In a well-documented, panoramic narrative, an insider demystifies what makes many doctors tick.
The former CEO of the Permanente Medical Group takes readers into the world that shapes the medical practitioner’s mindset and lays out necessary changes for a broken system.
By the early 2000s, the U.S. health care system, once a global leader, had become the most expensive and least effective in the developed world. Of course, Covid-19 has only exacerbated the situation. Among the number of factors that have led to our current state of affairs—a situation that implicates everyone from hospital administrators to insurers, regulators, and pharmaceutical giants—Pearl singles out for examination the flawed culture that guides doctors in their practice. Physician culture, writes the author, “elevates intervention over prevention,” resulting in a lack of effective treatment for chronic killers such as diabetes, obesity, hypertension, and heart disease. In a brightly delineated—and highly disturbing—dissection, Pearl lays out the rituals, rules, and beliefs that often isolate physicians from their colleagues and their patients. The foundation of the culture may rest on concepts of healing, resilience, and artistry, but it also breeds a hierarchical sense of individual exceptionalism, heroism, and invincibility. This entitlement and autonomy often clash with the implementation of advanced diagnostic technology, undercutting the doctor’s sense of status and control. In this new environment, characterized by long hours, lowered pay, diminished decision-making, and erasure of prestige, more and more physicians are experiencing burnout. Pearl sensibly advocates a coevolution of these two streams, taking advantage of a doctor’s experience and independent judgement while tapping into the structural and scientific changes in medical practice. Incorporating peer-reviewed research, personal experience, and anecdotal evidence, the author excoriates overtesting and overprescribing as well as institutionalized racism within the medical community, and he advocates for “broadly available, prepaid, integrated, high-quality healthcare,” a system that is open to change, collaboration, and “safe, effective, patient-centered, timely, efficient, and equitable” care.
In a well-documented, panoramic narrative, an insider demystifies what makes many doctors tick.Pub Date: May 18, 2021
ISBN: 978-1-5417-5827-8
Page Count: 400
Publisher: PublicAffairs
Review Posted Online: March 12, 2021
Kirkus Reviews Issue: April 1, 2021
Striking research showing the immense complexity of ordinary thought and revealing the identities of the gatekeepers in our...
A psychologist and Nobel Prize winner summarizes and synthesizes the recent decades of research on intuition and systematic thinking.
The author of several scholarly texts, Kahneman (Emeritus Psychology and Public Affairs/Princeton Univ.) now offers general readers not just the findings of psychological research but also a better understanding of how research questions arise and how scholars systematically frame and answer them. He begins with the distinction between System 1 and System 2 mental operations, the former referring to quick, automatic thought, the latter to more effortful, overt thinking. We rely heavily, writes, on System 1, resorting to the higher-energy System 2 only when we need or want to. Kahneman continually refers to System 2 as “lazy”: We don’t want to think rigorously about something. The author then explores the nuances of our two-system minds, showing how they perform in various situations. Psychological experiments have repeatedly revealed that our intuitions are generally wrong, that our assessments are based on biases and that our System 1 hates doubt and despises ambiguity. Kahneman largely avoids jargon; when he does use some (“heuristics,” for example), he argues that such terms really ought to join our everyday vocabulary. He reviews many fundamental concepts in psychology and statistics (regression to the mean, the narrative fallacy, the optimistic bias), showing how they relate to his overall concerns about how we think and why we make the decisions that we do. Some of the later chapters (dealing with risk-taking and statistics and probabilities) are denser than others (some readers may resent such demands on System 2!), but the passages that deal with the economic and political implications of the research are gripping.
Striking research showing the immense complexity of ordinary thought and revealing the identities of the gatekeepers in our minds.Pub Date: Nov. 1, 2011
ISBN: 978-0-374-27563-1
Page Count: 512
Publisher: Farrar, Straus and Giroux
Review Posted Online: Sept. 3, 2011
Kirkus Reviews Issue: Sept. 15, 2011
BOOK REVIEW
IN THE NEWS
The lessons to draw are obvious: Smoke more dope, eat less meat. Like-minded readers will dig it.
The chef, rapper, and TV host serves up a blustery memoir with lashings of self-help.
“I’ve always had a sick confidence,” writes Bronson, ne Ariyan Arslani. The confidence, he adds, comes from numerous sources: being a New Yorker, and more specifically a New Yorker from Queens; being “short and fucking husky” and still game for a standoff on the basketball court; having strength, stamina, and seemingly no fear. All these things serve him well in the rough-and-tumble youth he describes, all stickball and steroids. Yet another confidence-builder: In the big city, you’ve got to sink or swim. “No one is just accepted—you have to fucking show that you’re able to roll,” he writes. In a narrative steeped in language that would make Lenny Bruce blush, Bronson recounts his sentimental education, schooled by immigrant Italian and Albanian family members and the mean streets, building habits good and bad. The virtue of those habits will depend on your take on modern mores. Bronson writes, for example, of “getting my dick pierced” down in the West Village, then grabbing a pizza and smoking weed. “I always smoke weed freely, always have and always will,” he writes. “I’ll just light a blunt anywhere.” Though he’s gone through the classic experiences of the latter-day stoner, flunking out and getting arrested numerous times, Bronson is a hard charger who’s not afraid to face nearly any challenge—especially, given his physique and genes, the necessity of losing weight: “If you’re husky, you’re always dieting in your mind,” he writes. Though vulgar and boastful, Bronson serves up a model that has plenty of good points, including his growing interest in nature, creativity, and the desire to “leave a legacy for everybody.”
The lessons to draw are obvious: Smoke more dope, eat less meat. Like-minded readers will dig it.Pub Date: April 20, 2021
ISBN: 978-1-4197-4478-5
Page Count: 184
Publisher: Abrams
Review Posted Online: May 5, 2021
Kirkus Reviews Issue: June 1, 2021
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