La rebelión de los pacientes describe qué aspectos de la medicina actual, excesivamente industrializada, no resultan adecuados. Nos muestra cómo la práctica médica se ha corrompido como tal, alejándose de su misión, que no es otra que cuidar al paciente. El doctor Montori, médico en la Clínica Mayo, rescata el lenguaje del cuidado y propone una revolución basada en la compasión y la solidaridad, en conversaciones sin prisa entre médico y pacientes, y en una atención más cuidadosa y gentil. Este libro interpela al lector y constituye una llamada a la acción en el ámbito de la atención sanitaria para cambiar la deriva de las prácticas médicas. En 2016 el doctor Montori fundó The Patient Revolution, una organización sin ánimo de lucro para llevar a la acción las ideas propuestas en este libro. Las ventas de La rebelión de los pacientes financian esta labor. Más información en patientrevolution.org.
Victor Montori, MD, MSc (Lima, 1970-), works at the Mayo Clinic in Minnesota (U.S.) as a diabetes doctor. He graduated medical school in his hometown of Lima, Perú, and completed postgraduate training at Mayo Clinic in the U.S. and at McMaster University in Canada. Considered "a patient's doctor,", Montori received the Karis Award, a patient-nominated recognition for his compassionate care.
A researcher in the science of patient-centered care, Montori and his colleagues have authored over 600 research articles. At 39, he was promoted to professor of medicine. Today, Victor is one of the most cited clinical researchers in the world.
In 2016, Victor founded The Patient Revolution, a nonprofit organization to advance careful and kind patient care for all.
montori's description of the weaknesses of the american healthcare system are perceptive, although with the exception of his insights on the burden of being a patient he doesn't break a lot of new ground. his phrase "industrial healthcare", though, is evocative, effective and should be widely used by those who share montori's critique. if you want a quick accounting of the failures of our healthcare system, this book would be a good start.
his strategy for addressing these failures, though, is less persuasive. industrial healthcare isn't an exception to our more broadly accepted societal norms. industrial healthcare, rather, is a reflection of those norms — market-based norms (and underlying assumptions of individuality, meritocracy, etc.) are used as a justification to bend the interests of the many to those of the powerful in nearly every social context. if we're to revolt, we don't need a narrow revolt of patients against industrial healthcare, we need a broad-based people revolt of people against unfair and ineffective power structures. and while its impossible to argue with improving doctor-patient conversation, developing deeper relationships and understanding people better — the idea that montori's approach is widely applicable or that it would have the broad-based benefits that he implies, is vastly less certain. it'd be wonderful if medicine were predicated on developing closer and more effective relationships with patients, but the lack of those relationships is far from the only factor driving the failures of our industrial healthcare system. and, whether we have the
Many people are more and more optimistic about the state of medicine, in our time, and for many good reasons, the state of healthcare itself seems to be grim. As medicine is being industrialized and run as a business to generate astronomical revenues, the main element at the center of it all bears most of the suffering: the patient. From the greed of pharmaceutical companies to insurance and medical device companies to others, the financial burdens have never been highest on patients. The other central element at play is also suffering: the physicians. The sheer pressure for billing, documentation, and administrative tasks placed on their plates is dangerously taking away critical focus and time that is much more necessary to spend with patients. As Dr. Montori always says "The care is no longer in healthcare!". I have heard Victor give many talks about many of the ideas he wrote about in this book, and his enthusiasm is contagious and you can feel the pain he is feeling for the current state of affairs in healthcare. This book accurately reflects that as well as his burning desire to bring patient into focus with "high definition" in the eyes of not only their physicians, but also the healthcare systems themselves. A strong call for a Patient Revolution is indeed what we all need. I cannot recommend this book highly enough for all.
A cri de coeur from a well known internist at the Mayo Clinic. Montori provides a series of essays and stories to illustrate the dark side of 'industrial medicine'. The points made are not new, but the passion is. While the intent is good, references to revolution, solidarity and comrades will not serve to entice those even a bit to the right of center, to join his crusade.
This was actually beautifully written in parts, further emphasizing the sentiments Montori is raising. Although I’m already a convert, I’m also a natural cynic, sensitive to Pollyanna oversimplifications. It was with great relief to find little of that here. I am intrigued by the tools offered at https://patientrevolution.org.
This book is phenomenal. Dr. Montori's explanations are spot on, and I literally said "yes" out loud while on a walk around the neighborhood listening to the audiobook when he made the brilliant point that the reason medical charlatans are so successful is because they actually make patients feel heard and they listen to them, versus our regular medical providers that are rushed and can be prone to just following formulaic things.
Of course there are great providers out there, and I've gone to several and have worked with many, but ultimately the system itself is broken and in need of an overhaul. It's why so many great physicians and providers are burning out and getting out of the system. The current model isn't working, and in less than 200 pages Dr. Montori clearly and concisely demonstrates why.
Full disclosure: This was recommended by someone in one of our work Teams channels, as it is written by a colleague (but not anyone I've ever met, so thus my review is 100% honest because I will likely never come across the author IRL because I work remotely in another state in a totally different area of a 70,000+ person organization).
"Todo clínico que entienda su deber debe tener claro que son los clínicos los que tienen el privilegio de poder estar junto al paciente, los que deben sentirse honrados de poder tratar a cada persona, de merecer su confianza, y de estar al lado del paciente cuando se enfrenta a su infortunio." (66)
Soy médico general, ejercí la profesión en Colombia y hoy me encuentro en Chile haciendo lo mismo. He sido galeno desde hace unos escasos tres años, sin embargo, ha sido un tema recurrente la practica médica diaria a la que me veo expuesto: la explotación laboral, bajos salarios, escasez en los tiempos de consulta y la alta demanda habilidades para los profesionales en mi área, la medicina general. Estos conflictos me han llevado a cuestionarme mi vocación y la voluntad de continuar educándome en la carrera; perseguir una especialidad o un mayor grado académico.
Este libro sintetiza a cabalidad todas mis inquietudes con el ejercicio ,y tal vez, la génesis del problema: la industrialización de la medicina. Es posible que hayamos llegado hasta el punto que todo el ejercicio de la medicina gira en torno a la industria que se encuentra detrás de los hospitales, clínicas, batas blancas y pacientes. La medicina como practica responde a las insaciables necesidades de una sistema que alimenta a un mercado de consumo e intenta deslumbrar con avances tecnológicos a los pacientes mientras socaba el cuidado a costa de la gentileza y elegancia que caracterizaba la presentación de los servicio en salud. El Dr. Montori aborda el agonizante problema de la medicina centrada en el cuidado del paciente y propone un revolución para volver a eso, un giro paulatino pero inevitable de cómo se concibe la medicina en el presente.
La practica médica basada en la industria es inviable y poco efectiva. La medicina basada en el paciente y su cuidado, promueve el mejoramiento de la relación médico-paciente, además estimula el empoderamiento del este hacia su situación y agudiza la mirada del médico para ver más allá de los exámenes de laboratorios y pruebas costosas. Aunque el libro no aborda el método por cual se llegará al resultado final de la tesis de Montori, sí deja escritas las ideas por las cuales se pueden considerar un curso distinto en cómo ejercemos la medicina, donde el doctor no es el único participante, pero sí la industria, todos los profesionales, técnicos y asociados al sector salud, y por supuesto, el paciente.
Montori no aconseja dar la espalda a la tecnología, o avances científicos, todo lo contrario, propone una tregua, un cambio de mirada, una meta a la que se puede llegar de la mano con el paciente, la medicina basada en la evidencia, la elegancia y gentileza.
Parecería que cada vez que acabo un libro esto fuese una aventura épica a describir. Nada más lejos de la realidad. Me gusta guardar también como llegó a mi.
Cómo esos libros que alguna vez me regalaron sin haberse leído, o como otros que por alfuna razón decidí que tenía que leer, después de una ponencia de Victor Montori en las últimas Jornadas REDISSEC, decidí pedir en un arrebato este libro, que se tiró todo un 2022 en mi mesita de noche sin ayudarme a completar en reto GoodReads del año. o Simplemente estaba poco motivado pero al terminarlo ahora me alegro mucho de haber tenido ese arrebato.
Estoy sentado en la Sala de Espera de Salidas del aeropuerto de San Jose de Costa Rica. en un trayecto de cinco horas en bus para recoger a migas para seguir esta aventura, he finalizado lo que es el fiel reflejo del estado actual de la Medicina de Atención Familiar y Comunitaria y la esencia de su importancia en su liderazgo y eje vertebrador del sistema.
Con una lectura que huye de tecnicismos pero al más alto nivel, Montori sintetiza de una forma corta, amena, basadas en preguntas e historias lo que la medicina no Eficiente sino Elegante tiene que permitir para CUIDAR de verdad a nuestroa pacientes. Un alegato de lectura obligatoria que se aleja el foco de la medicina fantástica industrializada para ponerlo en la importancia "del cuidar" bailando con sus verdaderos protagonistas.
Este libro va a formar parte de la bibligrafía de Introducción a la Medicina de mis estudiantes del grado de Medicina, y puede que algunantarea también.
Why We Revolt is not a manifesto of anger, but a quiet, courageous insistence on humanity.
Through brief, reflective essays, Victor Montori exposes how modern healthcare has drifted away from care itself, how efficiency, metrics, protocols, and industrial logic have crowded out listening, presence, and compassion. What makes this book powerful is not outrage, but clarity: Montori does not vilify individuals, but illuminates the system that dehumanizes both patients and clinicians.
The writing is restrained, elegant, and deeply humane. Each essay functions like a small mirror, asking the reader, whether patient, clinician, or policymaker, to notice what has been normalized and to gently question whether it should be.
What truly distinguishes this book is its moral tone. It does not demand a revolution of violence or disruption, but of conscience, conversation, and care. The “revolt” Montori calls for is one of solidarity, slowness, attention, and dignity, values that feel radical only because they have been so thoroughly displaced.
This is a book that leaves you changed not because it tells you what to do, but because it reminds you what matters. It restores language, purpose, and moral grounding to healthcare at a time when all three are under threat.
Why We Revolt is essential reading for anyone who has ever felt unseen in a hospital room, unheard in a clinic, or quietly uneasy about what medicine has become.
El autor propone una revolución en la cual se le dé prioridad al cuidado (care) de los pacientes y no al dinero. Habla de un cuidado en el cual los profesionales de la medicina puedan ver al paciente como un ser humano con una vida, un trabajo, preocupaciones, etc. y cómo ese cuidado debe ser compatible con todas estas dimensiones del paciente. Me gustó mucho todo lo que el autor habla acerca de cómo debe ser la relación entre el médico y el paciente. Y cómo el valor de la integridad debe guiar el actuar de los profesionales de la salud. Ojalá algún día esa revolución que él propone se haga realidad y todas las personas tengamos acceso a un sistema de salud más humano en el que recibamos el cuidado que realmente necesitamos, así no dispongamos de los medios económicos para pagarlo.
While this could get a bit repetitive, the reason that I rated this so highly is because it's powerful food for thought and it's a book that I've brought out several times in conversation. Anytime that I book makes me think differently, that's automatically at least a star.
In general, this book advocates for Careful and Kind care. It provided a lot of different possible motivations for the current corruption we see in the healthcare industry. And, gave me a lot of questions so successful. I also really appreciated the 2nd edition because it addressed the COVID pandemic and how we were able to respond.
Dr Montori, thank you for sharing these words. This book is a call to action. It offers poignant, purposeful glimpses of clinician and patient encounters that are forcefully narrowed by power or money [fear, greed] - it catches the reader's breath when recognition sets in. Conversely, when we see moments of careful and kind care, the resonance stills the quandary and reminds us that we are instruments of meaningful change, one moment by one purposeful moment. I'm inspired and grateful to have read this work - I hope more is coming!
Victor Montori raises a lot of good points about what is wrong with health care in the US. In fact, he is spot on most of the time. The question is; what to do with it. Yes, we can all revolt, but how? Change in the arena is going to be slow, and ultimately will have to involve very controversial political solutions.... I would have enjoyed the book more if there was more practical advice about how to effect the change.
Some interesting info about our healthcare system, but no strategy for what to do about it I agree with Victor Montori that our U.S. healthcare system/insurance is broken and does not serve the people who need healthcare. Reading an entire book that states and restates and restates this premise was a waste of time. I was hoping to have some strategy presented on what could be done about the problem, but no advice or proposals were presented.
Not especially well-written, but tells the truth about the health care industry, emphasis on “industry,” including the false security of “evidence-based practice.” I would have liked more thoughts on how to navigate this industry as a patient, and how we can, as “consumers,” evoke some immediate change for ourselves and those we love.
This book made me think. There's much in it to reflect on - it helped me think more deeply about my patients' experiences and about my own. However, the author's approach and final diagnosis of the problems in medicine are very much embedded in his US context and may limit it relevance to other settings, such as my own.
I have read this book twice and each time it re-energizes me to help improve patient-centered care. The book is beautifully written and the stories are impactful. Thank you for your dedication to patients and their families. The Patient Revolution is here!
Thoughtful polemic/critique of "industrial healthcare"--on the mark in many ways. We're too driven by profit, even those of us in nominal non-profit organizations. We measure what's easy to measure rather than what matters.
Loved this! Really appreciated the authors experiences and observations around how our current system does not do our patients or providers justice. He offers alternative scenarios and empowers patients to demand more of the system.
I enjoyed this book and there are many commonalities of experience between the US and the UK (where I work as a family doctor) to justify the read. It's written in an accessible and not academic way (no references at the end of this book). Victor Montori mixes anecdote and experience effectively with experience he has built up working in different health care settings from his native Peru to US, where he now works at the prestigious Mayo Clinic. He often vividly conjures the emotions and play-offs that we have to navigate daily trying to do the best we can. He correctly places at the foreground of our attention the hard work involved in being a patient - often for a very limited return (especially in avoiding the complications of diabetes using medicines rather than "lifestyle" changes) - as compared with the challenges faced by doctors or other health care workers.
The highly bureaucratised and compartmentalised experience of being a patient, particularly with diabetes, presents common themes and challenges for health care worker and patient alike wherever they may be: what treatments should I take, what's important to me, how can we make the time we, the patient and the doctor, together helpful. Dr Montori's advocacy of a more humane health care system with patients and doctors working alongside one another as co-producers of health is one many of us would share. I was less clear about how he thinks we are going to get there and how relevant a US view on this is. The British NHS, where I work, which has moved a long way from being an organisation that relies on the "gift relationship" with little bureaucracy to underpin its work, (the prevailing form until the systemic organisational changes brought in during the 1980s and onward) to the more bureaucratised and compartmentalised service built around contracts and targets at all levels that exists today. However, we do not (thank God) face the challenges that US colleagues and patients experience. Over here all are covered with everyone having a personal family doctor, prescriptions are capped and for most people with chronic disease, free. We have access problems which sound pretty much the same as ours. Some of Dr Montori's battle cries can seem a little forlorn when confronted by a president and ruling cabal who would view his ideas as antithetical to their world view. Having said that, things must change, for all of us, and this humane vision of how health care should prioritise people and not profitability, is part of the way a generation of doctors and other health care workers will be inspired to create something different - even if that looks like a receding prospect at the moment.
I don't read this type of book much. Novels are my jam. Literary fiction is the place I like to visit in books. But once I peeked in the pages of Why We Revolt, I just kept reading. It's poetic and urgent at the same time.
This book is a collection of moving essays, written from personal experience within the confines of industrialized healthcare. Regardless of where you live in the world, of where you deliver or receive your care, the corruption of contemporary healthcare is affecting you. With compassion and passion, Victor Montori shares how working within the confines has made giving careful kind care a challenge for him, personally. He exposes ways our streamlined healthcare, meant for patients like you rather than you, is disconnecting us from caring. It is hurting our ability to become holistically healthy. However, one of the things I loved about reading Why We Revolt, is Montori builds every story around a vision of – and belief in – effective and kind care.
For a book that consistently reveals and reminds us of the harm being caused in healthcare systems around the world right this moment, it is surprisingly lovely to read. Rather than display anger and provoke readers to feel hate and blame, it excites us with possibilities and envisions a different system that is built of love for humanity and honest science. This book is careful and kind itself.
Why We Revolt explains with clarity so much of what is wrong with healthcare today, putting clear words to what most of us suspect even when we can't clearly state it. Through the stories and insights, it connects us; caregivers and care receivers – reminding us to fan the flame of noticing each other in order to know how to help each other.
I’m a rare disease patient advocate and was left unimpressed. Maybe it was because a physician was the one sharing his thoughts for hoping to make my experience in the clinic “better?” The patient’s perspective was plainly absent.
The essays in Why We Revolt were hardly revolutionary. The patient scenarios were powerful, but Dr. Montori’s thoughts read as though he and his colleagues are overworked and tired with EMRs. The innovative breadth of the healthcare industry - perhaps the very thing that saves lives for the critically ill - is made to be a villain, for no reason other than Dr. Montori’s distrust of his own industry. Montori misses the most crucial part of the patient’s view of healthcare hierarchy: expertise is not implied for patients, but is for physicians. He discusses some of his research and the power of his world leading medical facility, but beyond that speaks as though his standing in medical academia is reason enough to believe him. For this patient: it’s not.
Libro mordaz respecto a la sanidad y su funcionamiento. Una medicina industrializada que ignora el paciente, lo cuida solo por accidente y con frecuencia es cruel.
Lo que más me sorprende es que esté escrito por un médico, el cual pone en evidiencia los malos procesos, las inversiones en equipamiento que no hacen falta pero que con ello se enriquecen médicos, validaciones de medicamentos que no son correctos, ganancias de bonus en altas esferas dadas por farmaceúticas, gestores que no saben ser gestores pero lo son por ser médicos.