Family physician, author, blogger, speaker, physician leader.

American Sickness by Dr. Elisabeth Rosenthal and Mistreated by Dr. Robert Pearl – Healthcare Reform Book Reviews

Two great books on the failings and the opportunities on how to make the US health care system better and health care reform are An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Dr. Elisabeth Rosenthal and Mistreated: Why We Think We’re Getting Good Health Care—and Why We’re Usually Wrong by Dr. Robert Pearl.

In a time where America must reform healthcare so it is more accessible, more affordable, safer, and of higher quality, both books are welcome additions to what I recommended medical students and resident physicians read to not only become better doctors, but also doctors who will help lead changes necessary to make this a reality.

An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

An American Sickness is the most comprehensive and thoughtful investigation of the complexity and evolution of the US healthcare system and why it is failing patients. Easily readable by providing readers both the history and context of each participant (hospitals, insurers, pharmaceuticals, doctors and others) in the industrial health care complex and stories from patients, Dr. Rosenthal demonstrates convincingly how over the past 25 years the US healthcare system has developed to the point where each party is focused on maximizing revenues to the detriment of patients.

This book should be required reading for all medical students and post-graduate trainees. Doctors need to advocate for their patients by understanding that their responsibilities in the future is not only restoring health, providing treatment, but also ensuring patients are not bankrupted in the process. The leading cause of personal bankruptcy in the US is due to medical / health care costs. It should not be that way. Patients alone cannot fix the ails of the health care system. In the end, we are all patients.

Although Dr. Rosenthal provides excellent tips and resources for patients to fight back and not become victims, my experience and observation has been that for the majority of patients the level of activation and outrage needed to speak up and engage is significant and a barrier. Part of the reason I wrote my books in 2007 and 2011 was because my family was hurt more than once by the healthcare system and had I not been a physician, I would have been the none wiser and simply chalked up the bad outcome to bad luck The Thrifty Patient: Vital Insider Tips for Saving Money and Staying Healthy. There also have been other books over the years written by physicians, typically also compelled to write for similar reasons to help patients glean tips and insights to avoid similar mishaps. It isn’t clear these efforts have gained the traction needed to make a difference.

However, it is possible that this time, enough is enough. It is possible that now patients will speak up and behave differently by coming “difficult” patients. It is possible that doctors will increasingly become involved in advocating for their patients and also think hard about the costs of care. Many of these people were highlighted in this book. It is possible that finally a movement forms that is sustained, unyielding and focused to the point that a better health care system will one day become a reality.

With a physician insider who provides keen and clear insights of both the problems and possible solutions of what must be done so Americans get the most effective and affordable care that would be the envy of world, one cannot think of a better or more passionate person to lead that change than Dr. Rosenthal.


Mistreated: Why We Think We’re Getting Good Health Care—and Why We’re Usually Wrong

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

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