Book Review: Doctored
The Disillusionment of an American Physician
By Sandeep Jauhar
Farrar, Straus, and Giroux
I was already feeling cynical about the medical profession when my longtime doctor recently dumped me and her other patients to launch a “concierge” practice (with hefty annual fees). Then I read Doctored: The Disillusionment of an American Physician, and now I’m just mad.
Part memoir, part exposé, Doctored was written by Sandeep Jauhar, a Long Island heart doctor who regularly writes on health care for The New York Times. This thoughtful and honest insider’s view of our broken health system—think: “cardiology confidential”—highlights the perverse incentives that have led to an epidemic of inappropriate testing and other means for doctors to game the system for their own profit, while helping to jack up health care costs for everybody else. Under the fee-for-service model in which most of the American health system operates, many physicians get paid for every test or service they order, whether or not it’s in their patients’ best interest.
As a new husband, father, and doctor (with a mountain of medical school debt), Jauhar struggles with dueling impulses: to stay true to his ideals of practicing medicine with integrity, or to succumb to temptations—hustling patients, overutilizing medical services, dubious moonlighting arrangements—in order to afford private preschools and other perks of Manhattan life.
In truth a career in medicine doesn’t quite offer the good life it once did. It’s not just that physicians’ relative compensation has been dwindling for decades, Jauhar notes. Managed care is slowly eroding doctors’ autonomy and independence and expanding their workloads. No wonder their rates of depression and burnout are at record highs.
Health reform may take care of some of the system’s more egregious problems, improving things for doctors and patients alike. A welcome start would be to base physicians’ pay on how well they keep patients healthy, not on how many tests they perform, as some forward-thinking systems do. The bottom line: it’s the end of medicine as we know it—and that’s not all bad.