generators….keep patients in hospital longer than
necessary….order needless tests….helping predatory pharmaceutical companies sell dangerous
suffering from a “collective malaise” of discontent, insecurity, and
No no no no, we did not say that….we still hero-worship doctors..for us it is the ultimate noble profession.
But then according to Dr Sandeep Jauhar, things are very wrong with the medical community in the USA. He speaks as a person from within the belly of the beast, and he claims to speak on behalf of the many outstanding doctors from the Indian American community (and the medical profession as a whole). Who knows if there is any substance in his (devastating) allegations…common people will tend to think that no smoke can result without fire.
consequences for patients. One is a looming shortage of doctors,
especially in primary care, which has the lowest reimbursement of all
the medical specialties and probably has the most dissatisfied
in some parts of the country, it is next to impossible. Aging baby
boomers are starting to require more care just as aging baby boomer
physicians are getting ready to retire. The country is going to need new
doctors, especially geriatricians and other primary care physicians, to
care for these patients. But interest in primary care is at an all-time
however, is that unhappy doctors make for unhappy patients. Patients
today are increasingly disenchanted with a medical system that is often
indifferent to their needs.
People used to talk about “my doctor.” Now,
in a given year, Medicare patients see on average two different primary
care physicians and five specialists working in four separate practices.
For many of us, it is rare to find a primary physician who can remember
us from visit to visit, let alone come to know us in depth or with any
meaning or relevancy.
patient-doctor interactions has become almost normal. I once took care
of a patient who developed kidney failure after receiving contrast dye
for a CT scan. On rounds, he recalled for me a conversation he’d had
with his nephrologist about whether his kidney function was going to get
better. “The doctor said, ‘What do you mean?’ ” my patient told me. “I
said, ‘Are my kidneys going to come back?’ He said, ‘How long have you
been on dialysis?’ I said, ‘A few days.’ And then he thought for a
moment and said, ‘Nah, I don’t think they’re going to come back.’ ”
My patient broke into sobs. ” ‘Nah, I don’t think they’re going to come back.’ That’s what he said to me. Just like that.”
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.
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.
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
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.
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.
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.
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. “
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 PhD in physics).
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.
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
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.
Link (1): wsj.com/usa-ailing-medical-system-a-doctors-perspective
Link (2): A-heartless-profession