“Doctors’ sloppy penmanship kills more than 7000 people each year.”
Robert Pearl, MD - quoting from TIME Magazine


Excerpt from the book jacket:

Do you know how to tell good health care from bad?

Guess again. As patients, we wrongly assume the “best” care is dependent mainly on the newest medications, the most complex treatments and the smartest doctors. But Americans look for healthcare solutions in the wrong places. For example, hundreds of thousands of lives could be saved each year if doctors reduced common errors and maximized preventive medicine.

For Dr. Robert Pearl, these kinds of mistakes are a matter of professional importance, but also personal significance: he lost his own father due in part to poor communication and treatment planning by doctors.

If this can happen to Dr. Pearl, it can happen to anyone. Using multiple examples from the point of view of physicians, patients and health systems, the author speaks to the importance of participatory co-design to begin to solve these problems. The picture he paints is bleak, as you’ll see below - but the solutions are present today, and his vision for the future is inspiring.

We’ve highlighted and sticky-noted our copy of this book, and will reference it often. We recommend you do the same, but for the purposes of this post we’ll feature some highlights [and thanks to colleague Greg Merritt of Patient is Partner for introducing us to this book!].

Regarding American Healthcare:
“Our healthcare system functions in an environment unlike any other. There’s nothing comparable to it in American culture, society or industry. The rules are different, the stakes are elevated and the perceptions of everyone in it – from doctors to patients to US Presidents – get radically distorted, leading to behaviors that prove hazardous to our health.

As individuals and as a nation, we need to see what is happening, decide to do something about it, and take action”

Regarding the economics and equity of healthcare (published in 2017)

  • The cost of American healthcare is nearly twice that of any other nation. Today, the US spends close to $3 Trillion each year, approximately $10,000 for each man, woman and child. US healthcare accounts for 18% of every dollar Americans spend.

  • Because of the rapid rise in healthcare costs, hourly wages for US workers have remained relatively flat for the past two decades.

  • Despite the high cost, our clinical outcomes are below average. Among the 17 wealthiest countries, the US ranks dead last in life expectancy for men and second to last for women. Comparing the most advanced nations in the world, the US ranks last in infant mortality.

  • American doctors and hospitals invest millions in medical equipment, but US healthcare trails almost every other industry in the adoption of information technology. As a result, fewer than 15% of patients can use email with their doctors and even fewer can review their own medical information online or schedule a video consultation.

  • We pay doctors and hospitals based on the number of services they provide rather than the quality of care they deliver. Consequently, Americans undergo a very high volume of unnecessary tests and procedures.

  • The quality of a patient’s care and access to it varies dramatically based on such characteristics as race, ethnicity and socioeconomics. As a result, Latinos and African Americans on average experience clinical outcomes that are 20% worse than other ethnic and racial groups in their communities.

Regarding consumer expectations and perceptions:
”Americans live in a constantly connected world and value the conveniences of modern technology. Using their smartphones, they can schedule airline flights, check financial statements and communicate with friends around the world. Yet as a medical community, we deny people these same types of services, placing an undue burden on the lives of busy families all throughout our country.”

”Half of American adults have a negative view of the healthcare industry in general, but nearly 80% of all patients reflect positively on the healthcare they personally receive.”

What Doctors See:
”In business school, students are encouraged to dream big and innovate. Future doctors, on the other hand, are expected to check their creativity at the classroom door.”

“If healthcare were like most competitive industries, change would have already happened. However, the combination of strict regulation and entrenched institutions makes that shift difficult. Regardless, the future will be determined as much by patients as physicians. The balance between the patient’s desires and fears will determine whether the current system continues along the same sluggish route or changes radically.”

What Patients See:
“To patients, demanding greater convenience or better service seems dangerous. What we perceive about our medical care reflects our subconscious fears and hopes, much more than it reflects objective thought. As a consequence, the healthcare decisions we make and loyalties we hold dear remain steeped in the events, experiences and even neurobiology of the past.”

“When it comes to our health, our brains sometimes do our bodies a disservice. For example, if a surgical procedure goes well for someone we know, we magnify the significance of that outcome and project the likelihood of a good result upon ourselves. Having made a decision (even an irrational one) we cling to it. We filter out dissenting information while overvaluing the data points that support our original selection.”

“We would laugh at someone who bought stocks simply because a friend told them it would be a good investment. We’d roll our eyes at someone who accepted a job simply because the company was headquartered in an attractive building. But this is exactly what we’ve done with our healthcare choices.”

“It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” Mark Twain

This quote is attributed to Twain at the start of the movie The Big Short. It’s a truism about the dangerous assumptions we make and about how incorrect ideas get repeated until everyone believes them. But there’s no evidence that Twain ever wrote or said it. That’s the problem with conventional wisdom.

The Four Pillars of Healthcare Transformation

One: physicians working together on your behalf
Healthcare will need to be integrated, both horizontally within specialties and vertically across primary, specialty and diagnostic care. The healthcare of the future will demand that providers focus on:

  • Customer intimacy: personal knowledge and response to your preferences, using new (and old) technologies to be more responsive care partners

  • Product differentiation: this doesn’t have to be more expensive, provided doctors demand that technology investments do more than “glitter.”

  • Operational excellence: when doctors work together for the benefit of the patient, the combination improves outcomes, increases quality and reduces cost.

Two: it’s better and cheaper not to get sick in the first place
Healthcare will need to be prepaid, moving away from pay-for-volume toward paying for value and superior outcomes.

Three: what your doctor doesn’t know can hurt you
Healthcare will need to be technologically enabled, with comprehensive electronic health record systems, patient access to medical information and the ability to obtain care using mobile and video technologies.

Four: who will you trust?
Healthcare transformation will need to be physician led, which will require greater leadership training and development. Fortunately, physician leadership is a skill that can be taught, honed and developed.

We hope that this summary will be helpful to you, both in your work and as a healthcare consumer.