18. (Part 2) Uncaring: How the Culture of Medicine Kills Doctors & Patients w/ Robert Pearl, MD

Part 2 - 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

Patrick Swift, PhD, MBA, FACHE: [00:00:00] [00:00:00] Welcome folks to another episode of the Swift healthcare video podcast. I'm delighted that you're here and I have an amazing guest for our episode to Dr. Robert Pearl. Welcome back to the Swift healthcare video podcast, Dr. Pearl.

[00:00:13] Robert Pearl, MD: [00:00:13] It is a privilege to be back, Patrick , looking forward to it all week long.

[00:00:17] Patrick Swift, PhD, MBA, FACHE: [00:00:17] I'm glad, I'm glad. I'm glad. And we are talking about your book that is coming out Uncaring: How the culture of medicine is killing doctors and patients. I'm going to say that title again. It is packed Uncaring: How  the culture of medicine is killing doctors and patients. And in this episode, last episode, hopefully you've dialed in and heard that one.

[00:00:40] This episode, we're going to be talking about doctors. We're going to be talking about providers and it wouldn't do justice without giving  a little intro for Dr. Pearl here. So Dr. Pearl bear with me and for listeners, please take this in who you're listening to. This is Dr. Robert Pearl. He's the former CEO of the Permanente medical group, [00:01:00] the nation's largest medical group.

[00:01:01] At the time he was there in 99 to 2017, former president of the Mid-Atlantic Permanente medical group, 2009 to 17. He's led 10,000 physicians, 38,000 staff. These are people that get up in the morning and report to work. We're looking at 50,000 plus that he supported, uh, 5 million Kaiser Permanente members.

[00:01:20] He's been listen to this named one of modern healthcare's 50 most , influential physician leaders. And you're listening to him right now. He has a. Authored several books I'm gonna  touch on that, but he's also hosting podcasts, fixing healthcare, another one, Coronavirus, the truth. And then he has a newsletter Monthly Musings on American healthcare.

[00:01:42] He's a regular contributor to Forbes. And the first book I'm sure we'll touch on one was Mistreated: why we think we're getting good healthcare and why we're usually wrong. Holy crap. That is just a great title. Uh, and then this new book coming out, uncaring, how the culture of medicine kills doctors and patients.  With that [00:02:00] said the intro, Dr. Pearl, let's just jump right into it. And, , you have done some amazing things. I want to ask you number one, thanks for being on the show

[00:02:10]Robert Pearl, MD: [00:02:10] Thank you.

[00:02:11] Patrick Swift, PhD, MBA, FACHE: [00:02:11] Two , uh, we're talking about providers, folks, This book that's coming out is supporting doctors without borders, all the , all the proceeds of the goes to the doctors, to the borders. He's done some really cool stuff involving Ebola response to tsunamis, and I've got to pick his brain, uh, just because, um, share some insight being there. We're talking about providers, we're talking about professionals, we're talking about physicians. Um, what was your experience supporting providers, physicians, um, particularly, um, but supporting providers in response to Ebola and, uh, the tsunami

[00:02:45] The tsunami was fascinating because it was a lot more than just physicians. A lot of psychologists actually participated because the mental health issues of the people in Sri Lanka, which is where we went along with doctors without borders, [00:03:00] uh, was tremendous. So this happened, people may remember a little over a decade ago, a tsunami hit the area. Uh, it was the day after Christmas, but we knew that there were a lot of people who were killed, harmed and about to be harmed because the upcoming diseases with the communicable diseases and the contaminated water or the malaria then invariably would come. And so we worked with doctors without borders, uh, to figure out how we could send teams of volunteers there. I sent a secure email out to my physicians. Uh, they 10,000 of them. And I said, how many of

[00:03:47] day after Christmas.

[00:03:49] Robert Pearl, MD: [00:03:49] The day after  Christmas? So half of them were on vacation with their family. And I said, how many of you would be willing to volunteer? And they're not going to get paid. We'll provide the [00:04:00] supplies. We'll provide the transportation, but they're, they're on vacation.

[00:04:03] This is their vacation to go to Sri Lanka. And then of course I'm a physician. So I have to provide informed consent. Number one, there may not be any food. Number two, the water could easily be contaminated. And number three there's been a civil war for 20 years. I figured maybe I get five or six over 200 people volunteered that week.

[00:04:26] Or we ended up sending 10 trips, saving tens of thousands of lives, providing the psychological support to them, avoiding malnutrition, avoiding death from diarrhea, avoiding malaria, all the different pieces, depending upon how the epidemic happened. And then we said teams to Guatemala. After the earthquake struck there, we sent teams to the South.

[00:04:55] After hurricane Katrina to Louisiana, we sent them [00:05:00] a great story. They arrived there and the police have a barricade up. So no one can come into the area where Katrina has been. So what do they do? They rent a car at night and they go around the police barricade so they can get in there and provide care to these people who were in tremendous need.

[00:05:17] And then the Ebola comes, uh, Liberia and the physicians there. And they're all physicians in this case because you need infectious disease, expertise and emergency expertise. They actually have to have IVs going into their arms while they're providing care, because they're wearing the protective suits that are so hot.

[00:05:36] It's 120 degrees inside the suit.

[00:05:39] Patrick Swift, PhD, MBA, FACHE: [00:05:39] Oh my God.

[00:05:39] Robert Pearl, MD: [00:05:39] are alive unless they're receiving IVs.

[00:05:43] Patrick Swift, PhD, MBA, FACHE: [00:05:43] Oh my God.

[00:05:44] Robert Pearl, MD: [00:05:44] And this to me is the amazing piece. Patrick, I talked to  everyone who came back. Now just try to think about what it's like to be, be there. That 120 degree suit we're sitting there in the midst of a tsunami with knowing that there's civil war around you or the [00:06:00] hurricane debris of, uh, of central America. I have never seen happier physicians. The ones who went there made me think about all the trips that I've done. I fixed kids with cleft lip and cleft pallet. I've probably done a dozen trips to central South America, to some other countries as well. You know, you go there, you work 12 hour days, the ORs are not air conditioned.

[00:06:23] Food is rice and beans and everyone comes back fulfilled. Now think about in the context of burnout, what is missing? It's not the comfort, it's not the money. It's the mission and purpose. I think that we have lost that. And that's part of why I wrote on caring, how the culture of medicine kills doctors and patients, because I think some of it, much of it has been done to us, but much of it we've done to ourselves.

[00:06:53] And hopefully we'll get into that in greater detail. So people can start working on ways to [00:07:00] minimize the harm that they're experiencing.

[00:07:02] Patrick Swift, PhD, MBA, FACHE: [00:07:02] Yeah, your a story. It brings tears to my eyes. You're just talking about these people who are, um, volunteering. I mean, it's hope you speak about hope, Dr. Pearl. There's so much pessimism and confusion and misinformation and, and sarcasm and negativity and your story of expecting five and you get 200, um, people putting them their, their lives at risk, um, uh, giving up not only just vacation, but risking their lives, um, in Liberia and, and, and Sri Lanka. And, and these are stories of, of the reason why we go into healthcare. We all want to make that difference. Healthcare people are mission-driven people. And what you're talking about is, uh, facilitating folks, being able to follow their Dharma, follow their calling. And I know in the previous episode, we talked about you following your Dharma and your calling, and, um, it's so beautiful.

[00:07:57] That's why we go into healthcare we're mission [00:08:00] driven people, and you touch on being done to us as providers and doing it to ourselves, and that leads to a conversation about culture. Um, and, um, uh, I'm curious about your thoughts in this, in light of the amazing book that you have coming out, um, your thoughts about culture and how we're doing this to ourselves.

[00:08:20], in light of, , this episode, focusing on providers and physicians.

[00:08:24] Robert Pearl, MD: [00:08:24] If you ask physicians, why are 44% of physicians burned out? And why do they talk about moral injury? They'll tell you it's three things. At least the three most common we don't get paid enough. We have to do so many bureaucratic tasks and the computers in the exam rooms and the offices are so slow and clunky.

[00:08:52] They make a spend a huge amount of time documenting rather than providing the care.

[00:08:59] Patrick Swift, PhD, MBA, FACHE: [00:08:59] that is [00:09:00] maddening. I got to tell you.

[00:09:01] Robert Pearl, MD: [00:09:01] And they're all right, all those three things are there. But I wrote the book because my first book mistreated was about the systemic issues. And as I went around talking to people and I researched areas like burnout, there was still a piece missing.

[00:09:21] So let me give you a couple of examples. The people who were paid the least are pediatricians, but their rate of burnout is not that high, primary care is a much higher rate of burnout than pediatrics, even though the salaries are higher. What was even more amazing to me was the specialty that had the highest rate of burnout over 50% is urology.

[00:09:48] Now think about it. Urologists make almost a half million dollars a year. It's not the salary. They're making as much money now as they did in the past, when they [00:10:00] had low rates of burnout and compared to orthopedics or ophthalmology, they make just as much money, but they have 20% higher burnout rates.

[00:10:12] How do you explain this? It's not a lack of salary, because they're making a lot more than primary care and just as much, and even more than the other specialties, it can't be the bureaucratic tasks that goes into the same authorization processes. They have the same restrictions, the same regulations, and they're using exactly the same computers.

[00:10:31] So there's nothing different that explains it. If you look at the data over time, you start to see an interesting phenomenon, which is that urology used to have a low burnout rate, similar to some of the other surgical specialists specialties. And then what happened almost a decade ago is that the national preventive care oversight groups.

[00:10:50] Decided that the PSA, the prostate specific antigen that's used to find prostate cancer was causing as much harm, as good as [00:11:00] people underwent a huge number of biopsies and other tests. And people were also discovering that lo and behold, not intervening had as good a long-term expectancy in a lot of cases without the risk of impotence and urinary incontinence.

[00:11:18] And so the number of cases they did start going down a why is that important? Because in the hierarchy of medicine, it's not rational in the hierarchy of medicine, the cooler, the procedure, and this robotic prostatectomy, it's like a star Wars of surgery gave urologists this high status. And now as fewer and fewer urologists can do the procedure or have the opportunity to do the procedure.

[00:11:51] All of a sudden this level of satisfaction. One that's not created from the outside, because remember I said, urologist's are  making just as much [00:12:00] money, but simply from this hierarchy of medicine, I'm sure you're familiar with the work of Sir  Michael Marmot who looked at the relative hierarchies in British society amongst workers. And he could show a clear correlation. The lower down you were, the more dissatisfied, unfulfilled, fatigued. You were the exact same symptoms as burnout.

[00:12:26] Patrick Swift, PhD, MBA, FACHE: [00:12:26] beautiful point and you're not picking on urologist, obviously you're not, but I think it's worth pointing out. You're not picking on urologists. You're you're pointing out. You're shining a light on culture. And how we, we, like you said, we do to ourselves, we get caught up in this hierarchy and socially our families and culture and environment looks at us in pressure.

[00:12:48] There's this whole environment. you get to the, you get to 40 and don't give a shit what people think you get to 50. You don't give a fuck what people think I'll , bleep that out. But, but the notion that as you get older, you have to recognize praise and blame weigh the [00:13:00] same.

[00:13:00] All these, all this external, um, is,  Maya, this illusion , this, this farce. And so you're speaking to one is the  Occams' razor of cutting right through it. And that even saying that you breathe a little clearer of, of recognizing your own value. And that's the coaching I do as a psychologist and as an executive coach, it's about cutting through.

[00:13:23] So personally, there's that decision you touch on the other is now the culture, external culture. What can we do to move that culture, Dr. Pearl? Because your voice is so powerful that it speaks to putting a light on this, but there's also organizational institutional cultural things that, that, that needs to happen in order for this to shift in medicine.

[00:13:44] Right? The incentive.

[00:13:46] Robert Pearl, MD: [00:13:46] So, this is the piece of the book that I think is the most important, which is the way that culture and system move together. [00:14:00] So if you're going to try to create, you're going to try to create a, a logical way to say which specialties should be near the top of the hierarchy. And I told you that adding 10 community increases longevity two and a half times more than adding 10 specialists, you would say primary care should be at the top of the hierarchy. And yet they are not now in the minds of a lot of physicians, the order is we're not paid a lot, so we're not at the top of the hierarchy. And I'm making the point in this book that some of the reason why primary care is not paid as much is because the physician hierarchy does not put them higher enough.

[00:14:43] Because when you look at groups, the Mayo clinic or Kaiser Permanente, what you see as their primary care physicians are paid a lot more than in the community, because their value is seen more clearly.

[00:14:56] Patrick Swift, PhD, MBA, FACHE: [00:14:56] say that again. Please say that again.  [00:15:00] did you just say, I think I heard you say this, but I want our listeners to hear this. You just said in the Kaiser Permanente group, the primary care are compensated more because they're valued for the life-saving essentially, now  I'm putting words in your mouth, but it's also impacting preventing it saving lives.

[00:15:19] Is that what you said? That there's more compensation?

[00:15:22] Robert Pearl, MD: [00:15:22] If you look around the United States, I was also the chairman of the accountable care organization. And we had 24 groups, including the Mayo clinic and the Kaisers and the Geisinger's ad. And every group primary care is paid more in a group practice than it is an individual. But what, so what can be done?

[00:15:41] I think that physicians,

[00:15:43] Patrick Swift, PhD, MBA, FACHE: [00:15:43] one is they move their right to be part of that culture.

[00:15:49] Robert Pearl, MD: [00:15:49] the good part is they wouldn't have to move there

[00:15:51] Patrick Swift, PhD, MBA, FACHE: [00:15:51] Okay. How

[00:15:53] Robert Pearl, MD: [00:15:53] I think in the post, I think in the postcard, a virus era, there will [00:16:00] be everywhere. And what I mean by that is the following. You know, the United States will have borrowed $8 trillion that we'd have to pay back or we'll have to pay interest on by law every state in the United States has to have a balanced budget. They're going to have more unemployment claims, more Medicaid and less revenue. And small businesses that are the engine that drives employment. The people that drive the stock market are Amazon, Netflix, Apple, but the people who drive employment are this small businesses and they've been hammered a third of them saying they can't actually get through this year.

[00:16:39] without  continued government support. You know, we've talked about the need to lower the cost of healthcare for decades instead of we should. We must. I'm saying now that we will, because people won't be able to afford to pay the projected five to 6% costs [00:17:00] increased year over year. And when you can't afford something, you don't do it even if you want to do it.

[00:17:07] And I think that that's where our nation is going to be, and we're going to face.

[00:17:11] Patrick Swift, PhD, MBA, FACHE: [00:17:11] So hang on. Are you saying then that I agree with you that people are less likely to go to the, basically they're less likely to go to doctors. Ones are likely less likely to have procedures done those less likely to get care. They're less likely to get screening. So then mortality increases and then there's death.

[00:17:31] We're talking, we're talking over more mortality. So where, where is the, where's the solution here? How do we, how do we get, how do we address this before the tsunami, um, of poor care? Comes because of lack of access because of lack of resources to be able to pay for it.

[00:17:51] Robert Pearl, MD: [00:17:51] Look at the options you have, where you have a budget that cannot be exceeded a fee for [00:18:00] service system, which providers can just do more and more can't work. So you're left with two options. We'll either ration care or we'll transform care. Under a single payment, the technical word is capitation. And here's where the interesting part starts, which is that the physician culture that for decades has avoided progress because it's been the interest of physicians and hospitals and others to be paid in a fee for service type way when that's no longer possible.

[00:18:34] And the choice shifts into one of rationing versus capitation. I think we're going to see people start to move forward. Not everyone at once, but some people will move forward. I'm hopeful. It's going to be similar to when Roger Bannister broke the four minute mile. Once some people are doing it, as you know, with it, it was thought to be [00:19:00] impossible.

[00:19:00] And there were three years, there were 10 people who had done it because now once you're in a capitated system, you see the culture start to change. And what do I mean by

[00:19:09] Patrick Swift, PhD, MBA, FACHE: [00:19:09] Your lips to God's ears.

[00:19:11] Robert Pearl, MD: [00:19:11] Well, what you see is that in a capitated system, prevention becomes far more important. Primary care becomes far more important. Patient safety avoids a complication for chronic disease. All of these become positive

[00:19:29] Patrick Swift, PhD, MBA, FACHE: [00:19:29] and this is a provider, this is a provider of focus. Right? And so satisfaction goes up,

[00:19:35] Robert Pearl, MD: [00:19:35] and exactly,

[00:19:36] Patrick Swift, PhD, MBA, FACHE: [00:19:36] provider experience goes up the, the quality of life work-life balance. All of the benefits. There is a sea change for us as providers with that kind of model.

[00:19:48] Robert Pearl, MD: [00:19:48] where you ha you start to have the control, but you also have the risk. And this is why I think it's the risk aversion of physicians. That's kept them out of the model, but once you have the [00:20:00] risk, you need to find ways to obviate it, which means you've got to form groups. Working together in collaborative and cooperative ways, which I think psychologically is far better than everyone out for themselves.

[00:20:16] You have to find technology that's going to work. I mean, look what happened in COVID all of a sudden physicians started doing 60 to 70% telemedicine patients got better care. Everyone's talking about it as it as good. The fact that can address your problem right now, rather than telling you to come back.

[00:20:36] I mean, when I was the CEO in Kaiser Permanente, we set up a system whereby if a patient was seeing a primary care physician, this was pre COVID and the physician wanted to send the referral rather than sending a referral. We created a video link with a specialist. Dermatology was a great example of this.

[00:20:55] I don't know what it's like in your community. Most places in the United States, this is a six week wait, [00:21:00] the primary care physician, rather than telling the patient call. The dermatologist took a digital picture. Sent it to a dermatologist who was assigned that day to oversee this entire area for, for quite a number of physicians.

[00:21:14] and , within six minutes, there was an answer. So care was started that day, not six weeks later. How can you say this inferior care to seeing a doctor in his or her own office six weeks from now that opportunity physicians will figure out and I have tremendous faith that they will do the right things for patients. Once the incentives align and the culture evolves.

[00:21:43] Patrick Swift, PhD, MBA, FACHE: [00:21:43] You said something profound to me in another conversation we had in which you said, you tell me the incentives and I will tell you the behaviors. Is that what you said? Am I quoting you correctly? Or the outcomes you tell me the incentives. And you said, you tell me a sentence and I can [00:22:00] tell you what's gonna happen.

[00:22:01] Robert Pearl, MD: [00:22:01] I can tell you how people are going to behave.

[00:22:02] Patrick Swift, PhD, MBA, FACHE: [00:22:02] Yeah, yeah, yeah.

[00:22:04] Robert Pearl, MD: [00:22:04] commonly used business school phrase that somehow it in the culture of medicine, we don't think it's true. We don't think that the 30% of procedures that we do that have been shown to add no value. And I'm talking about by the Mayo clinic and a new England journal of medicine summaries of this that's somehow that's the right thing to do because the culture of medicine tells us somehow that it's okay.

[00:22:30] The reality says that is money, we could be better investing whether we want to invest it in prevention, whether we want to invest it in more primary care, whether we want to invest it in better education to make up for what's happened in COVID. Whether you want to invest in development of cities, I can come up with a lot of reasons why it is wasted.

[00:22:51] It makes us overlook things like surprise billing. I mean, the fact that we not only give people bills when they come to [00:23:00] get care, because we're battling an insurance company and we put the patient in the middle and then the hospitals that employ us Sue the patient when they can't pay. And we talk about moral injury, talk about inflicting  harm the culture. Doesn't let us see it. You're the psychologist. But to me, it's like a fine grain sieve. It seeps out. And I believe that it erodes the purpose and the mission. And I think that it contributes to the 400 suicides of physicians a year.

[00:23:33] Patrick Swift, PhD, MBA, FACHE: [00:23:33] Yeah. Grossly underestimated too.

[00:23:35] Robert Pearl, MD: [00:23:35] both doctors and patients.

[00:23:37] Patrick Swift, PhD, MBA, FACHE: [00:23:37] Yeah. Yeah. Ah, yeah, incredible. And this episode is your message is one of hope in the face of, you know, full circle in the face of acknowledging, , physician suicide, , the degree of suicide, , in providers and quite frankly, in the country and on a global scale, , providers around the planet right now, moral distress, everything we're going through, , to [00:24:00] the scope of this conversation about the culture of the self-inflicted wound and this wound we're born into, , , in medicine in a previous episode, we taped together, Dr. Pearl, you acknowledged a culture from the 18 hundreds. , and so the environment we're working in and beginning this episode, when you brought tears to my eyes, talking about Liberians, the tsunami, , this is there's such sacrifice on the part of our, our patients. And on the part of our providers, , there is such sacrifice in that his heart, , and what you speak of your message here is one of courage. , the, the courage, , to do something about this and your book is about that. Is it not

[00:24:41] Robert Pearl, MD: [00:24:41] Uncaring other culture, medicine kills docs and patients. It is. And I point out in one last thing and again, colleges, so you're more of an expert than I am to this, but the five stages of loss or grief, the Kubler Ross has the fond. And my understanding is they really can't be avoided. [00:25:00] And so the viewers should understand that they may not feel it's going to be necessary.

[00:25:06] They're going to deny the change is going to be there. And I hope that they're right, but I don't think they will be for the reasons that we said, and then what's going to happen. They're going to get angry because they feel like something's being done to them. I think some of that's already started

[00:25:21] Patrick Swift, PhD, MBA, FACHE: [00:25:21] Oh yeah.

[00:25:21] Robert Pearl, MD: [00:25:21] looked at the issue of moral injury as an example of burnout. Then what happens? Third, they start to bargain. Okay, I'll do it Tuesday and Thursday, but not Monday, Wednesday and Friday. I'll do it for some patients and not others. And then they get depressed. And I'm worried about that phase. And I'm hoping that they're going to get through that phase to acceptance, which is not the same thing as saying, it's what I want the saying under the circumstances, it's the best option that's there.

[00:25:49] And I'd be a miss to not also mention the article I'll be publishing in Forbes next week, about the impact of COVID-19 [00:26:00] on physicians, particularly in critical care and in infectious disease, the newest Medscape’s study has shown that actually urology is now number four with critical care and ID above because of the experience. I think these physicians are having, I talked to one doctor who said he lost four patients in one day. I talked to another one. She was a resident and she said that on day one of the rotation, she inherited six patients. By the end of the month later, they were all dead. I talked to people who are a woman, who's a double boarded physician, probably the grittiest smartest person. I know. And she said she can't go to sleep at night. And she wakes up before sunrise and sweats, sweating in bed. Uh, I think that we have got to understand that PTSD doesn't happen in the midst of the war. It happens afterwards. And I'm hoping [00:27:00] that if listening in are people who run residencies who run hospitals, this is the time to make sure that the psychological resources are there as a conversations can happen. If not, we're going to see as you call it a tsunami of problems with these individuals who have dedicated their life. And risked their life to take care of people infected with this horrible Corona virus pandemic experience.

[00:27:30] Patrick Swift, PhD, MBA, FACHE: [00:27:30] Absolutely. And, and I really want to encourage folks to take a look at Dr. Pearl's book, because it is a message of truth, recognizing what is going on here, but it's also a message of hope. There's the question of what can we do? And Dr. Pearl earlier you touched on, um, I, I wanted to bring up, , seeing the stages of grief, , and getting to that acceptance and that not being just, okay, I'm going to just take it, but it's about personal [00:28:00] leadership.

[00:28:00] I'd add personal leadership and professional leadership. That's the work I do with, with people is the personal professional leadership is about seeing things as they are not worse than they are. Not better than they are, but seeing things as they are. And then what do we do? And I know they're going to be QANON and wing nuts and people with propagating all kinds of garbage, um, as we have to adjust.

[00:28:23], but the vast majority of us are reasonable people, , who bring heart to what we do in caring for our patients and caring for our system. , and, and I couldn't think of a more, , global voice, um, to bring, , courage, compassion, joy, and hope, in the work we do. So it's my prayer that this episode may lift uplift people. And I, and I get to ask you my favorite question at the end of the show here, which is if you had the attention of all the healthcare professionals around the whole planet for a brief moment, what would you tell them? Dr. Pearl.

[00:28:55] Robert Pearl, MD: [00:28:55] First thing I would tell them is that the [00:29:00] culture of medicine is getting in the way of fulfilling the reason they chose medicine in the first place that the systematic problems around us they're real. But you know, the people in generations before us. They didn't have effective treatments or they didn't have necessarily the right procedures to perform . There's always difficulties that need to be overcome. And in this particular situation, I think the physician culture and again I  called the physician culture is really a clinician culture. It's just that I'm more knowledgeable. A lot of physicians is getting in the way, you know, the fact that, um, hypertension, the number one cause of strokes and kidney failure is controlled 55 to 60% of the time across , the country. And there are groups, large medical groups that control at 90%. That's not [00:30:00] a criticism. It's just the fact as you point out the question is what are we going to do about it? In the last episode, we talked about racism and the fact that black patients don't receive the same care as white patients, there's systemic issues as well. But the things that we can control. Again, you're the psychologist, but my sense is start with what you can do rather than starting with what you can't do and what you often will find that as you start to do the things that you can to raise quality, to provide care, that's more convenient, that's  more compassionate to be able to make care more affordable, low and behold.

[00:30:42] You're going to discover that the happiness and fulfillment that you experience, whether it's a combination of gratitude or there's a combination of being generous is going to come back and have people become more satisfied. I go [00:31:00] back to the tsunami experience, international experience, the happiest people I ever saw were clinicians who went over there and were able to do the right thing. Despite the fact that as you say that you volunteered, despite the risks that were out there, despite the hours, we need to work to change the system, but we also need to work to change the culture.

[00:31:25] Patrick Swift, PhD, MBA, FACHE: [00:31:25] incredible, incredible, Dr. Pearl , if folks are interested in following up with you learning more about your podcasts, your newsletters, the book, uh, where can they go?

[00:31:34] Robert Pearl, MD: [00:31:34] Best place to go is the website, RobertPearlmd.com. RobertPearlmd.com. They can order the book, pre-order the book. And if they pre-order the book, they'll get the signed book plate to discussion guide. They'll get the bibliography and they'll get the book delivered to their home. On the first day it's available.

[00:31:53] Uh, they could also get a lot of other information on the monthly musings on the articles that are being [00:32:00] written, the opportunity to broaden the knowledge and in all of my monthly musings, I always ask for reader feedback. And when it comes to this book, I'm encouraging people. Please read it if you love it, or you hate it. If you agree with it or disagree, let me know. That's how I learned. And I want to learn from all of your viewers and from all of the people who already are following the things that I get a chance to write and say, it's just a privilege to be able to work to transform medicine on behalf of people. And I appreciate all of you viewers who are going to come along on this journey,

[00:32:35] Patrick Swift, PhD, MBA, FACHE: [00:32:35] I pray they do. And he does read his email folks and, and the proceeds of the book goes to

[00:32:41] Robert Pearl, MD: [00:32:41] Doctors without borders, a tremendous organization that is running healthcare for those who can't contain it around the globe.

[00:32:51] Patrick Swift, PhD, MBA, FACHE: [00:32:51] Love them, love them. Outstanding, Dr. Pearl. It is a pleasure and an honor. Thank you so much for being on the Swift  healthcare podcast. Thank you so much for the heart and courage and [00:33:00] joy  and compassion that you bring to the show.

[00:33:02] Robert Pearl, MD: [00:33:02] Thank you, Patrick. I've had a lot of fun and I really appreciate you taking the time and educating your viewers. I can't wait to hear their feedback. Thanks so much.