Mistreated: Why We Think We're Getting Good Health Care -- and Why We're Usually Wrong

This received a 5 star rating because it far exceeded my expectations. My concern was that greatly qualified Dr. Pearl would turn his knowledge and experience into an excuse for medical mistakes and pharmaceutical greed. Quite the contrary...he told it the way he honestly believed it was without vilification. It is as if we sent the smartest, wisest and most honest person in our village to find facts upon which we could all rely. This is his report. Regardless of preconceived notions, you will be glad you read this.

Unlike other books, Mistreated focuses specifically on how our hard wired cognitive biases and how environmental context explains the behaviors of individual patients, doctors, and other legacy participants in our current health care system. More importantly, Mistreated explains how our cultural beliefs as Americans see our health care system as being the best in the world when objective measures tell a very different story.Opening with a powerful personal story about an error of omission that resulted in an avoidable premature death in his family, Pearl weaves plenty of fascinating stories and links them to scientific research findings in neurobiology, behavioral economics, and psychology to demonstrate that what we feel and believe may not be what is the truth. He highlights how less obvious facts of where we live and who we surround ourselves impacts our lives and health more than the hype and promise of startups and precision medicine do. In Mistreated, Pearl also reviews the key aspects of the Affordable Care Act (ACA) also known as Obamacare.To make health care more affordable, with better clinical outcomes, more convenience with coordination and more personal with compassion Pearl believes we should embrace the following: a prepaid model of care where physician led multi specialty groups are connected and enabled with advanced information technology.Given his unique experience as a CEO of the Permanente Medical Group (TPMG), the medical group part of Kaiser Permanente, the responsibility for the care of millions of Kaiser members, and his faculty position at both Stanford Medical and Business schools, Pearl provides a perspective rarely seen in many books analyzing the US health care system. Robbie (as Pearl prefers to be called) balances the perspectives from the science of medicine and the discipline of business with the purpose of upholding the promise of "do no harm" to patients when the current US health care system increasingly fails to put the patient first. Those interested in understanding why individual patients, doctors, and other legacy players behave as they do and the opportunities to learn and counter these biases will see that there is a chance to make the US health care system into one that truly is one that we can be proud of and have the evidence to prove it.For full disclosure, from 2000 to 2015, I worked at Kaiser Permanente led by Robbie (as Dr. Pearl prefers to be called) and had the privilege to also serve on the TPMG Board of Directors from 2005 to 2014. His book's premise and focus on context is a powerful one. Robbie is one of the most thoughtful and brilliant physician leaders I know. This book is provides the very best and latest in his thinking.It was the gaps between the care I provided my patients and what my family was experiencing outside of Kaiser that inspired me to write my own book as well.  The Thrifty Patient: Vital Insider Tips for Saving Money and Staying Healthy

Robbie (and I'm allowed to call him that because in the book, he says he prefers to be called "Robbie" rather than "Dr. Robert Pearl") is a practicing plastic surgeon who has also served for a very long time as the CEO of The Permanente Medical Group in California. During that time, it's become clear that his passion has been to remake American medicine into something that serves all Americans as well as possible - both by leading The Permanente Medical Group and by influencing American medicine as a whole.Now that he's stepping down as CEO, he's published this book of his thoughts on what's wrong with American medicine and how to fix it. You should definitely read this book. He touches on so much of what is going on with modern medicine that it's impossible to encapsulate it all in a brief review so I'll share a few tidbits here to whet your appetite for more. He talks about,* How his father suffered a critical and life-altering illness for want of a simple vaccine. It turns out that he was looked after by several different doctors and all of them knew that he needed the vaccine but in the hurly-burly of busy clinical practice, they all assumed that he'd gotten it from one of his other doctors.* How heart surgeons in Reddings, California were subconsciously influenced by money and their peers to perform hundreds of unnecessary heart surgeries, believing, all the while, that they were doing the right thing for their patients.* How an former President of the United States (one with an interest in reforming the health care system!) came to have his heart surgery at the one hospital in the State of New York that had the highest mortality rate for that very surgery.* How another former President ended up getting a heart stent that he probably didn't need.* The $4 billion that pharmaceutical companies have paid to doctors since 2010 to influence which medications doctors choose for their patients.* An in-depth look at the "legacy players" in the health care system who can be expected to fight attempts to change the health care system because the way the system is structured right now is quite profitable for them!* A chapter on the Affordable Care Act (aka "Obamacare") which is the best analysis I've ever read on what this Act attempted to accomplish and where it succeeded and where it fell short and why.* How a medical assistant saved a patient's life by making sure that she got the mammogram that she needed to diagnose her breast cancer... and why this sort of behavior is unlikely to happen in most medical centers!And on and on it goes. You do need to read this book even though, oddly enough, the Kindle version turns out to be almost as expensive as the hardcover version! Just do what I did and get the hardcover edition and give it to someone else when you're done! Enjoy!

Insider know the REAL problems. Unfortunately decisions are made by politicians based on corruption. Health care is a licens to steal. It will take an earthquake to change that.