I recently finished reading Doctored: The Disillusionment of an American Physician by Sandeep Jauhar, MD. In general, the book is a scathing criticism of our healthcare system, told in an honest and quite open manner. Reading early on, I found myself substituting the word “optometry” for “medicine” and found there were a lot of messages we ODs could gleam from his missive.
I recently finished reading Doctored: The Disillusionment of an American Physician by Sandeep Jauhar, MD. The author is a New York cardiologist, and his memoir is still on the New York Times Best Sellers list since its release in August 2014. In general, the book is a scathing criticism of our healthcare system, told in an honest and quite open manner. Reading early on, I found myself substituting the word “optometry” for “medicine” and found there were a lot of messages we ODs could gleam from his missive.
For example: “Eighty percent of medical diagnoses can probably be made on the basis of a patient's history.” So, my old optometry school professor was right; the case history never ends. He also subscribes to the Yogi Berra school of physical diagnosis: “You can learn a lot by looking.”
While the author takes a dim view of private medical practice-Those guys are a bunch of crooks” - and “Did I really want to become another private practice grunt, overtesting, kissing ass for referrals, fighting insurers to get paid”-he learns from his successful surgeon brother that practice success is derived from the three As: availability, accessibility, and affability. His brother claimed he learned that lesson from private practitioners. He also quickly caught on that, no matter what your practice environ, it was important to see as many patients as possible. “The culture today is to grab patients and generate volume,” the author laments.
He chafes at senior doctors’ abuse of junior associates. Abhorring the practice of taking on young associates, “exploiting them for cheap labor, and then firing them when they were up for partnership. I remembered a private cardiologist...bragging about hiring fresh graduates, running them into the ground for two years, then letting them go and enforcing a no-compete clause in their contracts if they tried to set up offices nearby.” Sad.
Dr. Jauhar is even critical of medical education. “Medical school teaches the bad lesson that in order to succeed, you have to memorize... they are never taught to think. ...I have worked in teaching hospitals (and) I have discerned a gradual decline in the intellectual climate of these institutions. It has been dispiriting to watch. Of all the places one might expect doctors to be curious about medicine, teaching hospitals should be first.” I loved to teach, a doctor told him, but the residents and fellows just didn't want to learn. They had “other things on their minds.”
Dr. Juahar saves his harshest comments for “the perverse financial incentives of our current fee-for-service system,” especially unnecessary medical testing. “No one ever goes into medicine to do unnecessary testing. However, this sort of behavior is rampant.” Everyone is looking for procedures, a colleague tells him. According to another one of his associates, “if a doctor doesn't do excess testing, forget it, he isn't going to be able to live.”
The author, with all his worries and misgivings surrounding his profession, is still optimistic. “Every patient teaches a lesson,” he says. And what, despite all the shortcomings, redeems the effort? “It's the tender moments helping people in need.” Focus on the craft and your relationship with patients, since this is something we can control, he says. That is a take-home lesson for optometry as well. It is the overarching reason we all do what we do: to care for our patients. And he asks the question: “What kind of doctor do you want to be?” A great question for us all, no matter our health care discipline.