17. Uncaring: How the Culture of Medicine Kills Doctors & Patients w/ Robert Pearl, MD

Part 1 - Uncaring: How the Culture of Medicine Kills Doctors & Patients w/ Robert Pearl, MD. Tune into Swift Healthcare Podcast to hear Robert Pearl, MD discuss his new book which has already become a #1 New Release in multiple Amazon categories and is soon to be a NY Times Bestseller!

Ranked a Top 60 Healthcare Leadership podcast by Feedspot.

In his new book, Dr. 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.

Robert Pearl, MD Links:

https://robertpearlmd.com

https://robertpearlmd.com/books/

https://www.linkedin.com/in/robert-pearl-m-d-32427b98/

Music Credit: Jason Shaw from www.Audionautix.com

THE IMPERFECT SHOW NOTES

To help make this podcast more accessible to those who are hearing impaired or those who like to read rather than listen to podcasts, we’d love to offer polished show notes. However, Swift Healthcare is in its first year. 

What we can offer currently are these imperfect show notes. The transcription is far from perfect. But hopefully it’s close enough - even with the errors - to give those who aren’t able or inclined to audio interviews a way to participate.  Please enjoy!

Transcript:

[00:00:00] Patrick Swift, PhD, MBA, FACHE: [00:00:00] Welcome  folks to another episode  of the Swift healthcare video podcast, I am delighted that you're here welcome to our listeners in Latin America and Eastern Europe and the United States and all over the planet because I have an amazing guest.

[00:00:12] I'm so excited about Dr. Robert Pearl, Dr. Pearl. Welcome to the show.

[00:00:17] Robert Pearl, MD: [00:00:17] Thank you, Patrick. It's an honor. And a privilege to be here.

[00:00:20] Patrick Swift, PhD, MBA, FACHE: [00:00:20] Well, delighted you're here. And folks, I want you to take a seat, get comfortable. You're about to experience a masterclass. And, um, I could not ask for, uh, a better guest for a show. That's looking at the intersection of healthcare and leadership. Pop the hood. Look at the engine of healthcare. Talk about it from a, from a, uh, heart and head, an understanding perspective and someone who can see the big picture.

[00:00:47] Uh, Dr. Robert Pearl, I have this bio, I've got to read you a portion of his bio. Dr. Robert Pearl is the listen to all this, the former CEO of the Permanente medical group, the nation's [00:01:00] largest medical group former president of The Mid-Atlantic Permanente Medical Group in these roles, he led 10,000 physicians, 38,000 staff, healthcare professionals, responsible, nationally recognized medical care and 5 million Kaiser Permanente members.

[00:01:15] That's one. Two: one  of the nation's Modern Healthcare's 50  most influential. Physician leaders. I know Robert is going to try to stop me, but hang on there. I want to share this with listeners. He's the author of mistreated, why we think we're getting good healthcare and why we're usually wrong. Can you not resonate with that?

[00:01:33] Uh, his next book coming out, which I'm so excited about uncaring, how the culture of medicine kills doctors and patients, ah, such a great title. He hosts multiple podcasts, fixing healthcare, coronavirus the truth. We got to hear the truth about coronavirus God, uh, publishes a newsletter with over 12,000 subscribers.

[00:01:52] If you're not subscribed, please subscribe a monthly musings on health American healthcare. He's a regular contributor to Forbes. Um, [00:02:00] the man is a dynamo, um, leading with heart and, uh, let's start with the book uncaring, how the culture of medicine is killing doctors and patients at the top of the show.

[00:02:12] We're going to end on this, but at the top of the show, uh, Robert, please just share with folks, um, the book and how folks can get it and who it's helping. This is listen to this. Who's helping.

[00:02:24] Robert Pearl, MD: [00:02:24] Well, thank you so much, Patrick. When I wrote the book mistreated, I was talking about the systemic problems, how healthcare is paid for how healthcare is organized, how it's technologically or not technologically supported. And as I travel around the country and I talked about this in patients, it was clear to me there was something else missing.

[00:02:49] And I researched trying to figure out what it was. And I wrote the book about what I believe it to be, which is the physician culture. I don't know. I call it the physician culture is really the [00:03:00] culture of all people provide care. I just know the physician side, having been the head of the medical group far better than I know all the other pieces, but it equally applies.

[00:03:10] And for those of your viewers who do pre-order the book. They go to my website, Robert Pearl md.com, where they can find access to a lot of providers, all the profits go to doctors without borders, if five Oh one C3 charity providing healthcare around the globe as did the profits from Mistreated  and anyone who pre-orders, the book will get some freebies, including a signed book plates, including the discussion guide, a bibliography of other books on the same topic and a chance to pre-read the introductory chapter.

[00:03:48] And it will be delivered to your home on May 18th, the official pub date.

[00:03:53] Patrick Swift, PhD, MBA, FACHE: [00:03:53] love it. I love it. I love it. And again, folks that the proceeds of this book are going for doctors without borders, Medecines [00:04:00] Sans Frontieres. Uh, this is for good. Um, and it encapsulates some wisdom and love and compassion and courage. and joy  that Dr. Pearl was compelled in that composing that book. So this up number one.

[00:04:13] Thank you. And two. This episode, we're going to do the show in two segments. The book is titled uncaring, how the culture of medicine is killing doctors and patients and being providers. We were talking who who's, who we going to focus on first. And we agreed the patients were going to start with an episode on the patients.

[00:04:29] And so we're going to touch on, um, the elements of the book, but from the patient perspective. And, um, part of this is a conversation about culture. And I want to start with your why you became a physician, because I know this influences your perspective on culture and, and your parent experience and, and how all this comes together.

[00:04:51] So, so where does this passion come from? Dr. Pearl?

[00:04:55] Robert Pearl, MD: [00:04:55] So as a naive 17 year old, I headed off to college [00:05:00] and I wanted to be a university professor. I wanted to teach philosophy and my hero who ultimately became the chairman of Reed college. He was brilliant. Didn't get tenure because of his political views. And I decided I wanted to go with this, something that would have no politics and that would Medicine. We're talking about life and death, Patrick, how could you be?

[00:05:30] How could there be politics? So I went to medical school and then I went on to Stanford to become a heart surgeon. And guess what? I found the best physicians didn't always get the referrals. Yeah, it was politics who you knew the club you belong to. And I, I almost dropped out of medicine,

[00:05:53] Patrick Swift, PhD, MBA, FACHE: [00:05:53] Yeah. Wow. Wow.

[00:05:55] Robert Pearl, MD: [00:05:55] and then I have a chance to go to Mexico on a volunteer [00:06:00] trip and fix children with cleft lip and cleft palette. And I fell in love with that opportunity, the mission and the purpose. And that's how I became what I do today, which is a reconstructive plastic surgeon.

[00:06:16] Patrick Swift, PhD, MBA, FACHE: [00:06:16] I love that. I love that story. And in your bio, your, you serve as a clinical professor of plastic surgery at Stanford university school of medicine and your faculty of Stanford graduate school of business, where you teach courses on strategy and leadership in lectures on informational tech and healthcare policy. And so you're taking the wisdom and the heart of your calling and the love for caring for patients that cleft lip surgeries, you, you, you it's, it's tangible how you can transform lives. Um, with, uh, medicine and how you've, you've brought that into the work you're doing here. So let's talk about patients and, and culture.

[00:06:53] And so, you know, from that perspective of, of, uh, which that just made me laugh, it's, it's, uh, you know, didn't want to go [00:07:00] into a career that involved politics that you went in medicine, and here we are, who am I? God, talk about politicized. Um, let's put the lid and let's put the politics aside. If we, if we put the heart of healthcare to this conversation and kick the politics to the curb, um, let's talk about the culture, um, of medicine and how it's impacting patients.

[00:07:22] Robert Pearl, MD: [00:07:22] Culture represents beliefs, the values, the norms that we as clinicians learn medical school residency, or we carry the with us throughout our entire career. It's not written down in any textbook. It's not giving a lecture, but it's through the stories through the language that people use. When I try to explain to people about culture, I start in the 1850s with Ignaz Semmelweis.

[00:07:57] He's a physician in [00:08:00] Austria, in Vienna at the leading hospital, and he's appointed the head of the delivery service and he's appalled. He's embarrassed. 18% mortality rate. What's really irksome is that the adjacent facility one run by nurse midwives has two thirds lower mortality. Now at the time when patients died from was puerperal fever, overwhelming infection of the uterus spread throughout the body and the cause was felt to be miasmas . Foul smelling particles that wafted up from the streets below, but he said, why should my patients be dying 18% when the nurse midwives' (patients)  are dying, two thirds lower. Now, as you know, Patrick, we often make our best discoveries through serendipity. And that's what happened. A colleague doing an autopsy  on a woman who died from puerperal [00:09:00] fever, nicks, his finger develops a local infection and goes on to have a clinical course identical to these women who will die so  he hypothesizes ,  maybe there's something being carried from the autopsy room into the delivery room, either on the hands or the leather aprons. These physicians wore the days they had underlying three piece suits that's being  given to women in labor. So he decides that every doctor before they go into the delivery area will change that leather apron.

[00:09:34] Dip their hands in chlorinated, water and low and behold mortality drops from 18 % to 2% 90% reduction. He writes it up in the leading journal. He writes letters to every delivery service. And guess what happens, Patrick?

[00:09:50] Patrick Swift, PhD, MBA, FACHE: [00:09:50] what

[00:09:51] Robert Pearl, MD: [00:09:51] Nothing. No one pays attention exactly right now. Well, why don't we? Well, it's not indifference. [00:10:00] See, in the culture of medicine, the doctors were elevated high esteem. The only way to think about them was healers. They were incapable of carrying disease and those leather aprons, the more blood, the more pus the more experience, the last thing they would be as associated with an infection. He dies  four years later alone in a mental institution where no one will listen to them and now we leap forward 150 years. And what do we find? Hospital acquired infections are the number one cause of death for hospitals. 1.7 million people develop a hospital, acquired infection, a hundred thousand die. The bacteria is called claustrum difficile . We know it gets carried on the hands of humans. Doesn't go through the air. And if we have some researchers hiding in the corners, where do they see what? In three [00:11:00] times today, doctors don't wash their hands

[00:11:03] Patrick Swift, PhD, MBA, FACHE: [00:11:03] it's so true. It drives me nuts. I was CEO of a hospital in which I was trying to have a conversation with one of my physician colleagues saying I'm a PhD clinical neuropsychologist, not a physician, but talking to a physician saying, I'm not going to say the person's names. I don't wanna give a gender, but the person is saying I do. So it's, it's it's there are individuals who say that they are doing the right thing because they want to believe they're doing the right thing. People don't choose evil for evil sake. They mistake it for happiness. And when, when they're not doing the right thing, people want to believe they are doing the right thing. So it's to your, to your point, uh, they're still not doing it. Like they should , we, are not doing it like we should.

[00:11:46] Robert Pearl, MD: [00:11:46] no, this is just humans. . I mean, that's, that's what you have to understand doctors are just humans with the same, uh, for foilties , the same, uh, weaknesses, uh, they'll have excuses. Well, I didn't really plan to  [00:12:00] touch, the patient or I  wore gloves not  we can put it on top of the gloves. Um, and when someone dies. The culture provides the excuse that it had to be someone else. It wasn't a doctor. It had to be the nurse or that housekeeper.

[00:12:17] Patrick Swift, PhD, MBA, FACHE: [00:12:17] housekeeper. That's a big one. Thank you. I used to oversee support environmental services and they were the first ones that were brought up as well. They clearly didn't clean the room and they're the ones who are wearing the right PPE. I've got story. After story, I went undercover boss as a CEO to know what it was like to be an EVs worker and you touch on culture.

[00:12:37] Um, I, I'm so glad you're talking about this because we've got to look at the culture who we are as healthcare professionals is impacting patients, this episode is on the patients . Um, and, and, and we're talking about quality safety, uh, and this leads to disparities too. It's it's impacting everything. So, but so in your book, um, you're talking about culture, you're talking about moving forward to the future to now. [00:13:00] Um, what do you see is, is where we're going in this culture right now and how can we improve patient care?

[00:13:05] Robert Pearl, MD: [00:13:05] Well, I think it's important to look at what's happened during COVID-19 to get a good sense of this culture. And I want to make the point culture's invisible to the people who are in it. I often think about  smokers in North Carolina, they can sit in a small room and they don't notice all the smoke around them.

[00:13:27] If you or I walked in the room, we'd start coughing immediately. That's where the culture is. Like others can see it, but not the individuals in that culture. You know, what, what physicians say about washing their hands? Well, first they'd say, as you said, they do it, but they might talk about, you know, expense.

[00:13:46] Why don't they do the right thing? Well, it's expense. There's bureaucratic regulation. No, that  takes no time with an alcohol based disinfectant, the cultural lets them not see what is going [00:14:00] on. So during COVID 19, the clinicians were heroes, what they did when they couldn't get protective gear, they put on garbage bags and salad lids .

[00:14:12] They went to the hospital and when they pass tubes through the mouth, down the throat, into the lung, they knew the patient would cough spewing virus in their face. They did it anyway. And when they didn't have enough ventilators, they figured out how to put two patients on one machine. Something  that had never been done, not even thought about before they were heroes.

[00:14:33] Culture has that ability to make people do remarkable things. And the physician culture is no exception at the same time, all the things I didn't see. That we can tell from the data that exists. Number one 88% of people died from with chronic disease with two or more chronic diseases. Now think about that.

[00:14:57] You don't hear the big societies [00:15:00] going on, about what a poor job physicians are doing relative to chronic disease, you don't hear people. In fact, even talk about the value of prevention and avoiding complications for chronic disease. They talk about the cardiologist who goes in and unblocks a coronary artery, not the person who prevents it from happening.

[00:15:22] We'll talk in the next show about primary care and how the physicians there are suffering to some extent from the systemic issues, but equally inside the cultural let's look at some of the other pieces. If you ask physicians, why do black patients have three times the mortality of white patients during COVID-19.

[00:15:44] They'll give you a litany of answers. They work in jobs that they have to be there rather than being on zoom from home. They take buses and subways. They live in multi-generational homes and they're all true. What they don't talk about it as the fact that early in the pandemic, [00:16:00] when a black patient or white patient came to the ED with the same symptoms the white patient got tested for COVID twice.

[00:16:08] As often as the black patient, they don't talk about the fact that give 40% less pain medication. They don't talk about the fact that, uh, women in labor have three times the higher chances of dying. If there are black patients, except when the attending physician is a  black physician,

[00:16:25] Patrick Swift, PhD, MBA, FACHE: [00:16:25] True.

[00:16:26] Robert Pearl, MD: [00:16:26] when you put these pieces together, what's going on there.

[00:16:30] This is the nature of culture. We see people inside our group differently than we see people outside our group. We think they are more. Worthy. We have greater empathy sympathy. It's not that doctors want to harm anyone. This is not negative. This is just what culture does. But if you want to change that, you need to address the cultural issues.

[00:16:59] And that's [00:17:00] why I wrote uncaring, how the culture of medicine kills doctors and patients.

[00:17:06] Patrick Swift, PhD, MBA, FACHE: [00:17:06] In credible. And when a colleague, whether you're a physician healthcare professional, hearing the data you just said, knowing, knowing the data about disparity in pain management, for women in labor and long bone breaks, all the disparities you were touching on Dr. Pearl, there are colleagues of ours who will say in the back of their head, they'll think to themselves.

[00:17:29] Well, you're calling me racist. There are people I'm a neuropsychologist. I know though the process for some of our colleagues is that instead of hearing the message, basically, if you practice evidence-based evidence-based medicine, the disparages go down, what's heard in the ego is, well, you're calling me racist.

[00:17:46] Somehow I'm giving different treatment treatment and it's like the Monty Python response,  "No I'm Not" . So what do you say if there were a colleague sitting here with us now and whether they said it or implied [00:18:00] it, and they said, well, you're basically saying I'm racist  in my care . How do you get around that in a dinner conversation with a colleague sitting next to us, having a glass of wine, talking about this data, how do you get around? When, when someone gets defensive and says, well, you're calling me racist.

[00:18:16] Robert Pearl, MD: [00:18:16] As a neuropsychologist, I'm sure you're very familiar with the literature on what's called implicit bias. You take someone and you show them various images and they've got to match. A particular word, be it a positive word, like intellectual or a negative word, uh, against an image with the same word on it.

[00:18:39] And what you see is that white physicians will be much slower to put the positive label with the picture of a black patient or a black individual with that same word on his or her picture versus, um, a [00:19:00] white, uh, person with the exact same photos and everything else. That's how our brains work. That's the impact that culture has

[00:19:09] Patrick Swift, PhD, MBA, FACHE: [00:19:09] Yes.

[00:19:09] Robert Pearl, MD: [00:19:09] now. That's not racist. That's just simply the facts of how our brain work what's racist is if you don't pay attention to it. Now, there are, I'm not saying there's no one out there who intentionally discriminates or is racist, but almost all of these people we're discussing right now. are  not aware. And so if you want to be, what's often called anti-racist, which you have to do is understand the data. That's there recognize that it didn't start with something you decided to do, but now you have the opportunity to do things about it. When you order pain medication and the patient is black, a black patient, you ask yourself, is it possible? I'm ordering the wrong medication. You may not be, but if you stop yourself and ask when you're [00:20:00] seeing a patient in the emergency department, and there's a shortage of supplies, this case COVID testing, you have to just ask yourself if this were my friend, if this was someone who looked a lot more like me, would I do it differently? If you're on rounds in the maternity area. Are you checking all of the patients and recognizing where the bias is likely to be? You know, I often refer to it like golf. If you know, you have, what's called a hook and you hit the ball right handed to the left all the time, you might be smart to consider aiming occasionally to the right, especially when there's water hazard to your left.

[00:20:38] The same thing exists within racism. What's interesting is there was an article on artificial intelligence published about a year ago where the headline was, AI is racist. Now what happened is United health group's   subsidiary Optum. decided they wanted to invest some dollars in the patients who were sickest. [00:21:00] So there's an AI application to figure out who those patients were.

[00:21:04] The problem was that as a insurer, they had claims data. What they didn't have was actual care delivery. So they made the assumption that the more money that's spent on you, the sicker you are now in actuality, physicians provide $1,800 a year, less care to black patients with the same insurance as white patients.

[00:21:27] So guess what happened? It picked a disproportionate number of white patients. Not black patients only had 14% black patients that should have been over 40%. The headlines blamed AI. It wasn't AI. It's the way we practice medicine

[00:21:44] Patrick Swift, PhD, MBA, FACHE: [00:21:44] that's , it's the question they ask.

[00:21:45] Robert Pearl, MD: [00:21:45] All AI is  doing is duplicating the results that we get doing it even better than we can do it. But if we have an implicit bias, we have to be aware of it. And I think hopefully researchers will be aware about this in the future.

[00:21:58] Patrick Swift, PhD, MBA, FACHE: [00:21:58] incredible, [00:22:00] incredible. I, I love everything you've said. And the notion of AI being described as being racist when we're just asking the wrong questions and I love the analogy you gave about golf, and if you've got a hook to the left, you adjust your, your, your, your, your golf club. Um, and then you will hit more straight.

[00:22:22] I think the parallel goes on to say, if you're rounding in the maternity ward, for example, Pick your patient population. But when we take care of our patients, if we're more mindful that there are these biases, at least that'll help us adjust to be more in the center. And that is the opposite of perceiving it as being, just being, giving disproportionate extra effort, which also gets people defensive.

[00:22:47] Thanks. No, I'm not going to give extra effort to someone else. That's not what you're saying. You're saying, just adjust your club so you can hit straight. How about you just get the right diagnosis for everybody? Not just for some so, [00:23:00] before I run out of time on this, I want to ask you, I know there's a chapter in your book. Nine questions patients should ask doctors.

[00:23:06] Could you tell us a little bit about that please?

[00:23:09] Robert Pearl, MD: [00:23:09] This goes back to what you just said, Patrick, about the golf story, which is that if you know that there's a water hazard, you want to do things to try to avoid it. If the culture of medicine, the physician culture is one in which there's potential hazards. How do you minimize them? And again, I want to stress to the viewers.

[00:23:36] I could not be more positive about medicine, about  the profession, I encourage everyone to try to be part of it, to have the ability to provide care, to go home at the end of the night. knowing , you saved a life. So it's not negative in that way. It's just a recognition of that culture that exists that we need to get over. [00:24:00] But until that happens, there are dangers out there. So I don't have time for all nine, but I'll give you three areas. One area is if, as a patient you have the kind of problem. That's not very significant, but it requires some kind of follow-up. For the physician to see how you're doing over the possibility that maybe it was the wrong diagnosis or the possibility you might need more care.

[00:24:28] There's a set of questions you should ask. Can I contact you with email? Can I send you a text message? Can we just speak over the phone? Can we have a video visit? How can I get care without having to miss another day of work or school ? If the answer is I don't do any of those things, at least you're prepared for what's likely to happen in the follow-up period.

[00:24:57] If you need a procedure done, the [00:25:00] questions to ask is how many of these did you do last year? And how many did the most experienced person do in this community last year? And what's the worst complication you ever had? And how many of these procedures would you require someone to have done for  you to let them operate on you or do whatever the intervention is going to be.

[00:25:25] Patrick Swift, PhD, MBA, FACHE: [00:25:25] great question.

[00:25:26] Robert Pearl, MD: [00:25:26] then you can figure out whether that experience that this person has is worth it. It's not necessarily a right wrong answer. And then finally, for people who have advanced disease, heart failure, lung failure, they'd been in the hospital a couple of times or cancer. That's recurred multiple times. You want to know what are the other options that I have for care. You want to know when, as my problem progresses, will you be able to keep my pain adequately managed? [00:26:00] Maybe the most important question to me is when I decide that I do not want any more intervention, you still be with me or will you desert me? And that to me , I think, is what people want to know as they face a terminal illness and end of life set of decisions.

[00:26:20] Those are the kinds of questions. They're all put into the context of the physician culture, but people who want to understand what to ask doctors respectfully, but for the information they need to participate in the decision-making process will find that chapter particularly relevant and helpful.

[00:26:39] Patrick Swift, PhD, MBA, FACHE: [00:26:39] Absolutely  powerful questions, Dr. Pearl. I, I recall, uh, a, a dear colleague of mine, who I was interviewing for another episode, and she's currently battling ovarian cancer a silent killer. And she was with a urologist who, um, uh, was not doing [00:27:00] the testing and the assessment necessary to get to the bottom of it to help.

[00:27:04] And when she shared, there were some abdominal pain, uh, some GI symptoms, he turned around and said, well, I guess I'm off the hook. And it's the antithesis about what you described? Uh, this episode coming up was with Diane Powis . Um, when this episode comes out, we'll see, which comes out first, but, um, uh, in Diane show, she speaks about the urologist saying, well, I guess I'm off the hook.

[00:27:28] Your question, the third question you touched on there. If, if, if there's no longer care required, will you abandon me? You're touching on, are you still caring for me? You're not asking, are you going to continue to treat me gratis and forever be my best friend? No, you're talking about really the question is, do you respect me enough to keep a relationship? If I need care, if I just need you to care, um, is there connection there, right? Is that where you're going?

[00:27:58] Robert Pearl, MD: [00:27:58] In the culture of medicine [00:28:00] as physicians, death is not something we're used to, but something we don't really like. We see it as our own failure.

[00:28:07] Patrick Swift, PhD, MBA, FACHE: [00:28:07] Oh, sure.

[00:28:08] Robert Pearl, MD: [00:28:08] We feel powerless. Um, we worry that how people are gonna view us as a failure. Of course, that's not the reality, but that is the culture.

[00:28:21] Patrick Swift, PhD, MBA, FACHE: [00:28:21] A hundred, a hundred percent of us die.

[00:28:23] Robert Pearl, MD: [00:28:23] I can't necessarily cure you. In fact, I probably can't, but I'll be there for you and I'll make sure you're comfortable and I'll make sure you have the information you need and I'll help you find the resources. And again, people will point to the systemic issues. Well, that kind of conversation is not reimbursed and that conversation is not adequately funded, but it's why we chose medicine in the first place. When we get to the episode around physicians, I think not doing that creates the loss of mission and purpose [00:29:00] and harms doctors, as much as it harms patients.

[00:29:04] Patrick Swift, PhD, MBA, FACHE: [00:29:04] and your book is titled uncaring. How the culture of medicine is killing doctors and patients, and for listeners, viewers, where can people get a copy of that? Dr. Pearl

[00:29:17] Robert Pearl, MD: [00:29:17] The easiest thing to do is to go to my website, Robert Pearl md.com because there they'll have a choice of nine different providers, including Amazon and Porchlight and Barnes and noble, they can pick what they want to have the purchase go through. Uh, and they also can get, if they pre-order all the freebies that are available and they can check out other pieces of information, uh, I'll be writing an article next week. About the impact that the COVID-19 pandemic has had on physicians, particularly critical care physicians and infectious disease individuals, because I think they're going to have post-traumatic stress disorder [00:30:00] and it's going to be a crisis in medicine. If we don't act now and provide the mental health and psychological support that they need and deserve.

[00:30:11] Patrick Swift, PhD, MBA, FACHE: [00:30:11] there is that crisis. As a practicing psychologist, I'm caring for health care professionals, struggling with that burnout. And, um, as an executive coach, I'm supporting, um, executive struggling with that. Dr. Pearl, you, you hit the nail on the head, um, that that crisis is occurring as we speak. And I'm just so grateful that you've worked on this book, it's the culmination of the love and passion and care that you bring to medicine, uh, and our culture. So I want to thank you for being on this show on the Swift healthcare podcast. And I want to encourage folks to tune in for our next episode which we'll be touching on uncaring, how the culture of medicine, killing doctors and patients, um, as we discuss in the next episode, we'll be focusing on our, our providers, our doctors, and the [00:31:00] providers in healthcare.

[00:31:00] So Dr. Pearl, thank you so much for being on the show.

[00:31:03] Robert Pearl, MD: [00:31:03] Thank you, Patrick. I'll look forward to the next episode next week.