Doctored: The Disillusionment of an American Physician

In the 1971 movie, "The Hospital", one of the supporting characters was an enterprising and mercenary doctor called, "Dr Welbeck". He was played by the wonderful actor, Richard Dysart, who turned his portrayal of the venal and uncaring "Dr Welbeck" into almost a caricature of the greedy doctors we're used to seeing lately. "Welbeck" was supposed to be the anti-Dr Marcus Welby, the saintly TV doctor of the 1960's. "Welbeck" got his comeuppance when his medical/business partner ran off to a Caribbean island with the proceeds of their joint medical practice. He died of a heart attack - richly deserved.I'm staring off my review of Dr Sandeep Jauhar's memoir "Doctored" with the story of "Dr Welbeck" because the practice of medicine today is closer to "Dr Welbeck" than "Dr Welby". Gone are the days of house calls. Today's medicine seems to be practiced closer to a business model than a medical one. Patients who come into the hospital system or into private practices seem to be inundated with "tests". Expensive, often-not-needed-by-the-patient tests but tests needed to enhance the bottom line of the doctors' practices and hospitals. And, in some cases, tests to ward off accusations of malpractice if the patient goes south; did Dr So-and-so really do all he could to help/cure/save, etc?Dr Jauhar's second book - his first was "Intern" - is part memoir and part business and societal "cri de coeur". Jauhar is a cardiologist and is proud of his work. He grew up in a family of doctors (except his father, who was a scientist) and he knew he wanted to "help others". But in the years since his internship, he realised that the economics of the practice of medicine was against him and most other doctors. The cost of malpractice insurance and the costs of maintaining a private practice are becoming exorbitant in today's world and Jauhar - with a young family to support - was finding it harder and harder to maintain his love of medicine. "Referrals" from internists to specialists were becoming the currency of medicine in today' world.Sandeep Jauhar is pretty open about these economic slight of hands - "you wash my back and I'll wash yours" - and without naming real names gives the reader the idea that economics is a major player in today's medical system. His book is an excellent look at that world by a middle-age, dedicated doctor who, I think, just wants to practice medicine.

I have been a consistent reader of Dr. Jauhar's NYT columns and eagerly awaited the publication of this updated memoir and commentary on the state of US medicine in 2014. As a fellow physician, much of what the author has experienced rings true. I was, however, shocked at the way the cardiology colleagues in private practice set up shops to milk as many procedures from their marks, uh, I mean, their patients, as possible. Perhaps I am naive, but I have not encountered anything like that in my 19 year career. If this is all true, Dr. Jauhar should be able to earn multiples of his salary as a whistleblower.In general, much of the author's experience parallels that of all doctors of our generation. You start a career wanting to help people and have a great professional career. As the years have gone by, the treadmill seems to get a little faster every year, the administrative hassles grow, and the paycheck gets a little smaller. Obviously, the doctor is the loser in this game, but the patient is also the loser. He or she gets a physician who is stressed out, hassled from every direction, frustrated, and has less time than ever to dwell on the encounter. Regrettably, I do not see the situation changing anytime soon, and I also see, on the horizon, a large egress from the profession of mid and late career docs, the ones who cared, worked early and late, and understood and possessed the best attributes of the culture of medicine of a bygone era.Things will get worse, maybe much worse, before they get better.Back to the book, I did not find many of the autobiographical aspects of the book to be very useful, especially when they did not pertain to the subject at hand. Many of us have families we wish we had more time with, marriages that are stretched and often strangled by the lifestyle, and successful and happy siblings or in-laws that make us reconsider our paths. At any rate, I read these parts quickly and/or skipped these sections entirely.The author is a very talented writer, and I look forward to reading more of his work in the future. I hope that this book becomes a rallying point for physicians who care to work to make the system better.

Sandeep Jauhar is an excellent writer! I found myself wanting to read the next chapter to find out what would happen next.This story is not pretty. While the setting is the medical profession, it could be any profession where market forces come into play. It is the old story of should I do "what everybody else is doing."However, I want to address other reviewers' complaints that Sandeep offers no solutions. A memoir isn't written to provide solutions. It is written to share a story. Sandeep has accomplished this task, and done it well.Too often in business you hear a boss say: "Don't bring me a problem unless you also bring me the solution." This view reflects conventional business wisdom, and it is wrong. Smart bosses know that people who discover a problem might not honestly know what the solution is. Their value is to exposing the problem to somebody who can get assistance. This alerting is always the first step toward problem solving, especially if the source of the problem multi-departmental. The second step is not the solution, either. It is getting the key solution creating people engaged. The third step is actually working on a solution.Therefore, Sandeep has done us a service. He is sharing a problem the medical community has. The problem is not going away, so let's not fault him for not presenting a solution. Instead, let's find the people (and organizations) that are best suited to tackle the issues he raises.Sandeep has done his part. Now others must do their part.

La triste evolución de un médico sin muchas ambiciones, en medio de un mundo donde siempre gana el mas fuerte. Me pregunto si necesitó todos los años de estudio mas la residencia para saber a qué se enfrentaba.