Pearl, a plastic surgeon and former CEO of a large medical group, writes powerfully and poignantly about the major role of physician culture - the customs and rituals, traits and beliefs of doctors. This culture is entrenched through years of medical training. He decides that physician culture "can be both a virtuous force and an equally destructive influence" (p70).

Some of that culture is readily on display: attire, tools of the trade, unique medical terminology, insensitive humor, frequent handwashing. Positive aspects of physician culture include self-confidence, integrity, compassion, and selflessness. Negative elements are ingrained to keep emotions and dread at bay: detachment, callousness, denial. This culture of medicine must navigate dual interests - healing (the mission of medicine) and profit (income, status, prestige).

Pearl suggests an evolutionary pathway for physician culture that he dubs "the five C's of Cultural Change" - confront, commit, connect, collaborate, contribute. He tackles issues of sexism, racism, and elitism in American healthcare. He explores the suffering of physicians and their need to seek forgiveness - often secretly and even in cases of perceived "failure" when everything possible was done correctly. His discussion is filled with agonizing, frustrating, and loving stories about patients, family members, and colleagues (including physician suicide).


These are tough times for doctors. Diminished autonomy, an increasing burden of bureaucracy, less time spent with patients than with computers and electronic health record systems, burnout at a rate between 40-50%. And if that is not enough, there is the crushing strain - mental, physical, and emotional - of dealing with a raging COVID-19 pandemic. Physician frustration is cresting. For many doctors nowadays, the profession of medicine began as a calling, grew into a career, and winds up as an overwhelming job. The joy of the work is less and less its own reward.

Here is an instructive, humbling, and cathartic examination of a doctor's experience. Pearl's book unveils the goodness and flaws of physician culture. Not so much a remedy for all that troubles the medical profession as it is a roadmap pointing the way towards professional satisfaction and a meaningful career in medicine. Be warned that the journey remains long and hard and sometimes treacherous.

Primary Source

Uncaring: How the Culture of Medicine Kills Doctors & Patients


Public Affairs

Place Published

New York



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