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 bestsellers
“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
“Uncaring is a brilliant and incisive dive into physician culture, both its seamy underbelly and the moments that inspire. Pearl’s vast experience as a physician steeped in the culture, and as leader of one of the largest healthcare systems in America, allows him to write with authority, yet in a personal and engaging way, and at the end to offer solutions. The result is a wonderful and compelling read.”—Abraham Verghese, MD, professor of medicine, Stanford University, and author of Cutting for Stone
“Uncaring lifts the veil on the deeply conditioned culture that drives American physicians and our multi-trillion-dollar health care system. To solve our biggest challenges, we can’t ignore this elephant in the room, and Dr. Robert Pearl never flinches once. Sunlight is the best disinfectant, and Uncaring illuminates the shadows that many doctors themselves are reluctant to see.”—Zubin Damania, MD, host of The ZDoggMD Show, the internet’s most popular live medical show and podcast
“The history and culture of medicine has set the stage for the way our current system of care is organized and delivered. In these unprecedented times, this book offers insights into the way our system of care is both working and failing the people that it serves. Pearl spells out the case that to really understand how the health care system works you must really understand how physicians work. Through storytelling and personal reflections of a career in medical leadership with distinction, Pearl shares how physicians view their patients and themselves. This rare ‘under the covers’ view of medicine offers insights into tough issues that plague our system but also offers a path forward for improving healthcare. This personal and fascinating read shows doctors as humans and offers hope for those wanting to see empathy and compassion remain an essential part of the way we deliver care in the future. I highly recommend this book to all who seek a better understanding of health care and want to make a difference in improving the way it works.”—The Honorable David J. Shulkin, MD, ninth secretary, US Department of Veterans Affairs
“In this hard-hitting, immensely valuable book, Robert Pearl pulls back the veil from the face of the culture of medicine. He reveals the truths, both good and bad, about what drives physicians and the system of care. As an accomplished surgeon, admired executive, sophisticated policy analyst, and master storyteller, he does that with both expertise and compassion, as few others could. His recommendations—tough, clear, and right—for what needs to change provide a roadmap for all who seek better health and care.”—Donald M. Berwick, MD, president emeritus and senior fellow at the Institute for Healthcare Improvement
“Dr. Robert Pearl has peeled back the curtain and revealed major challenges facing the culture of medicine. His insights are a must-read for anyone who wants to improve our health care system, and in so doing, provide better care and save lives.”—Leana Wen, MD, public health professor at George Washington University and author of When Doctors Don't Listen
“Culture squashes innovation. And this may just be a defining truth for the practice of medicine today. Pearl takes a probing look at America’s medical practice and reveals the sacrosanct clinical hierarchy, entrenched clinical biases, financial drivers, and physician burnout. He’s pressing on the tender and sensitive spots. And while conventional medicine might suggest that this won’t hurt a bit, it will. As Pearl suggests, denial isn’t the path to recovery. Uncaring provides an honest history and physical of medicine today, with a bold vision to define and protect the very best of care.”—John Nosta, technology innovationist, Google Health Advisory Board, and World Health Organization technology expert
“Dr. Robert Pearl’s Uncaring is a deeply readable, empathic, and insightful exploration of the status of twenty-first-century American physicians—their heroism, their altruism, their limitations, and the shared culture that too often makes them less than they could and must be to heal our health care system. Health care leaders, policymakers, and physicians can all benefit from understanding the lessons Uncaring teaches.”—David Blumenthal, MD, MPP, president of the Commonwealth Fund
“Dr. Robert Pearl’s Uncaring explains the unique challenges of the health care system in providing quality care in an equitable manner. He distills the issues down to the salient points, providing a roadmap to make the necessary changes. Now is our time to act! Dr. Pearl provides the way.”—John Whyte, MD, MPH, chief medical officer, WebMD
“Dr. Robert Pearl is uniquely qualified to take us inside physician culture and provide key insights on the medical mind. Physicians are the key resource in our health care system. Uncaring is a sweeping must-read exploration of physician culture, bringing together poignant stories, deep research, and vast professional experience to help us all understand how physician culture shapes health care. Patients, physicians, and policymakers will all benefit from this invaluable and highly engaging book that teaches us what works and what needs to change in the future.”—Ian Morrison, PhD, author and healthcare futurist
“Dr. Pearl writes with authority, having served as CEO of two successful Kaiser Permanente medical groups, one on each coast, leading 12,000 physicians. He traces the evolution of physician culture, which has come into conflict with modern demands for accountability in cost and quality. This has led to frustration and physician burnout. He explains how, ‘A health care organization that is integrated, prepaid, and tech savvy can bring out the best in physicians—enabling better collaboration, cooperation, and prevention—creating a set of behaviors that lead to superior clinical results.’ Dr. Pearl’s prescription for the United States could make us one of the world’s health care leaders. It would be a powerful and effective treatment for a very ill health care system.”—Alain C. Enthoven, PhD, Marriner S. Eccles Professor of Public and Private Management (Emeritus), Graduate School of Business, Stanford University, and member of the National Academy of Medicine
“The relationship between doctors and technology is complicated. On one hand, technological advances have made it possible for physicians to prevent cancer, greatly reduce deaths from heart attacks, and streamline overall patient care. On the other hand, doctors bemoan computers and medical technologies because they stand in the way of the most important relationship—the one between the physician and the patient. Thanks to the rapid digitization of health care, many of the doctor’s time-honored skills and virtues have become irrelevant or obsolete seemingly overnight. In a profession now fueled by clinical algorithms, electronic health records, and sophisticated machinery, physicians are being told their clinical intuition and decades of expertise no longer matter—and could even prove harmful to patients. In Uncaring, Dr. Pearl traces the historical rise of technology in medicine and explains how physicians arrived at this critical juncture. In the end, he details how doctors can find an increased sense of purpose in a profession that seems to be leaving them behind, revealing that the solutions of the past can’t adequately address the challenges of today.”—Kevin Pho, founder of KevinMD, social media’s leading physician voice
“In Uncaring, Robert Pearl takes on all of health care’s inconvenient truths through the lens of an increasingly beleaguered component of the US health care system: American physicians. Physicians have never been more central to solving America’s health care problems. But, in some ways, they have never been more sidelined. Pearl offers a thoughtful diagnosis and treatment plan that aims to restore what we all want to be front and center: the physician-patient relationship.”—Sachin H. Jain, president and CEO of SCAN Group and Health Plan, and former CEO of CareMore Health
“Uncaring speaks to the beating heart at the core of the US medical profession. It’s a supremely engaging book that manages to be personal, compassionate, and painfully direct about the problems that plague physician culture and ultimately how it impacts American health care. Most importantly, at a time when we are at the pinnacle of a physician crisis, it offers concrete solutions to address our issues. Uncaring should be essential reading for anyone who went into health care to make a positive impact.”—Halee Fischer-Wright, MD, CEO of Medical Group Management Association, and coauthor of Tribal Leadership
“This is an extraordinary, moving tribute to the future of American medicine by one of its boldest practitioners. Dr. Pearl doesn’t pull punches about disgraceful problems with quality and costs. But he does so from a unique and powerful vantage point, a love of medicine and confidence in his fellow physicians to ultimately rise to the challenges ahead. This book should be on every desk in Washington.”—Leah Binder, MA, MGA President and CEO of The Leapfrog Group
“American healthcare costs twice as much, leaves many more uncovered, and delivers poorer health outcomes than any of the other advanced countries in the world. How did we get here? Robert Pearl, a physician leader with a distinguished record of delivering quality, affordable health care, finds the roots in the culture of American medicine. His astute observations point the way forward in a book that is compelling and highly readable.”—Peggy O’Kane, president of the National Committee for Quality Assurance (NCQA)
“Uncaring is the most comprehensive and scholarly book I’ve come across on the interplay between our long-standing physician culture and the larger healthcare system. To say that it is a must-read is an understatement. It is a ‘must-have-read’ for anyone who is seriously interested in transforming health care. With Uncaring, Dr. Robert Pearl establishes himself as one of the leading medical authors and storytellers of our time. Dr. Pearl brings a unique perspective as a practicing surgeon with decades of experience coupled with nearly two decades as the CEO of one of the largest and most progressive health care systems in our country. His stories are heart-breaking and heart-warming, and the historical facts, medical stats, and diverse fields of knowledge he draws upon are engaging and enlightening. This is a book that will be quoted and referenced for years to come.”—Zeev Neuwirth, MD, author of Reframing Healthcare and Atrium Health’s senior medical director of Population Health
“We often hear that what ails US medical care is the structure of our health care system itself. In Uncaring, Dr. Robert Pearl reveals a problem that runs much deeper: how physician culture fails both doctors and the patients they so eagerly aim to help. What if health care providers aren’t just operating within a flawed system, but are also operating out of a flawed philosophy? Dr. Pearl provides an expert examination of the history of medical culture, how it has shaped our current health care system, and most importantly, how we must rectify it.”—Avik Roy, president, the Foundation for Research on Equal Opportunity
“In a well-documented, panoramic narrative, an insider demystifies what makes many doctors tick.”—Kirkus (starred review)
★ 2021-03-13
The former CEO of the Permanente Medical Group takes readers into the world that shapes the medical practitioner’s mindset and lays out necessary changes for a broken system.
By the early 2000s, the U.S. health care system, once a global leader, had become the most expensive and least effective in the developed world. Of course, Covid-19 has only exacerbated the situation. Among the number of factors that have led to our current state of affairs—a situation that implicates everyone from hospital administrators to insurers, regulators, and pharmaceutical giants—Pearl singles out for examination the flawed culture that guides doctors in their practice. Physician culture, writes the author, “elevates intervention over prevention,” resulting in a lack of effective treatment for chronic killers such as diabetes, obesity, hypertension, and heart disease. In a brightly delineated—and highly disturbing—dissection, Pearl lays out the rituals, rules, and beliefs that often isolate physicians from their colleagues and their patients. The foundation of the culture may rest on concepts of healing, resilience, and artistry, but it also breeds a hierarchical sense of individual exceptionalism, heroism, and invincibility. This entitlement and autonomy often clash with the implementation of advanced diagnostic technology, undercutting the doctor’s sense of status and control. In this new environment, characterized by long hours, lowered pay, diminished decision-making, and erasure of prestige, more and more physicians are experiencing burnout. Pearl sensibly advocates a coevolution of these two streams, taking advantage of a doctor’s experience and independent judgement while tapping into the structural and scientific changes in medical practice. Incorporating peer-reviewed research, personal experience, and anecdotal evidence, the author excoriates overtesting and overprescribing as well as institutionalized racism within the medical community, and he advocates for “broadly available, prepaid, integrated, high-quality healthcare,” a system that is open to change, collaboration, and “safe, effective, patient-centered, timely, efficient, and equitable” care.
In a well-documented, panoramic narrative, an insider demystifies what makes many doctors tick.
