Failure to Treat with Peter Kowey, MD
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At The Nocturnist, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.
This is The Nocturnist, and I'm Emily Silverman. Today's episode features Dr. Peter Cowie, a cardiologist whose career spans more than five decades and whose latest book asks a difficult question. How did medicine lose its way? Peter entered medicine at a time when doctors made house calls, knew their patients intimately, and relied on bedside skills as much as technology. Over the course of his career, he watched healthcare become increasingly shaped by insurance companies, corporate consolidation, administrative burdens, and financial incentives that often compete with patient care. In our conversation, we talk about his book, Failure to Treat, a collection of fictionalized stories drawn from real experiences across a lifetime in medicine.
We explore what has changed, what has been lost, and why Peter believes the future of medicine still holds reason for optimism if we can find our way back to the human relationships at the center of healing. But first, take a listen to Peter reading from his book, Failure to Treat.
What follows is a series of short stories which were synthesized from hundreds of patient cases in which I participated during my many years of clinical research regulatory and consulting activities. Every story reveals a part of what is wrong with our healthcare system and how patients and healthcare providers are being harmed by obstacles to good care that are frequently generated by greed. As noted in the book's disclaimer, none of these stories come from a particular institution or from any one patient or patient family. In addition, fictional details have been added to preserve anonymity and to make the stories readable and to illustrate important patient care issues. I did not write this book with a hostile or destructive intention.
Neither doctors nor patients have anything to gain from turning medicine into a mushroom cloud. Most healthcare providers are highly principled, well-intentioned people. My own experience as a patient have reinforced my high opinion of providers at all levels. It is a minority of practitioners who have chosen greed over principle and have besmirched the reputation of our profession. But it is their egregious actions that capture the attention of the media. Instead of banishing these villains from our profession, we, their colleagues, compound the scandal by turning a blind eye.
I am sitting here with Dr. Peter Coey. Peter, thank you so much for coming on the show.
I'm very grateful for the opportunity. Thank you.
I loved reading this book, 20 vignettes, human stories that illustrate different facets of the healthcare system, things that are working sometimes in some cases, but mostly things that aren't working. And I want to dive into that in a bit. But first, I was wondering if we could start by talking about the world you came up in. Where are you from? What was it like growing up? And I know in the book, you mentioned a bit about your experience with your pediatrician and sort of community doctors. So talk to us about that era.
How did the practice of medicine change from house calls to corporate hospitals during Dr. Kowey’s career?
Yeah.
Well, I came from parents who never graduated from high school. My father was a truck driver and my mother was a stay-at-home mom. And no one in my family had ever gone to college, let alone professional school. So I was really starting out without really knowing a whole lot about what I was getting myself into. It all turned out fine, but I can't say that I really planned the journey. It was very fortunate. And you're right, I did start the book with some of this background because I think it's important for people to understand that I honestly don't have an ax to grind. I'm really speaking up at the end of my career because I believe that there's still a very large opportunity to make changes to enhance the medical care of people not only in the United States but around the world.
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