A very fascinating insight into the medical profession from a viewpoint that I have not read before. The author does a very good job of braking down part of the book that I really appreciated. Thank you to NetGalley and the publisher for an advanced copy of the book in exchange for a review.

I picked up this ARC several months ago because my wife, who's an MD, had an advance copy and kept sending me screenshots tagged THIS!!!! Also, I'm a frequent flyer as a patient, so I kind of have a ringside seat to the issues as seen from both sides of the EMR screen. When I got the ARC I realized what I should already have known: this was going to be some seriously painful reading. It's not a long book, but it took me months.

Moral injury in healthcare might be most familiar to non-healthcare professionals from the worst days of the pandemic, when it was discussed with respect to the misery of not knowing how to take proper care of desperately ill people. Medical people in general want to help, and when they can't help they feel like failures.

The moral injury described in If I Betray These Words is inflicted by, in a word, capitalism. The for-profit entities that now control a large percentage of hospitals and medical practices and thus employ a large percentage of docs and nurses are far, far more interested in maximizing shareholder profit than they are in making it possible for healthcare workers to help their patients. Docs are allotted 15 or 20 minutes per appointment, and never mind if, for example (like my wife), they're managing cancer pain, which also entails addressing their patients' emotional state and that of their families.

If you're inclined to scoff at the idea that a doc who makes a lot of money might be suffering and deserve compassion, consider this: doctors commit suicide at twice the rate as the general population. For-profit healthcare is why.

I have been fairly fortunate in my doctors and surgeons, for many reasons. (None of which have to do with referrals from my wife, by the way; race and class privilege, education, and living in NYC have everything to do with it.) But I can see those doctors struggling. My neurosurgeon is kind and funny as well as very good at not paralyzing me while he's dicking around next to my spinal cord, but at every visit the initial intake is done by his (also lovely) NP, because docs are set a quota of daily appointments and to meet it they have to break pieces off each one. A third person checks my temperature and blood pressure. A fourth draws blood.

Where If I Betray These Words stumbles is in being liberal rather than radical. The trouble starts with the authors' frequent references to a halcyon past in which doctors could show patients all the kindness and care they wanted to. LOL. For starters, fifty years ago I wouldn't have dared to tell any of my doctors that I'm queer. But also, what a weird obliviousness to the history of medicine as an institution! You know why we don't have universal healthcare in the US? Harry Truman proposed it. The American Medical Association lobbied against it. The AMA won. The AMA also opposed Medicare. And (a little racist icing on this ugly cake), until 1968 the AMA admitted only white doctors.

Another stumble is in the focus exclusively on doctors. In one respect, this makes sense -- the authors are doctors, and some of the sources of moral injury are specific to them. But overall this framing leaves an impression that other HCWs -- nurses, especially -- aren't suffering just as much, being trapped in the same for-profit system.

There you have the whole problem. Dean and Talbot propose a number of improvements to the system: limit consolidation and vertical integration of healthcare systems; "choose our elected officials carefully" (have they not noticed the damage done to voting rights in the past decade?); make insurance more transparent; ditch prior authorization; ease up on documentation requirements. (This last might seem counterintuitive wrt patient safety, but ask yourself how much of your last visit your doctor spent looking at the screen instead of you. Also, be aware that the doc is probably spending at least another full workday's worth of hours on EMR every week besides what you're seeing.)

Well, you can see what's missing. All those proposals are fine, as far as they go, but they're nibbling at the edges. Every single doctor I know socially, and I know a lot of them, wants nothing more than to take good care of people. (Yes, yes, sampling error. Nevertheless.) But as long as our healthcare system functions on the basis of profit, they're not going to fulfill that wish. That's the elephant in the room, and Dean and Talbot describe it in great detail while still, somehow, managing to not quite see it.

Thanks to NetGalley and Steerforth for the ARC.

Such a timely and much needed book on the business of medicine and how administratiors can get in the way of the quality of care provided when profit motive and shareholders' satisfaction are regarded more highly than the patient’s health.

I loved how the issue was presented in the form of a biography, introducing the physicians individually as people who were only trying to do their jobs, getting increasingly frustrated with the status quo and subsequently gaslighted and punished for daring to criticise their employer's ways when they got between them and their oaths to heal. While this book particularly addressed the failings of the US healthcare system, I believe many of those faults apply globally: from overinflated medical bills to dysfunctional health insurance plans, rendering basic care an unaffordable luxury for many. Equally heartbreaking and mind-opening, If I Betray These Words is a must read for anyone who is frustrated with the current state of healthcare.

I received a copy of this in exchange for my honest review. Thank you NetGalley.

I love medical books. I'm always drawn in to these books that have fun or unique patient stories. I love when doctors can show empathy towards patients and put themselves in their shoes as opposed to being condescending or frequently thinking they know our bodies better than we do.

I know their job isn't easy. The schooling, the grueling hours, etc. It must be hard to find a balance. We all know how broken the healthcare system is, but a lot of us don't realize the toll it takes on the doctors as well. This book describes that all well. Interesting and informative.

I received a free copy of, If I Betray These Words, by Wendy Dean, Simon Talbot, from the publisher and Netgalley in exchange for an honest review. It is not an easy profession being a doctor, all the training, med school, al the bills. Some hospitals make it really tough to treat patients, when all they see is profit, when you set a time limit for each patient so you can see as many patients as you can in a day/week/month, use can and may miss diagnosis. A really good read, I enjoyed it, though its a tough subject.

I had been hearing grumblings from some of my doctors for years about there is more focus on record keeping then on patient care.
It wasn't until one of my primary care doctors went into a Direct Care Model on her own, that I really fully understood just how broken doctors were.

The authors do a wonderful job of describing and relating what a "moral injury" is and how it affects doctors.

Everyone in America knows the healthcare system is broken, but this is the first book that explored how DOCTORS are handling the cracks, the demand to keep making profits, and more importantly what can be done to remedy the situation.

I want to thank the authors for pointing out and writing about moral injury and the increasing challenges that doctors are under to keep making money for their 'healthcare' systems.