None of this is a great secret; discerning patients, activists, and even many physicians themselves have recognized this for a long time in the US. But its Dr Jauhar’s astonishing candor in `Doctored: The Disillusionment of an American Physician‘ that has shocked the medical fraternity and layman alike, shattering the image of the doctor as a do-gooder -and for Indians, that of the NRI physician as the epitome of nobility . No one comes out looking good in this tortured, self-lacerating book: not Jauhar himself, nor his brother (also a cardiologist), nor physician friends and mentors, and not the American system. This is the Ferguson moment in medicine -ugly but true.
Asked in an interview on Thursday if he intended to stay on in the medical profession at all, given the shock and horror his book is creating (the NYT reviewer said this is the first book that’s prompted her to write “Yuck!“ in the margin), Dr Jauhar said he owed it to his readers to give them the unvarnished, unfiltered truth, without being irresponsible.“Probably the person who comes in most for criticism is myself. When you are willing to be self-critical, people will appreciate it,“ he told me gravely , after initial jokes about his taking potshots at his own family , including his father, subsided. “I am disillusioned with how medicine is practiced in this country but not disillusioned with being a physician.“
Jauhar’s sulfurous chronicle of the medical profession in the US begins almost as soon after he graduates from fellowship and takes a salaried job at a hospital (after 19 years of college education, including a Ph D in physics).The hours are brutal, the money is meager, and before long he becomes part of the venal system, treading dodgy ethical terrain to keep his body , soul, and family together. He moonlights on other jobs and shills for pharma companies as he observes compromises, cronyism, and corruption flow like crud through the system. Doctors, hospital administrators, the health insurance sector, and pharma industry collude and conspire in sundry ways to rip-off patients -some who want to live forever despite being at their careless best.
The dysfunction is not entirely due to doctors. Jauhar describes how external sources -the government, the insurance industry , and pharma companies -have all played a role.Doctors, particularly primary care physicians and internists, who previously spent 20-30 minutes with each patient, now hurry out after 10 minutes because they now have to see twice the number of patients to generate the same revenue. As a result, patients do not get the attention they deserve and are not diagnosed properly . Meanwhile, some specialist doctors get to bilk the system (which is why everyone wants to specialize and there are fewer primary care doctors in the US), prescribing a multitude of tests and treatment -some to cover for malpractice liability, others to generate more revenue. Patients who came in complaining of even routine breathlessness are hustled into taking nuclear stress tests and bumped into cardiac procedures. That’s because insurance companies don’t pay doctors to spend time with patients trying to understand their problem. But they pay for CT scans and stress tests whether they’re needed or not.
Elsewhere, hospital administrators are also constantly putting pressure on doctors to keep occupancy rates high enough to generate profits (somewhat like hotels). Jauhar cites the economist Julian Le Grand‘s idea of humans as knights, knaves, or pawns, to describe how the American system promotes knavery over knighthood. The chapter headings in his book says it all, going from “Learning Curve“ and “Good Intentions“ to “Denial“ and “Deception,“ before he takes a “Diversion“ and becomes “A Country Husband“ -leaving New York City for suburbia and greater attention to his family and children, instead of running on the treadmill of practicing soulless medicine. It is an unfinished story , in part because Jauhar is still on the margins of the system, even though he is “an outlier“ as a fellow Indian-American physician, gastro-enter ologist L Chandrashekhar describes him.
The book, he says, should serve as a warn ing to India, where some physicians are already on the hook put out by American companies, with paid trips to Las Vegas and Disneyland (under the cover of invitation to conferences) for hawking expensive and often unnecessary surgeries and treatments -from stents to hip and knee replacements.
But most of all, once you read this tormented, self-lacerating book, it’s hard to see a doctor with the same respect. Doctors know it too. In a survey cited by Jauhar, 30 to 40% of US physicians today say they will not choose the same profession if they had a choice; and even more would not encourage their children to. The medical profession, it appears, is terminally ill, in the United States at least.