I had high hopes for Doctored, Sandeep Jauhar’s “memoir-expose” about the American health care system. I was hoping for an insightful look at medicine in America with thoughts about what works and what could be done better. Sadly, I was disappointed.
Jauhar’s memoir is primarily about his experience working as a cardiologist on Long Island. He is shocked by the financial and business practices he sees around him in the other doctors and hospital. He feels pressured to see more patients and make money and realizes that much of the system has become corrupt and focused on making money rather than on truly caring for patients. At the same time, Jauhar is feeling financial pressures at home with the expense of raising a young family in NYC. He finds himself compromising his ideals and then hating himself for it.
I think many readers are going to find Jauhar more than a little whiny and annoying. It’s hard to relate to a physician who is complaining about never having enough money. Jauhar and his wife make many choices that they feel put them in a financial bind but they take a LONG time to accept that it’s their own choices more than the American health care system that is the problem. (They want to live in Manhattan. They insist on sending their kids to a private preschool. Jauhar’s wife, a physician also, chooses not to work in order to care for the kids.) The reader will have figured out 100 pages before they do what the solutions to their crisis are. Jauhar also comes across as a man faced with growing up and not liking it. There is a lot of angst about youthful ideals vs. middle age pragmatism. There are a lot of references to vague spiritual searching. Many of his issues seem to stem as much from familial expectations and pressures (competition in a traditional Indian-American family with an older golden-child brother for example) as with the health care system.
My main disappointment, however, was in what Jauhar left unsaid about being a doctor in America today. He talks a lot about the unsavory practices of private practice physicians (and clearly has a bias towards academics which he views as somehow more pure). Much of what he said wasn’t my experience. However, pediatric medicine is very different than adult medicine so I may just not see what he sees. More interesting to me would have ben an issue he touches on only briefly: what does it mean to be a good doctor.
I think most doctors go to medical school with some idea of wanting to help people and we come out of the training process with some idea of what being a good doctor means. It means healing people, getting the right diagnosis, listening to your patients, caring for them. It means practicing excellent medicine, reading up on current therapies, practicing evidence-based medicine instead of just doing what you’ve always done.
I’ve been in practice for 15 years and I find that it’s so much harder than I thought to figure out how to actually do all those things in real practice. Patients often want things that I think are bad medicine. Antibiotics for colds. Unnecessary lab testing. Referrals for unproved treatments. Do I do it and keep them happy? Does a happy patient equal a good doctor even if the medicine being practiced is questionable? I’m sure doctors through history have struggled with these issues but I feel like today the added pressures of self-diagnosis by Google, doctor rating sites on the Internet, Minute Clinics in pharmacies that will almost always give the medicine the patients want, and insurance companies who are monitoring referral and testing and prescriptions makes it even more difficult to know by what standards we should measure ourselves.
Jauhar talks a bit in his book about factors that cause dissatisfaction in work. I think a large source of dissatisfaction is not knowing how to know if you are doing a good job. And today it’s hard for a doctor to know by whose standards to grade themselves (and if anyone has been trained over time to care about grades and standards it’s a doctor who has been through 20+ years of schooling). Should I care that I am performing well on the insurance company’s annual report? The local hospital’s report card (yes, we get them)? My patient satisfaction level on an Internet site? How closely my practice follows the guidelines of my specialty? I don’t think any of those are good ways. I tend to measure myself by an internal barometer of sorts: Am I satisfied that I did the right thing even if the patient is unhappy? If the patient and I don’t agree on a plan, is there a way to compromise to find a solution? Do my patients respect me even if they don’t always agree with me? Have I truly listened to each person? Have I tried my best to have them walk away feeling somehow healed, even if that doesn’t mean cured?
I think that it would do my profession good to talk about these issues more. Unfortunately, Doctored is not the start of this discussion.