If you’ve got troubles, don’t tell them to your doctor, who is probably more stressed and impoverished than you, and more exasperated than even her patients with the state of medicine today. This is the gloomy take-away of Dr. Sandeep Jauhar’s Doctored, The Disillusionment of an American Physician.
Trawling through Sermo, an online community of physicians, Jauhar finds one doctor who calls American medicine a “charade” and believes he is a “pawn in a money-making game for hospital administrators” and another who figured he made $11.74 an hour the previous year.
This is the cheery prologue to Jauhar’s own story, in which his wife longs to escape their one-bedroom apartment and a “cash-poor” life that is rich in angst and overtime, but scarce in rewards that were plentiful just two generations ago. Back then, Jauhar writes, “If you were smart and sincere and ambitious, the top of your class, there was nothing nobler or more rewarding that you could aspire to become. Doctors possessed special knowledge. They owned second homes. They were called upon in times of crisis. They were well-off, caring, and smart, the best kind of people you could know,” he writes.
What happened? Well, Medicare, for one thing, then the dastardly Health Maintenance Organization Act of 1973, explosive malpractice liability premiums and the rapid growth of a “labyrinthine payer bureaucracy.” Throw in an aging population that requires more care than its parents and grandparents did, and pressure to make money, not for one’s family, but for vaguely sinister “hospital administrators” and you’re likely to just take an aspirin and call it a day.
It could be argued that Jauhar, a cardiologist who writes regularly for The New York Times and who chronicled the early days of his career in 2007’s Intern: A Doctor’s Initiation, is burned out, not from the rigors of medicine, but from his moonlighting as a scribe. And he is, in fact, a masterful writer who might have scraped by as a poet or novelist, and foregone the medical-school debt, if he hadn’t succumbed to family pressure to become a physician. Jauhar’s mother, he reveals, wanted her sons to become doctors so people would stand when they walked in the room. He complied, but also became a fine wordsmith along the way. Here he is, musing about the notes he writes after making hospital rounds one afternoon:
“How limited our interactions with patients, I thought. We see them for a few minutes, then pen a quick summary and leave directions for the nurses to follow. To whom are we speaking in these inky chart drizzles? Doctors, patients, a phantom lawyer?”
In this, and in case histories, in which Jauhar makes plain the psychic agonies of the profession (in one case, he urged a man to have a diagnostic catheterization that, because of complications, resulted in the man’s death), Doctored delivers with enlightening punch. Its theme, however, remains darkly consistent. It’s as if Eeyore got a medical degree.
Jauhar’s points are well taken, and you don’t have to believe, as Cicero did, that men are as gods when they bestow health, to think that doctors should be well-compensated. They should be, if not for their knowledge and their willingness to do things others won’t do, then simply so they won’t be distracted by how they’re going to pay the light bill while they’re pulling our gall bladders out.
Then again, in an age in which almost every profession is convulsing, and pensions and Social Security can no longer be relied upon for old age (not that they ever should have been), there’s only so much hand-wringing from doctors that patients of modest means can take. When the average American takes a second job to pay bills, it most likely involves delivery of pizza. When Jauhar takes a second job, he’s paid a thousand dollars to deliver a speech about a drug he prescribes – and on the job, he gets dinner “with fine wines flowing freely” and even car service if he’s not up to the drive. Cue the world’s smallest violin.
At one point, while bemoaning a monthly budget that was $2,000 short of bills that had to be paid, Jauhar verbally spars with his father, who yells at him, “What’s not to enjoy? You are a doctor! You have the respect of the world!” Though this is a parent whose influence has not always been admirable, on this point, the reader may be inclined to agree. Doctored opens a door into a once-golden world that, for most, is still enviably silver. Forgive him that, it’s still a fine read.
Originally published in The Hippo.