This week’s episode is the second part of our conversation with Dr. Robert Pearl. In his book, Uncaring: How the Culture of Medicine Kills Doctors & Patients, Dr. Pearl asserts that doctors are taught how to cure people, but they don’t always know how to care for them. There are many contributing factors, ranging from how doctors are trained, to increasing workloads and lack of resources, a widening disconnect between patients’ and doctors’ values and expectations, and increased risk and death due to the pandemic, all of which are intertwined with systemic and cultural issues. These are people who, with the highest ideals of caring for people, have entered a system rife with misaligned incentives that undermine and contradict their own hopes and expectations, and a culture that shapes them into being unable to care in the way they originally intended. The book examines the elements of physician culture that need to be corrected, the ones that should be preserved, and how to accomplish both.

Dr. Robert Pearl is the former CEO of The Permanente Medical Group (1999-2017), the nation’s largest medical group, and former president of The Mid-Atlantic Permanente Medical Group (2009-2017). In these roles, he led 10,000 physicians, 38,000 staff, and was responsible for the nationally recognized medical care of 5 million Kaiser Permanente members on the west and east coasts. He is the author of Washington Post bestseller “Mistreated: Why We think We’re Getting Good Healthcare—And Why We’re Usually Wrong,” and “Uncaring: How the Culture of Medicine Kills Doctors & Patients” which is scheduled to be published in spring 2021 (all proceeds from the book go to Doctors Without Borders). Dr. Pearl also hosts the popular podcasts Fixing Healthcare and Coronavirus: The Truth.

Episode Bookmarks:

00:30 The cultural hierarchy in medicine

01:00 Research on effects of concentrated primary and specialty care on life expectancy

03:00 Dr. Pearl explains how primary care was once on top of the cultural hierarchy before technology advancements

04:00 The need for Primary care to adjust to the current world (The Acceptance stage of the Kübler-Ross grief cycle)

05:30 Leading innovation in Primary Care and the success of ChenMed as a primary care model that can lower cost and improve outcomes

06:30 How the current fee-for-service model creates ineffective primary care delivery to ensure population health (e.g. lack of access and availability)

08:00 The use of telemedicine in the primary care setting to improve patient outcomes

09:15 The need for interdisciplinary, technology-enabled primary care teams and the integration of specialty services

10:00 How Kaiser Permanente leveraged telemedicine and other digital tools for clinical integration

11:30 PCP/SCP collaboration to determine evidence-based practices in a consistent, technologically-enabled, efficient way

12:00 Redefining primary care to elevate its value.

12:20 “Primary care shouldn’t just be the gatekeeper for referrals; they should be the facilitators of higher quality care by collaborating with specialists."

12:40 Inefficient, low-value referrals from primary care for consultations that could be prevented with better integration

14:00 Onsite primary care clinics for Apple employees that are improving collaboration with specialists

14:30 Consumerism and Patient Experience -- patients feel disrespected by long wait times, short visits, and poor communication.

17:00 “Culture, to some extent, allows you to avoid the harm you inflict and take privilege in what you desire.  Some of that exists within the physician world.”

17:20 Physicians that refuse to value patients’ time as much as their own as seen by long wait times, limited access and availability, and limited consumer-driven technology

18:20 The culture of customer-focused technology and service, exemplified by Amazon, has changed patient expectations

18:50 Patients value empathy,

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