set of anecdotes from a doctor's life, somewhat disjoint in places. Many of the stories seem a bit forced under their headings, though may be readable as blog posts.