An Uneasy Exploration of Modern American Medicine in “Doctored”

The state of medicine in America today leaves something to be desired, whether you’re a patient or a physician. In his eye-opening second book, Doctored: The Disillusionment of an American Physician, Dr. Sandeep Jauhar, a cardiologist and heart failure specialist, details the way things stand, explains how we got here, and describes what it means to be a doctor in today’s medical landscape.

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In Jauhar’s first book, Intern, he explored his own journey into medicine and those first tough years in residency, when sleeplessness and overwork were common. This book takes a mid-life look at both his development as a doctor and the evolution of American medicine.

Over the last five decades, the practice of medicine here in the U.S. has changed considerably. Jauhar’s historical explanation of how we went from private fee-for-service practice, where doctors charged patients what they could afford, to our earliest instances of health insurance, to the introduction of Medicare in 1965 was fascinating. Medicare reimbursements changed medicine in unanticipated ways, and health management organizations (HMOs) were introduced in the early 1970s to (in theory) help keep costs under control.

As the system has developed from there, a confluence of factors has made it difficult for the doctor of today to really know you and have a relationship with you. First, there are the unintended consequences of the reimbursement system. And second, doctors understandably fear being sued for malpractice and must shoulder the necessary cost of expensive malpractice insurance.

What this creates, then, is a situation where doctors need to see as many patients as possible, and will be more inclined to order tests and procedures to both cover their own liability in case of a misdiagnosis and to be paid for those tests via reimbursement. In the early years of Medicare, many doctors’ salaries soared, but that trend has reversed for most physicians, thanks to reimbursement cuts and increased costs of practice. Another wrinkle here is that doctors’ salaries are linked to how much revenue they generate for the hospital, which can create misaligned incentives between good patient care and billing. For Jauhar, a hospital employee, this link isn’t as direct as it would be were he in private practice, but it’s still a consideration.

This book is an uneasy inside look at the many challenges doctors today must contend with. I’d recommend it for anyone thinking about going to medical school, as well as anyone interested in why our system is as it is currently. Jauhar is a smart, compassionate, and worthy guide.

(Originally published here: http://msbusiness.com/2015/10/louann-lofton-a-complicated-look-at-modern-american-medicine/)

Books: On Intern: A Doctor’s Initiation

True story. When I was little, I decided I wanted to be one of three possible things when I grew up: a writer, a stand-up comedian, or a doctor. Luckily and happily, I’ve managed to make the first one happen. Not sure what I was even thinking with that second one — maybe too much early exposure to Richard Pryor and Eddie Murphy?

As for the last, I think I actually might have made a good doctor, but life had other plans. I had severe asthma as a kid growing up in south Mississippi. I was in the hospital at least twice a year and I loved being around the doctors and nurses. They made me feel safe. I knew I would feel better, thanks to them. And my pharmacist father had taught our family doctor high school chemistry (in my dad’s pre-pharmacy days), so that was a very familiar relationship. I looked up to Dr. Burris and respected him.

Looking back on it now, he displayed so much patience and kindness with our family — my dad would call him at all hours about me and my also-asthmatic sister and sometimes we’d end up at the doctor’s house at 3am, sitting and wheezing at his kitchen table while he decided whether we needed to be admitted to the hospital. The beauty of small-town life, I guess. (To be fair, my father also opened his drugstore at all hours of the day and night to help people in our community get the medicine they needed — often not charging them for it. But those acts of kindness deserve their own separate post.)

So, despite not becoming a doctor myself, I’m still drawn to reading about it. And talking about it. And thinking about it. I’m simply fascinated. Heaven help you if you’re my friend and also a doctor — I have so many questions for you! But all from a place of deep admiration.

And with that introduction as background, here’s my write-up of the excellent book Intern: A Doctor’s Initiation for the Mississippi Business Journal:

Cardiologist Sandeep Jauhar’s memoir, Intern, about his residency at a New York City hospital is a touching, honest account of the difficulties young doctors face when they leave medical school and attempt to become practicing physicians. In particular, the first year of residency, known as internship, is legendarily grueling and the learning curve steep. Even those of us not in the medical field have likely heard about the all-nighters, the exhaustion, and the overwork. After reading Jauhar’s book, this view doesn’t seem to be an exaggeration.

In addition to making his readers feel like we’re right alongside him in the hospital late at night with blurry eyes and twitchy nerves, Jauhar’s book is also interesting because of his own unique path to becoming a doctor. Unlike many of his fellow interns (as well as his older brother), who’d wanted to be doctors for their entire lives, Jauhar majored in physics in college, was working towards a PhD in that field, and had always wanted to be just about anything but a doctor. A change of heart drove him to switch from physics to medicine.

During his internship, however, self-doubt about his decision arises repeatedly. His candidness about this ongoing ambivalence towards his chosen profession and his understandable worries that maybe he’s just not cut out to be a doctor make his story so relatable. And they underscore how emotionally draining that first year of residency is.

Jauhar also struggles with how to balance the need to be efficient and decisive when it comes to treating patients and his desire to have an emotional connection to them. He wants to be a good doctor, but he also wants to be a good person, and he discovers that those two goals are often at odds. Some of this is related to the sheer workload and the very real time constraints interns are faced with, and some of it, as he notices with older residents, appears to be a coping mechanism. Doctors see so much pain and encounter so many awful stories that some of them have to resort to dark humor about their patients or, worse, a callousness that Jauhar wants no part of. He promises himself that he’ll become a different sort of doctor.

Reading this book deepened my appreciation for doctors, their hard work, and the complicated choices they’re often faced with. I also empathized even more with my friends who’ve become doctors. Of course, I’d heard about their sleepless nights, but this book gave me whole new insights into the relentless nature that’s required to become a physician.

(Originally published — without the introduction about my childhood choices of profession — here: http://msbusiness.com/blog/2014/12/12/louann-lofton-story-physicians-early-years-inspiring/)