Uncaring
How the Culture of Medicine Kills Doctors and Patients
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Narrated by:
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James Fouhey
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By:
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Robert Pearl MD
About this listen
Doctors are taught how to cure people. But they don’t always know how to care for them.
Hardly anyone is happy with American health care these days. Patients are getting sicker and going bankrupt from medical bills. Doctors are burning out and making dangerous mistakes. Both parties blame our nation’s outdated and dysfunctional health care system. But that’s only part of the problem.
In this important and timely book, Dr. Robert Pearl shines a light on the unseen and often toxic culture of medicine. Today’s physicians have a surprising disdain for technology, an unhealthy obsession with status, and an increasingly complicated relationship with their patients. All of this can be traced back to their earliest experiences in medical school, where doctors inherit a set of norms, beliefs, and expectations that shape almost every decision they make, with profound consequences for the rest of us.
Uncaring draws an original and revealing portrait of what it’s actually like to be a doctor. It illuminates the complex and intimidating world of medicine for listeners, and in the end offers a clear plan to save American health care.
©2021 Robert Pearl, MD (P)2021 PublicAffairsListeners also enjoyed...
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Critic reviews
“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 best sellers)
"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)
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- Length: 10 hrs and 27 mins
- Unabridged
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On average, a physician will interrupt a patient describing her symptoms within 12 seconds. In that short time, many doctors decide on the likely diagnosis and best treatment. Often, decisions made this way are correct, but at crucial moments they can also be wrong: with catastrophic consequences. In this myth-shattering book, Jerome Groopman pinpoints the forces and thought processes behind the decisions doctors make.
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Disappointing
- By Audiophile on 05-13-07
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The Price We Pay
- What Broke American Health Care - and How to Fix It
- By: Marty Makary MD
- Narrated by: Marty Makary MD
- Length: 9 hrs and 29 mins
- Unabridged
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One in five Americans now has medical debt in collections and rising health care costs today threaten every small business in America. Dr Makary, one of the nation's leading health care experts, travels across America and details why health care has become a bubble. Drawing from on-the-ground stories, his research and his own experience, The Price We Pay paints a vivid picture of price-gouging, middlemen and a series of elusive money games in need of a serious shake-up.
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Very important book!
- By Wayne on 05-17-21
By: Marty Makary MD
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In Pain
- A Bioethicist’s Personal Struggle with Opioids
- By: Travis Rieder
- Narrated by: Travis Rieder
- Length: 8 hrs and 56 mins
- Unabridged
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A bioethicist’s eloquent and riveting memoir of opioid dependence and withdrawal - a harrowing personal reckoning and clarion call for change not only for government but medicine itself, revealing the lack of crucial resources and structures to handle this insidious nationwide epidemic.
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An essential read in a time of crisis
- By Kelly Heuer on 06-25-19
By: Travis Rieder
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Changing the Way We Die
- Compassionate End-of-Life Care and the Hospice Movement
- By: Sheila Himmel, Fran Smith
- Narrated by: Coleen Marlo
- Length: 6 hrs and 49 mins
- Unabridged
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There’s a quiet revolution happening in the way we die. More than 1.5 million Americans a year die in hospice care - nearly 44 percent of all deaths - and a vast industry has sprung up to meet the growing demand. Once viewed as a New Age indulgence, hospice is now a $14 billion business and one of the most successful segments in health care. Changing the Way We Die, by award-winning journalists Fran Smith and Sheila Himmel, is the first book to take a broad, penetrating look at the hospice landscape.
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Sadly, not very engaging.
- By Debra S. Long on 06-16-18
By: Sheila Himmel, and others
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A Bittersweet Season
- Caring for Our Aging Parents - And Ourselves
- By: Jane Gross
- Narrated by: Kate Reading
- Length: 15 hrs and 35 mins
- Unabridged
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In telling the intimate story of caring for her aged and ailing mother, Jane Gross offers indispensable, and often surprising, advice for the rapidly increasing number of adult children responsible for aging parents. Gross deftly weaves the specifics of her personal experience with a comprehensive resource for effectively managing the lives of one's own parents while keeping sanity and strength intact.
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Exceptional, thought-provoking, liberating!
- By Anne on 08-10-11
By: Jane Gross
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Epic Measures
- One Doctor. Seven Billion Patients.
- By: Jeremy N. Smith
- Narrated by: Patrick Lawlor
- Length: 10 hrs and 12 mins
- Unabridged
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Performance
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Moneyball meets medicine in this remarkable chronicle of one of the greatest scientific quests of our time - the groundbreaking program to answer the most essential question for humanity: How do we live and die? - and the visionary mastermind behind it.
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Fabulously insightful read!
- By Dr. Jack E. Fincham on 10-08-15
By: Jeremy N. Smith
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One Doctor
- Close Calls, Cold Cases, and the Mysteries of Medicine
- By: Brendan Reilly
- Narrated by: Rob Shapiro
- Length: 15 hrs and 7 mins
- Unabridged
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An epic story told by a unique voice in American medicine, One Doctor describes life-changing experiences in the career of a distinguished physician. In riveting first-person prose, Dr. Brendan Reilly takes us to the front lines of medicine today.
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Simply Brilliant
- By Jan on 06-20-14
By: Brendan Reilly
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To Repair the World
- Paul Farmer Speaks to the Next Generation
- By: Paul Farmer, Bill Clinton - foreword, Jonathan Weigel - editor
- Narrated by: Joe Barrett, David Ledoux, Kevin T. Collins
- Length: 8 hrs and 58 mins
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Here, for the first time, is a collection of short speeches by the charismatic doctor and social activist Paul Farmer. One of the most passionate and influential voices for global health equity and social justice, Farmer encourages young people to tackle the greatest challenges of our times. Engaging, often humorous, and always inspiring, these speeches bring to light the brilliance and force of Farmer's vision in a single, accessible volume.
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Resist the Impoverishment of Aspiration
- By Susie on 05-14-13
By: Paul Farmer, and others
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State of the Heart
- Exploring the History, Science, and Future of Cardiac Disease
- By: Haider Warraich
- Narrated by: Neil Shah
- Length: 11 hrs and 8 mins
- Unabridged
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In State of the Heart, the journey to rid the world of heart disease is shown to be reflective of the journey of medical science at large. We are learning not only that women have as much heart disease as men, but that the type of heart disease women experience is diametrically different from that in men. We are learning that heart disease and cancer may have more in common than we could have imagined. And we are learning how human evolution itself may have led to the epidemic of heart disease
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Good information, bad organization
- By Conor Cox on 09-03-19
By: Haider Warraich
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Teeth
- The Story of Beauty, Inequality, and the Struggle for Oral Health in America
- By: Mary Otto
- Narrated by: Suehyla El'Attar
- Length: 9 hrs and 37 mins
- Unabridged
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Teeth takes listeners on a disturbing journey into America's silent epidemic of oral disease, exposing the hidden connections between tooth decay and stunted job prospects, low educational achievement, social mobility, and the troubling state of our public health.
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Content everyone should know; dismal narration
- By Elaine on 08-04-17
By: Mary Otto
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The Heart Healers
- The Misfits, Mavericks, and Rebels Who Created the Greatest Medical Breakthrough of Our Lives
- By: James Forrester MD
- Narrated by: Jonathan Yen
- Length: 15 hrs and 45 mins
- Unabridged
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At one time heart disease was a death sentence. By the middle of the 20th century, it was killing millions, and, as with the Black Death centuries before, physicians stood helpless. Visionaries, though, had begun to make strides earlier. On September 7, 1895, Ludwig Rehn successfully sutured the heart of a living man with a knife wound to the chest for the first time.
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Great review of the landmark achievements in Cardiology.
- By Trauma NP on 12-14-15
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Doing Harm
- By: Maya Dusenbery
- Narrated by: Dara Rosenberg
- Length: 13 hrs and 33 mins
- Unabridged
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Editor of the award-winning site Feministing.com, Maya Dusenbery brings together scientific and sociological research, interviews with experts within and outside the medical establishment, and personal stories from women across the country to provide the first comprehensive, accessible look at how sexism in medicine harms women today.
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One of the most important books ever written
- By Dresden on 03-18-18
By: Maya Dusenbery
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Where Does It Hurt?
- An Entrepreneur's Guide to Fixing Health Care
- By: Jonathan Bush, Stephen Baker
- Narrated by: Patrick Lawlor
- Length: 7 hrs and 21 mins
- Unabridged
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A bold new remedy for the sprawling and wasteful health care industry. In this provocative book, Jonathan Bush, cofounder and CEO of athenahealth, calls for a revolution in health care to give customers more choices, freedom, power, and information, and at far lower prices.
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No critical thinking
- By Steve from MD on 07-31-14
By: Jonathan Bush, and others
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Everyone should read this book.
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Make sure this is what you think!
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Medical Apartheid is the first and only comprehensive history of medical experimentation on African Americans. Starting with the earliest encounters between black Americans and Western medical researchers and the racist pseudoscience that resulted, it details the ways both slaves and freedmen were used in hospitals for experiments conducted without their knowledge - a tradition that continues today within some black populations.
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Sobering... but necessary.
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What listeners say about Uncaring
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- M. Thomas Frederiksen
- 08-14-22
An Interesting Listen.
Overall a fascinating insight into medical culture. However, it was marred by the failure to recognize that the medical community, did not respond to the flu heroically, but rather with grotesque cowardice, that brought great harm to their patients and the larger world. Undoubtedly the admission of that shame and disgrace would be too difficult to bear for the author, for the reasons that he outlines in the book.
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- Angelo Pulgiano
- 03-26-24
Criticism of physicians
The views and opinions expressed in this book sound terrific. The studies describing how great “quality measures” are for patients were done with a 5 million dollar EHR. Most physicians cannot afford such an EHR making quantification of such measures very difficult, if not impossible, to attain. The end result is medical insurance companies keeping anywhere from 25-50% of the doctor’s well earned income.
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- Amazon Customer
- 01-16-22
Thought provoking, insightful and flawed.
I listened to every word, learning from Dr Pearl. It was a hard book for me to swallow--being a doctor myself. I loved his points, his stories, and I too have witnessed moments where culture is a problem in the course of practicing. I guess where I get hung up on is that there is "tone" here. He has tone against the suffering of doctors--although he does acknowledge it. His recipe for dealing with burnout has to do with falling back in love with the work, while sacrificing more, working harder, and putting patients first. He emphasizes the need for a return to general practitioners and preventative care. Good points. He talks about being an open book about what care costs. 100% agree.
I guess what bothers me is that I am a veterinarian--the virtual medical champions of preventative care. We are 100% transparent with our costs, and many of the colleagues I have worked with are giving well beyond 110%. Meanwhile we are killing ourselves at a rate that is double our MD counterparts. He has missed a key point in the recipe to helping physicians (and other health professionals), and their patients. There is no attention to a patients responsibility to themselves, the book comes across like every patient is a potential victim of the "culture" of physicians. This part is a turn off. I can tell he is brilliant, and I definitely learned from him. Just wish there was a bit more balance in those pages.
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- DMM
- 07-12-21
Important to understand the current medical world
This is a love story and a critical review of the medical world by an M.D. insider. He is supportive of physicians but also critical of outcomes from the "physician culture."
I enjoyed his perspectives - and he acknowleges that some of the topics will make people reflect and be uncomfoprtable.
The worst part is that the reader mispronounces a number of medical words. Jarring to the audiobook . Interupts the train of thought.
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4 people found this helpful
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- Momomentous
- 06-22-21
Peal is great writer and storyteller w much insight
Robert - you are a great writer and story teller. Great insight on doctor culture - positive and negative. Some touching personal stories re the doctor who operated on your arm and the young child and the trans KP doctor/exec. I was shocked by the chemotherapy kickbacks and lack of effectiveness. And the story of Da Vinci robot surgery and how surgeries have declined at local yokel hospitals and are now done at centers of excellence. I have a neighbor friend who blithely just had prostatectomy here in my very upscale coastal California area. He never got 2nd opinion and bought into PSA despite its lack of accuracy and never for 2nd opinion and never explored centers of excellence. Did have high Gleason so maybe it was indeed necessary. Don’t really know. But his biopsy was through his ass which is outdated approach itself. Shows his doctor was not current on research and techniques. Massive infection after biopsy just as you discussed. Took him a week to recover from that alone before any real surgery! Though current technique is to go through peritoneum - taint- as I understand. I sent him info and a podcast link w a Peter Attia interview w a urologist but my friend is sadly did not explore in much depth it seems. That is my impression at least. I’m a total cynic about the doctors and the fee for service medical business . Anyway now he is very incontinent and is getting PT for pelvic floor exercises etc. He pees his friggin pants! May have ED too but that subject hasn’t been broached. Though he is quite open about incontinence and is an upbeat positive person. I remember that the minister who did my wedding in ‘95 got prostate removed in 80’s at peak of PSA scare and he has since regretted it. Admits he acted too quickly. So watchful waiting and imaging and less invasive evaluation as you advocate is the way to go it seems. So far so good for me. I’m fit and super healthy and lifelong athlete and healthy food fanatic.
Will plan to read your other writings and signed up for newsletter. I like your perspective and balanced experience. Have listened to some of your podcasts recently. Enjoyed your interview w Zuben Damania (ZDogg) where I first learned about you.
Best regards -
PS The Audible voice actor mispronounced a few words. Inexcusable. Publisher should have better quality control. A minor complaint - still a useful and informative and at times touching book.
DM
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3 people found this helpful
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- CJ Torontow
- 07-29-22
This is required listening
This is the best description of American Medical Culture. If you want to know why our healthcare system is so broken, listen. Dr. Pearl does an amazing job of describing the culture that got us here and he lets you know what he thinks are the next steps forward.
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- SM
- 05-26-21
Thought provoking perspective
Dr. Pearl’s unique experience as the former CEO of Kaiser make this a valuable listen. He brings forward a perspective that makes you think about the realities of healthcare, as well as potential solutions to get the conversation started.
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3 people found this helpful
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- Dasa Gangadhar
- 08-29-21
A Surgeon’s Perspective on the Book
Gripping. Hard to hear the raw truth, being a physician myself. However, what Dr. Pearl says is true. We must all look in the mirror and correct what is wrong with our culture and continue to embrace all that is so right. I will encourage my 3rd year medical student daughter to listen to the book. The earlier in our career we understand all these issues, the better chance we have of not falling victim to what is wrong with physician culture.
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1 person found this helpful
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- Paul Robb
- 08-04-21
A must read for physicians!
Eloquently written with anecdotes and teachings that both inspire and provide humility. A must read for physicians and those interested in the highs and lows of healthcare in America. One of my favorite books in the last decade.
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2 people found this helpful
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- erika mitchell
- 06-28-23
Good but narrow minded
Just call pride what it is. Then get off the soapbox where you pretend to know it all.
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