Picture of Jason KinninJason Kinnin
Memorial University of Newfoundland
Class of 2018

How We Do Harm: A Doctor Breaks Rank About Being Sick in America by Otis Webb Brawley, M.D., with Paul Goldberg. St. Martin’s Griffith; US, October 2012.

This book is a non-fictional account written by Otis Webb Brawley, who is the chief medical officer and vice president of the American Cancer Society. In this book, Brawley revisits his past cases and experiences from his childhood up until the present day. His descriptions point out  many faults in the American health care system. Specifically, Brawley makes the point that sometimes doctors do harm rather than good, whether this is intentional or not. The problems that he brings into focus relate to the care that citizens without health insurance are forced to receive, as well as the corruption of several doctors that take advantage of those patients who do have health insurance. Additionally, Brawley proposes some ways to try and repair a broken health care system.

The book visits many locations across America, but  starts off at the Grady Memorial Hospital in Atlanta, Georgia. Although the patients who come to Grady without insurance wait an exceptionally long time to be seen and are not given access to the newest forms of treatments, Dr. Brawley argues that, in comparison to insured patients, these patients may be receiving care from better, more honest, doctors. Dr. Brawley argues that the salaried doctors at Grady (Dr. Brawley himself is one of them) know they are treating patients who cannot pay. Patients with health insurance, and more money, see doctors who are fee-for-service and seem to not  have their patients’ best interests in mind. Brawley cites many examples of cases where doctors prescribed treatments to patients either when it was not necessary, or when a safer treatment was available, just because it would earn them more money. The unfortunate result of these incidents was a decrease in the quality of life, if not death, of some patients.

Although he gives many examples of doctors acting in despicable ways, Dr. Brawley also provides some examples of excellent doctors who treat all patients as they should be treated – with evidence-based medicine. This is the type of medicine that Dr. Brawley himself practices; in his practice, he looks at  current research and informs his patients of  the risks and benefits of every possible treatment. Dr. Brawley argues that  corrupt doctors who are driven by greed prescribe the newest and most expensive drugs, while keeping patients in the dark about their treatment, regardless of whether these drugs are ineffective or unsafe.

Otis Webb Brawley makes a desperate cry for a complete overhaul of a corrupt medical system which is harming patients more than healing them. However, he is not optimistic about the possibility of a reform, as he states that the health care system is trending downhill. He attributes this to a lack of patient knowledge about current medical research, patients’ desire to seek out treatment for every illness, the evolution of technology, and the powerful advertising of pharmaceutical companies. Thankfully, he does provide some hope by giving examples of groups of patients who have come together to educate other patients on how to play an informed role in their own health care. It seems that he is trying to point out the fact that, if the system is to be fixed, it must start from the ground up, with the patients themselves.

This book has many positive features. It is easy to read and  keeps the reader engaged by constantly introducing new stories and characters. It also appeals to all audiences. There is enough explanation and accessible language that a non-medical individual can understand Brawley’s writing. However, scientific detail and intricacies about the health care system enable health care professionals to  enjoy the book as well. Personally, I really enjoy the way Brawley introduces every one of his characters by providing the reader with some background information about their lives. This makes it enjoyable when he makes reference back to these characters later on in the book. Finally, thanks to his use of pseudonyms, Brawley  is able to write about many interesting, controversial, and private cases while still maintaining patient confidentiality and anonymity. This allows the reader to learn about some of the hidden flaws and secrets of the health care system.

However, there are  also some negative features about this book. For example, I find Brawley’s writing hard to follow at times, as he jumps back and forth from his childhood, his time in medical school, and his early and late professional life. The timeline does not follow a chronological order. Finally, this book is extremely American-centric; consequently, it can be confusing for those not familiar with that particular health care system.

Despite the fact that this book is tailored towards an American audience, it still has value to other readers as well. By reading this book, patients may make the effort to be more informed about their own health care and to ask their doctors questions that may prevent themselves from being harmed by the system. However, one must also consider whether or not all patients would have equal access to this book, and whether accessibility to this work would further demonstrate the consequence of the socioeconomic divide that Otis Webb Brawley is speaking about.

I would also recommend this book to health care students and professionals because it may alert them to see flaws in their own healthcare system. This book will hopefully encourage individuals to try and do something to change the system for the better and  discourage others from abusing the system and causing their patients harm.