Why We Think We’re Getting Good Health Care – and Why We’re Usually Wrong

The Finest Tradition of My Calling: One Physicians Search of Renewal of Medicine

Robert Pearl, MD, Public Affairs. Philadelphia. 2017.

Dr. Robert Pearl, a plastic surgeon and former CEO of Kaiser Permanente, believes that American medicine fails as a system and needs to be transformed. His book, Mistreated: Why We Think We’re Getting Good Health Care – and Why We’re Usually Wrong, uses stories to illustrate and make suggestions about how to change the system.

The book devotes the first two-thirds of its layout to what most agree on: our health care system is broken and needs fixing. Within the final third of the book, the author offers his views on what we need to do differently.

Dr. Pearl’s first pillar of health care transformation is the need to work together, rather than separately, to benefit our patients. He argues that health care needs integration, both horizontally within specialties and vertically across primary, specialty and diagnostic care. As a Kaiser employee, it is not surprising that he believes in the benefit of integrated delivery systems, but he is able to support this recommendation. Increased collaboration combined with economies of scale and more preventive services could lead to less hospital beds and reduction of redundant community hospitals, resulting in cost savings.

The second pillar suggests that it is better and cheaper to prevent people from getting sick. He argues that fee-for-service promotes unnecessary utilization and even rewards medical errors and complications.

His third suggestion is that what you do not know can hurt patients. This leads to his recommendation that health care needs to be technologically enabled with comprehensive health records systems, patient access to medical information and the ability to obtain care using mobile and video technologies. Delivering the best quality care without 21St century IT systems is not possible. Data can overcome the gap between faulty perception and medical reality.

The final pillar of his health care transformation requires that doctors be given charge of it all. He insists that we must have more leadership training for physicians. Dr. Pearl says that only doctors can “influence three vital organs of their fellow colleagues: the heart, brain and guts.” The heart is a combination of purpose and mission. The brain is crucial because doctors will not move forward until they understand the “why.” Trust is essential because it is a gut feeling. Leaders who want to inspire trust must be willing to take risks. Leaders need to provide an inspirational vision, detail the behaviors expected, present context and data as well as engage in authentic ways with the people they hope will follow them.

The conclusion of this book is that what patients need and want are the four Cs of transformed health care: cost, clinical excellence, coordination and compassion. Now is the time.



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