Elephants in the Exam Room


Synopsis from Elephants in The Exam Room

What are the real problems with health care in America today? Are we, as consumers, asking the right questions? Are doctors able to address the issues freely and practice medicine as they were taught to do, without repercussions? Minnesota-based doctor and writer Wayne Liebhard argues that, in order to tackle the very serious and potentially irreparable damage within the “system,” we need to face some hard, cold truths.

Without apology, Liebhard has written a passionate and learned exposition that argues against some popular myths favored by the media, pundits, and professionals alike. Why does health care cost so much? Why do we pay so much for drugs? Why doesn’t my primary-care doctor have more time to spend with me? Why does it take so long to get an appointment with my doctor and why can’t she just treat me over the phone if needed? Why do insurance companies restrict my health care choices? Are we really experiencing a health care “crisis”? Where do agenda-driven politics end, and where does reality begin?

In Elephants in the Exam Room, you will find controversial and often surprising answers–and solutions–from an experienced doctor who has been in the trenches of the health care system for years, as both a committed primary care practitioner and an advocate for change.



Elephants in The Exam Room has won numerous national awards, including being named the winner of the Next Generation Indie Book Awards “Current Events/Social Change” category. The Next Generation Indie program is considered by the book industry to be the “Sundance” of book awards.  


This is an excerpt of a review of ‘Elephants in the Exam Room’, from Karen Coiffi – Ventrice of BookPleasures.com

Elephants in The Exam Room is a powerful book. The author, Dr. Wayne Liebhard, picks apart the American health care system and shows why we are in a health care crisis and what needs to be done about it. What I found extraordinary about this book is that Liebhard not only candidly exposes the problems within America’s health care system, but he also offers realistic and practical solutions. I hope every American reads this book and voices their concern, even outrage, at what’s going on.

“Health care is a very touchy and complicated subject, so let me refer you to what I think is the best treatise I have ever read on this subject: ‘Elephants in the Exam Room,’ by Dr. Wayne Liebhard.”
— Minnesota state representative Michael Beard

“Dr. Liebhard debunks health care myths and demystifies the dangerous doublespeak of today’s health care debate. He points out that terms like “quality,” “evidence-based medicine,” and “pay-for-performance” are drawing physicians into an ethical quagmire that undermines the altruistic, patient-centered heart and soul of medical practice.”
–Twila Brase, RN, PHN, President Citizens’ Council on Health Care

This book is a “must read” for anyone interested in returning control of their health care decisions to consumers and their physicians and away from government regulators and HMO executives. Health care costs can be significantly cut if consumers take responsibility for their lifestyle decisions as well as eliminating the middleman’s “piece of the action.”
–Thomas A. Stolee, M.D. Past President, Minnesota Medical Association

Elephants in the Exam Room has been profiled in several news publications. Here are some excerpts:

The Mess We’re In: A review of “Elephants in The Exam Room” (University of Minnesota medical School Medical Bulletin)


Over the last 40 years, medicine has experienced a radical change in the role of primary care physicians. Once captain of the health care ship, they’re now more like a funnel through which patients pass into the greater health care system.

In his book, Elephants in the Exam Room: The Big Picture Solution to Today’s Health Care ‘Crisis,’ Medical School alumnus Wayne Liebhard, M.D. (Class of 1983), laments these changes and gives us a very personal look at how they affected the vocational life of a suburban Minnesota primary care physician. He begins with an honest description of the emotional pain he experienced when he moved from primary care to urgent care and ends with a quotation from Rousseau that encourages us all to act in concert to direct the forces shaping our world.

Along the way, Liebhard catalogs a common list of concerns with health and health care in the United States (the elephants in the exam room as it were), but a few are worth noting for the hardnosed approach he takes: lack of personal responsibility for health, the high price of prescription medications, and the growth of part-time practice…

This admonition will undoubtedly stimulate controversy and conversation, but in an era in which we are looking to such things as medical homes and accountable care organizations to rescue health care from the mess we are in, Liebhard sounds an important alarm for policymakers that this may be more hominess and accountability than the next generation of physicians is up for.

Reviewed by University of Minnesota Medical School alumnus James Hart, M.D. (Class of 1975). Hart was a general internist in Stillwater and with HealthPartners until 2005 and has been teaching public health at the University of Minnesota since then.


This is a review of ‘Elephants in the Exam Room’ included in the commentary newsletter of former Senator Dave Durenberger, now director of the National Institute of Health Policy


Wayne D. Liebhard, M.D. has been a primary care physician in a small family clinic in a Minneapolis south exurb for more than 20 years since graduating medical school at the University of Minnesota . His bachelor degree in natural and social sciences is from St. John’s University and he has involved himself in many phases of medicine, medical education, and community service. While I was in the U.S. Senate trying to change the practice of medicine by changing the way Medicare finances patient care, Wayne and doctors like him were growing frustrated. First in their efforts to meet patient needs and demands, and then by the changes in the system, in the life styles of practitioners, and the growing emphasis by folks like me in changing practice behavior from the outside in.

The book he has written is in part protest against the changes in medicine and its rewards, in part his view of the real cost-drivers in medical care, and in part a view of the role third parties are playing in removing incentives from family physicians to practice quality care. He nicely sums up the reason that the health crisis is so difficult to understand: “Because everyone has made up his (her) own set of rules by which this game should be played and there is no clear-cut referee. Everyone seems to have their own set of opinions and, unfortunately, their own set of facts. (p. 160)” For those of us who believe that community and family health professionals, not bionic medicine men, are the key to improved access, quality, and cost, this nicely-written plea by a Minnesota doc and friend is a good read.


This is a review comment on ‘Elephants in the Exam Room’, from state representative Mike Beard, in response to a campaign question in the Shakopee Valley News on the high cost of medical care.

Shakopee (Minnesota) Valley News

Article Text:

Incumbent Rep. Michael Beard, R-Shakopee, is being challenged by Sue Bruns, a DFLer from Prior Lake . The district includes the cities of Prior Lake and Shakopee.

Q. Why are health care costs so high? What can or should be done to reduce them?

A. Here is food for thought: health care has been in some crisis mode ever since the Great Society introduced us to the idea that the government should be responsible for paying for our health care. Divorcing consumers … the patients … from the costs associated with their treatment and handing control over to managed-care companies has led us directly to the predicament in which we find ourselves. The only medical procedure I can think of that has gone up in quality and quantity and down in price is Lasik surgery, which, you will note, is not paid for with government dollars or HMO money. Health care is a very touchy and complicated subject, so let me refer you to what I think is the best treatise I have ever read on this subject: “Elephants in the Exam Room” by Dr. Wayne Liebhard (of Prior Lake ).



Read the first 26 pages of Elephants in the Exam Room


Learn More

This book is a unique behind-the-scenes look at what is really happening in health care today as observed by a practicing physician. Read Elephants in the Exam Room to get the real answers to today’s most important health care questions:

1. Why doesn’t our health care policy really address the rising cost of health care?

2. What drives the real cost of expensive health care in the United States?

3. What major factors that influence the cost of health care are purely behavioral?

4. What can we do right now to solve our health care cost “crisis”?

5. Does the “quality” movement really do anything to mitigate the high-and ever increasing-cost of health care?

6. Can a movement toward a single-payor, universal, or nationalized health care system support primary care medicine and effect insurance industry reform?



Dr. Liebhard has discussed Elephants in the Exam Room at multiple book signings (including at the Minnesota Academy of Family Physicians annual meeting) and various other appearances, including policy panels such as the Minnesota Physician Roundtable.  He has also been interviewed in several media outlets, including TV (example: “Voice of Democracy”), radio (examples: Jason Lewis, KTLK-FM; Dave Thompson, KSTP-AM), periodicals (example: Sen. Dave Durenberger NIHP newsletter), and newspapers.


Promotional Materials

Wayne Liebhard – Press Release

Wayne Liebhard – Pitch Letter


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