Robert Pearl - Mistreated - Why We Think Were Getting Good Health Care and Why Were Usually Wrong

America has the greatest health care in the world. At least, thats what people say. Its a claim made often and by a variety of influential leaders, from high-ranking politicians to hospital administrators to corporate executives. And despite the rancorous politicizing of the health care system, when it comes time to actually visit a doctor or hospital, the majority of Americans agree. Seventy-six percent of patients describe the quality of care they personally receive as good or excellent. When their doctors speak, they listen, trusting that they are in the best of hands.

Theres just one problem. When independent researchers crunch the numbers and compare nations, American health care ranks nowhere near the top of the list. In fact, among developed countries, the United States has the highest infant mortality rate, the lowest life expectancy, and the most preventable deaths per capita.

Several years ago, I set out to understand the strange division between our positive perceptions of health care and the reality of the current system. The closer I looked, the more questions and contradictions I encountered.

As a nation, we spend 50 percent more on medical care than any other country, and yet we rank seventieth globally in overall health and wellness. We pay US physicians far more to intervene during a heart attack than to prevent one in the first place. We have the best-trained doctors on the planet, and yet their avoidable mistakes kill nearly 200,000 Americans each year. And as consumers, we demand the latest technologies from our banks, telecom providers, and retailers, but we passively accept last centurys technology in our hospitals and medical offices.

While searching for answers to these and other mysteries, I was fortunate to collaborate with my colleague and a respected neurologist, Dr. George York. We were interested in a different but related topic: Why do smart people do dumb things in their jobs, relationships, and everyday lives?

As part of the research, we combed through the latest brain-scanning studies and decades of psychological literature to uncover a surprising connection, one that helps explain some of the most puzzling contradictions in American medicine.

Scientists have demonstrated that under the right conditions, our brains undergo a shift, causing us to perceive the world around us in ways that contradict objective reality. Im not talking about illusions or magic tricks. Rather, its something that is decidedly more serious and prevalent than you might think, especially in the world of medical care.

As youll soon see, our health care system functions in an environment unlike any other. Theres nothing comparable to it in American culture, society, or industry. The rules are different, the stakes are elevated, and the perceptions of everyone in itfrom doctors to patients to US presidentsget radically distorted, leading to behaviors that prove hazardous to our health.

Whats most problematic about this neurophysiological process is that the changes in our brains occur subconsciously and therefore beyond our awareness or control. This reshuffling of perception is entirely independent of our personal values, beliefs, or intelligence.

To help shed light on this phenomenon, some of the studies described in Mistreated come from recent psychological and medical literature. Other studies referenced in this book are decades old and familiar to many. Ive chosen to cite them here for three important reasons. First, this type of research can no longer be performed. Newer ethical restrictions are designed to protect research subjects from experiments with the potential to cause psychological damage. As such, these classic studies are the best examples of mistreatment available. Second, their findings have been reviewed and validated dozens of times. Finally, when they are combined with recent brain-scanning studies, something never done before, all of us can better understand why the American health care system fails us time and again.

When we hear the word mistreated in the context of medical practice, we associate it with botched surgeries and flawed individuals who act dishonestly, out of greed and with a blatant disregard for the well-being of others. Although those individuals do exist, they are the exception.

This distinction is crucial. If character flaws were the central challenge facing American medicine, the solutions would be much simpler. We would select different medical students and isolate the sociopaths. But health cares most common failings arent individual. Theyre contextual, systemic, and therefore much more problematic. Transforming the conditions of American medicine will be difficult but possible. These chapters contain real case studies that demonstrate whats possible and help light the way.

Mistreated incorporates a variety of patient anecdotes and personal stories, included with the hope of holding your interest through the more academic and policy-focused sections of this book. As the song goes, a spoonful of sugar helps the medicine go down.

Accounts of the patients profiled herein come from several sources. In almost all cases, real names have been alteredand when necessary, some medical details modifiedto protect individual identities. The exceptions are three patient vignettes, originally filmed (with their permission and their doctors approval) as part of an educational series created by the Council of Accountable Physician Practices, an organization for which I serve as chairman. Other stories and information found in this book come directly from my work as a contributor to Forbes, in which I explore the intersection of business and health care.

Throughout my career, Ive had the opportunity to observe American medicine from many different angles: as a physician and a health care CEO, as faculty at both the Stanford University School of Medicine and the Stanford Graduate School of Business, and as the son of a man who died too young from a series of medical errors. My conclusion is that the American health system is sick. We have excellent physicians who are burned out, unfulfilled, and in some cases, terribly depressed. We have a number of billion-dollar pharmaceutical companies raising drug prices upward of 5,000 percent, operating without fear of public backlash or legislative overhaul. We have already unaffordable health care costs that continue to rise at twice the rate of our nations ability to pay. And even after the implementation of the Affordable Care Act, millions of Americans remain uninsured.