Mini book review of Robert Pearl's Mistreated

Ruth Ryan ruth at RYAN-GRAHAM.COM
Fri Jun 9 12:28:51 UTC 2017

Mistreated: Why We Think We're Getting Good Health Care -- and Why We're Usually Wrong, Robert Pearl's 2017 book
He's a surgeon and CEO OF Permanente Medical Group.
I've not seen any reviews of this in any medical sites.  It's aimed at the general public and is an easy read, maybe that is why. He explains elegantly such concepts as homeostasis as background for the reader. It's beautifully written.  Some citations are provided, not all.
But Verghese, Gawande, and Rosenthal wrote glowing blurbs for it-good enough for me to buy it.
There's a section pp. 29-44 on diagnostic error and sepsis.  I am interested in this since my liability and case review background has showed me that many deaths have been classified as just people with infections who happened to code and die.  Until recently they were not even identified or categorized as death from septic shock.  Pearl gathers statistics: 1/6 hospital deaths are from sepsis. 210,000 people die of it annually.  Instituting the EGDT protocol cuts mortality 20-40% (true in Rivers study, and in subsequent cases where protocols were instituted institution- and system-wide on an ongoing basis).
About half of US hospital have a sepsis protocol of some sort, one quarter are "working on it", and the other quarter-nothing.  He notes sepsis is an "orphan" disease owned by no particular specialty that takes charge and promotes protocols and has no equivalent Heart Association that sponsors fundraisers and raises awareness. He does an enlightening and thorough discussion of Kahneman/Tversky with respect to this diagnosis and the reasons evidence is not consistently followed in it.
I haven't gotten to his recommendations yet, and he is boundlessly enthusiastic about electronic health record capabilities, while casually noting that many of those capabilities are not actually available or reimbursed yet. This book may be overshadowed by Elizabeth Rosenthal's American Sickness at the moment, but it is well worth the airplane read.

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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