The Dangers of a Harmful Culture of Medicine

Former CEO of Permanente Medical Group and physician writer Robert Pearl recently published a seminal book. Uncaring: How medical culture kills doctors and patients.¹ Its message is: A deeply ingrained culture hinders the changes needed to improve her two key problem areas in medicine: the prevention and treatment of chronic disease.

Wisely, Dr. Pearl first points out that not all drugs are bad. He recalls a long history of compassion, devotion and a desire to help those in need, passed down since Hippocrates in the 5th century BC. Additionally, he marvels at the wonders of medicine, from organ transplants to controlling coronaviruses to dramatically extending lifespans.

It is then that he reaches a key point in the book: It is not enough to fix the various parts of the system until it changes the harmful culture of medicine, so it is not enough to have experts and planners to improve medicine. Efforts fail. Dr. Pearl believes that largely unconscious thoughts and attitudes underpin this culture. This means that medicine itself is unaware of the emotions and beliefs that drive its harmful behavior. Currently ignored.

For example, he laments that medicine shows little interest in preventing disease. Some estimate that 80% of heart disease, 80% of diabetes and 40% of cancer could be prevented.² Still, medicine prefers to wait until the disease develops before treating it. It could save trillions of dollars, prevent many deaths, and prevent many more disabilities and heartbreaks, but Dr. Pearl says that switching to preventive mode, medicine is now not only an exorbitant reward, but also its prestige and power. He claims he will lose it.

As another example of medicine’s resistance to change, he argued that despite COVID-19 hitting people with chronic illnesses hardest, medicine has made no effort to improve their care. (See my previous post for an extensive review of chronic disease issues). The critical role of the patient is in mental health and other psychological and social aspects that are currently neglected). Medicine remains agnostic to the human dimension, which should come as no surprise to readers who have experienced rushing doctors paying more attention to computers than to themselves.

Dr. Pearl points out the most important points of the book for me because they suggest definitive solutions. Medicine has irrevocably embedded its culture through the education of doctors. boys in white Howard Becker and colleagues describe the transition of students in medical school.³ It is no exaggeration to say that medical training brainwashes them.

Here is an example.^Four 49% of students entering medical school show a strong interest in psychiatry. However, only 4% chose to specialize in this field when they graduated four years later. Something happens in medical school that turns students against psychiatry. Medical culture has established an anti-psychiatric mindset that negatively views mental health and other psychological and social problems.^1,5

Despite his insightful critiques of modern medicine, I was surprised that Dr. Pearl advised that medicine would need to take the lead in correcting its culture. Given the resistance in medicine so far, this seems like a huge stretch. Especially because, as he points out, medicine does not recognize its pernicious culture.

Importantly, however, Dr. Pearl advises that governments and others can play a role in bringing about new directions. He concludes by convincingly outlining the process of change in medicine, whether of its own will or at the behest of others. ii) take action; iii) Embrace others and learn from their successes. iv) collaborate with others; v) Reviving old values ​​of caring for patients.

In short, anyone interested in understanding how to improve healthcare should inconsiderate important contribution. Dr. Pearl struck a nail in his head when he identified the distorted culture of medicine as a starting point for correcting society’s biggest current health problem: disease prevention and better management of chronic diseases. .

inconsiderate In my opinion, it will establish itself alongside the classics on the unfavorable culture of medicine. boys in white³ and Paul Star’s Social transformation of American medicine.^Five