A heartless
Profession
Does being a doctor
amount to being heartless?
It is the Holy Grail for almost every Indian parent: that their
son and or daughter go to medical college, become doctors, and embark on a
thriving career that brings laurels - and sure, some lolly. It's no different
with NRIPIO parents, in the US, UK, or elsewhere, which is why the nearly
100,000 Indian American physicians in the US includes some 20,000 who are
either born or have
grown up in America and graduated from US medical schools.
Dr Sandeep Jauhar has been there, done that - and not liked it one bit. And
he's blown the whistle on his profession - or ripped it apart with a scalpel.
Medicine, as practiced in the United States , is
sick - very, very, sick.
In a devastating - and immensely self critical
- book that is making waves in the US, the Indian-American physician, with
specialization in cardiology, describes how the medical profession has become a pitiless, mercenary medical profession, money
ripping vocation where doctors treat patients as revenue generators rather than
human beings, keep patients in hospital longer than necessary to bill them
more, order needless tests to generate profits, and cozy up with drug reps
helping predatory pharmaceutical companies sell dangerous drugs.
American doctors - and that includes Indian-Americans like himself -are
suffering from a "collective malaise" of discontent, insecurity, and
immoderation.
None of this is a great secret; discerning
patients, activists, and even many physicians themselves have recognized this
for a long time in the US . But its Dr Jauhar's astonishing candor in
`Doctored: The Disillusionment of an American Physician' that has shocked the
medical fraternity and layman alike, shattering the image of the doctor as a
do-gooder -and for Indians, that of the NRI physician as the epitome of
nobility. No one comes out looking good in this tortured, self-lacerating book:
not Jauhar himself, nor his brother (also a cardiologist), nor physician
friends and mentors, and not the American system. This is the Ferguson moment
in medicine - ugly but true.
Asked in an interview on Thursday if he
intended to stay on in the medical profession at all, given the shock and
horror his book is creating (the NYT reviewer said this is the first book
that's prompted her to write "Yuck!" in the margin), Dr Jauhar said
he owed it to his readers to give them the unvarnished, unfiltered truth,
without being irresponsible. "Probably the person who comes in most for
criticism is myself. When you are willing to be self-critical, people will
appreciate it," he told me gravely, after initial jokes about his taking
potshots at his own family, including his father, subsided. "I am
disillusioned with how medicine is practiced in this country but not
disillusioned with being a physician. "Jauhar's sulfurous chronicle of the
medical profession in the US begins almost as soon after he graduates from
fellowship and takes a salaried job at a hospital (after 19 years of college
education, including a Ph D in physics). The hours are brutal, the money is
meager, and before long he becomes part of the venal system, treading dodgy
ethical terrain to keep his body, soul, and family together. He moonlights on
other jobs and shills for pharma companies as he observes compromises,
cronyism, and corruption flow like crud through the system. Doctors, hospital
administrators, the health insurance sector, and pharma industry collude and
conspire in sundry ways to rip-off patients - some who want to live forever
despite being at their careless best.
The dysfunction is not entirely due to doctors.
Jauhar describes how external sources - the government, the insurance industry,
and pharma companies - have all played a role. Doctors, particularly primary
care physicians and internists, who previously spent 20-30 minutes with each
patient, now hurry out after 10 minutes because they now have to see twice the
number of patients to generate the same revenue. As a result, patients do not get the attention they
deserve and are not diagnosed properly. Meanwhile, some specialist doctors get
to bilk the system (which is why everyone wants to specialize and there are fewer
primary care doctors in the US ), prescribing
a multitude of tests and treatment -some to cover for malpractice liability,
others to generate more revenue. Patients who came in complaining of even
routine breathlessness are hustled into taking nuclear stress tests and bumped
into cardiac procedures. That's because insurance companies don't pay
doctors to spend time with patients trying to understand their problem. But
they pay for CT scans and stress tests whether they're needed or not.
Elsewhere, hospital administrators are also
constantly putting pressure on doctors to keep occupancy rates high enough to
generate profits (somewhat like hotels). Jauhar cites the economist Julian Le
Grand's idea of humans as knights, knaves, or pawns, to describe how the
American system promotes knavery over knighthood. The chapter headings in his
book says it all, going from "Learning Curve" and "Good
Intentions" to "Denial" and "Deception," before he
takes a "Diversion" and becomes "A Country Husband" -
leaving New York City for suburbia and greater attention to his family and
children, instead of running on the treadmill of practicing soulless medicine.
It is an unfinished story, in part because Jauhar is still on the margins of
the system, even though he is "an outlier" as a fellow
Indian-American physician, gastroenterologist L Chandrashekhar describes him.
The book, he says, should serve as a warning to India,
where some physicians are already on the hook put out by American companies,
with paid trips to Las Vegas and Disneyland (under the cover of invitation to
conferences) for hawking expensive and often unnecessary surgeries and
treatments - from stents to hip and knee replacements.
But most of all, once you read this tormented,
self-lacerating book, it's hard to see a doctor with the same respect. Doctors
know it too. In a survey cited by Jauhar, 30 to 40% of US physicians today say
they will not choose the same profession if they had a choice; and even more
would not encourage their children to. The medical profession, it appears, is
terminally ill, in the United States at least.
No comments:
Post a Comment