Ep 43 – How the Culture of Medicine Kills Doctors and Patients (Part 1), with Dr. Robert Pearl

What this episode covers

In a year of great need, during the pandemic, Americans saw and celebrated an army of physician heroes. In doing so, they overlooked an uncomfortable reality. Doctors are humans who share a culture that produces both remarkable successes and abysmal failures. As in Robert Louis Stevenson's gothic novella The Strange Case of Dr. Jekyll and Mr. Hyde, it is possible that one person -- or this case, one culture -- can be both a virtuous force and a destructive influence. Until now, the negative aspects of physician culture have remained largely invisible. But like a virus, it affects people even if they can't see it. Physician culture wields tremendous influence over the lives of patients, doctors, and the nation, regardless of whether people acknowledge (or are even aware of) its existence. This week, we have as your guest Dr. Robert Pearl. He will be discussing his new book which tells the story of a profession that is both triumphant and dangerously flawed, filled with people who aspire to help others, yet who sometimes act coldly, callously, and indifferent. This book takes you inside the doctor's world, revealing unique insights about their training, their daily practices, and the culture they share. It is a book about people striving for perfection and about the impossibility of achieving it. It sheds light on the norms, rules, and expectations of doctors, and shows how culture shapes their thoughts and beliefs. It deciphers their evolving language, symbols, and codes. It highlights what brings doctors together and what isolates them from their colleagues and patients. Finally, this book examines the elements of physician culture that need to be corrected, the ones that should be preserved, and how to accomplish both. If we are to win this Race to Value, we must fully understand and reform physician culture so it can be more caring. Episode Bookmarks: 2:00 “The Strange Case of Dr. Jekyll and Mr. Hyde” – Is it possible that one culture can be both a virtuous force and an equally destructive influence? 2:40 If we are to win this Race to Value, we must fully understand and reform physician culture so it can be more Caring. 3:00 Dr. Robert Pearl’s new book, “Uncaring : how physician culture kills doctors and patients.” 4:45 Physician culture tolerates low value care, inequitable outcomes, excessive profiteering, and perpetuation of institutional racism. 5:40 Despite the clear link between avoidable chronic disease and excessive COVID-19 deaths, physicians are not speaking out on this. 6:45 Dr. Robert Pearl defines what culture really is and how drives physicians to perform but also inflict harm 7:30 The “invisible” nature of physician culture 8:45 The heroism of physicians during COVID-19 10:00 Systemic issues and cultural issues go together – Why Mistreated and Uncaring are perfect companions in solving for healthcare. 10:45 Chronic diseases and the lack of accountability in physician culture 11:30 The focus on Prevention is not elevated in medicine, as illustrated by how we undervalue primary care 11:50 Research study showing that adding PCPs increases life expectancy in communities, while adding specialists does not have a comparable effect. 12:30 Primary care physicians are paid more in large multispecialty medical groups like Mayo Clinic, Kaiser Permanente, and Geisinger 12:50 Pre-Order information for “Uncaring” and all profits go to Doctors Without Borders/Médecins Sans Frontières (MSF) 14:00 How the “Art of Medicine” philosophy in physician culture prevents progress towards evidence-based medicine 15:30 Research showing that as much as one-third of physician services is low value care, offering little to no benefit for patients

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