Uncaring

How the Culture of Medicine Kills Doctors and Patients

By: Robert Pearl MD

Narrated by: James Fouhey

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

Hardly anyone is happy with American health care 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 Both parties blame our nation’s outdated and dysfunctional health care system.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 listeners, and in the end offers a clear plan to save American health care.

©2021 Robert Pearl, MD (P)2021 PublicAffairs

Critic reviews

“No one is better qualified to write about what ails health care than Robert Pearl. Uncaring ought to trigger a rethinking of the professional culture of American medicine.” (Malcolm Gladwell, author of five New York Times best sellers)

"In Uncaring, Dr. Robert Pearl provides an X-ray examination of the medical profession and how it has both promoted and adversely affected American healthcare. It’s deep, insightful, and can be considered the modern version of what Francis Peabody wrote almost a century ago: ‘The secret of the care of the patient is in caring for the patient.’ We need to get that back.” (Eric Topol, MD, professor at Scripps Research and author of Deep Medicine)

“How do so many young doctors who enter medicine filled with idealism and the desire to do good end up decades later as cynical professionals, caring about money, prestige, success - everything but the patient? Dr. Robert Pearl, in this riveting examination of the physician culture, diagnoses the pathologies in the system that too often strips the ‘caring’ out of health care." (Elisabeth Rosenthal, editor in chief of Kaiser Health News and author of An American Sickness)

An Interesting Listen.

Overall a fascinating insight into medical culture. However, it was marred by the failure to recognize that the medical community, did not respond to the flu heroically, but rather with grotesque cowardice, that brought great harm to their patients and the larger world. Undoubtedly the admission of that shame and disgrace would be too difficult to bear for the author, for the reasons that he outlines in the book.

Criticism of physicians

The views and opinions expressed in this book sound terrific. The studies describing how great “quality measures” are for patients were done with a 5 million dollar EHR. Most physicians cannot afford such an EHR making quantification of such measures very difficult, if not impossible, to attain. The end result is medical insurance companies keeping anywhere from 25-50% of the doctor’s well earned income.

Thought provoking, insightful and flawed.

I listened to every word, learning from Dr Pearl. It was a hard book for me to swallow--being a doctor myself. I loved his points, his stories, and I too have witnessed moments where culture is a problem in the course of practicing. I guess where I get hung up on is that there is "tone" here. He has tone against the suffering of doctors--although he does acknowledge it. His recipe for dealing with burnout has to do with falling back in love with the work, while sacrificing more, working harder, and putting patients first. He emphasizes the need for a return to general practitioners and preventative care. Good points. He talks about being an open book about what care costs. 100% agree.
I guess what bothers me is that I am a veterinarian--the virtual medical champions of preventative care. We are 100% transparent with our costs, and many of the colleagues I have worked with are giving well beyond 110%. Meanwhile we are killing ourselves at a rate that is double our MD counterparts. He has missed a key point in the recipe to helping physicians (and other health professionals), and their patients. There is no attention to a patients responsibility to themselves, the book comes across like every patient is a potential victim of the "culture" of physicians. This part is a turn off. I can tell he is brilliant, and I definitely learned from him. Just wish there was a bit more balance in those pages.

Peal is great writer and storyteller w much insight

Robert - you are a great writer and story teller. Great insight on doctor culture - positive and negative. Some touching personal stories re the doctor who operated on your arm and the young child and the trans KP doctor/exec. I was shocked by the chemotherapy kickbacks and lack of effectiveness. And the story of Da Vinci robot surgery and how surgeries have declined at local yokel hospitals and are now done at centers of excellence. I have a neighbor friend who blithely just had prostatectomy here in my very upscale coastal California area. He never got 2nd opinion and bought into PSA despite its lack of accuracy and never for 2nd opinion and never explored centers of excellence. Did have high Gleason so maybe it was indeed necessary. Don’t really know. But his biopsy was through his ass which is outdated approach itself. Shows his doctor was not current on research and techniques. Massive infection after biopsy just as you discussed. Took him a week to recover from that alone before any real surgery! Though current technique is to go through peritoneum - taint- as I understand. I sent him info and a podcast link w a Peter Attia interview w a urologist but my friend is sadly did not explore in much depth it seems. That is my impression at least. I’m a total cynic about the doctors and the fee for service medical business . Anyway now he is very incontinent and is getting PT for pelvic floor exercises etc. He pees his friggin pants! May have ED too but that subject hasn’t been broached. Though he is quite open about incontinence and is an upbeat positive person. I remember that the minister who did my wedding in ‘95 got prostate removed in 80’s at peak of PSA scare and he has since regretted it. Admits he acted too quickly. So watchful waiting and imaging and less invasive evaluation as you advocate is the way to go it seems. So far so good for me. I’m fit and super healthy and lifelong athlete and healthy food fanatic.

Will plan to read your other writings and signed up for newsletter. I like your perspective and balanced experience. Have listened to some of your podcasts recently. Enjoyed your interview w Zuben Damania (ZDogg) where I first learned about you.

Best regards -

PS The Audible voice actor mispronounced a few words. Inexcusable. Publisher should have better quality control. A minor complaint - still a useful and informative and at times touching book.

DM

This is required listening

This is the best description of American Medical Culture. If you want to know why our healthcare system is so broken, listen. Dr. Pearl does an amazing job of describing the culture that got us here and he lets you know what he thinks are the next steps forward.

Thought provoking perspective

Dr. Pearl’s unique experience as the former CEO of Kaiser make this a valuable listen. He brings forward a perspective that makes you think about the realities of healthcare, as well as potential solutions to get the conversation started.

A Surgeon’s Perspective on the Book

Gripping. Hard to hear the raw truth, being a physician myself. However, what Dr. Pearl says is true. We must all look in the mirror and correct what is wrong with our culture and continue to embrace all that is so right. I will encourage my 3rd year medical student daughter to listen to the book. The earlier in our career we understand all these issues, the better chance we have of not falling victim to what is wrong with physician culture.

A must read for physicians!

Eloquently written with anecdotes and teachings that both inspire and provide humility. A must read for physicians and those interested in the highs and lows of healthcare in America. One of my favorite books in the last decade.

Good but narrow minded

Just call pride what it is. Then get off the soapbox where you pretend to know it all.

Great book

As a fellow physician, Dr Pearl does a phenomenal job diagnosing our broken healthcare system. Fellow doctors might recoil at some of the accusations made in this novel but anyone who wants to be better in their field needs to objectively examine their own foibles. If you are a doctor please do not get defensive at what you read in this, but rejoice that fact that someone had the courage to write this