User:Barbaro Montiel/Doctored: The Disillusionment of an American Physician

Doctored: The Disillusionment of an American Physician is a follow up of the book Intern: A Doctor's Initiation where Dr. Sandeep Jauhar narrates his first ten years practicing cardiology. In his book, Dr. Jauhar shows us his point of view about medicine and explain how he felt through different stages of his first ten years as a cardiologist. This memoir takes place at the prestigious New York City Hospital from 2004 to 2014 and at a hospital on the outskirts of Queens. Sandeep Jauhar explains how he viewed medicine and the medical system through these teen years of practice and mentions how sometimes he felt with respect to the treatment towards patients and how most doctors were bias and ambitious. He blames the medical system in the US for most of the broken doctor-patient interactions but explains that medical development also plays an important role in how doctors practice today. Sandeep Jauhar expresses in his book how sometimes he felt down and disappointed about medicine in the US. He explains that being a doctor was not how he dreamt it and that there were many people and rules that made his work tedious and boring. However, he explains how he fought to see the good side of it and was able to overcome many of these difficulties to felt in love again with his profession. Unluckily, it is fair to mention that doctor Jauhar doesn't provide a solution to his book for the problems of the medical system in the US.

Author
Sandeep Jauhar was born in New Delhi, India; December 16, 1968. His father was a plant genetics doctor and his mother was a lab technician. His family came to the US when he was eight years old and settle just right in the country. Both of his grandfathers died from heart attacks, and his older brother Rajiv became a cardiologist. Sandeep began studying physics until he was 24, but his parents were very disappointed because they wanted him to become a physician. It wasn't until a female friend of his contracted lupus and got really sick that Sandeep started to become interested in medicine. He started researching for cures, and treatments, in order to help his friend when he fell in love with medicine and realized than practicing medicine, could actually have a greater impact on others life than physics. Therefore, he stopped working on quantum dots and applied to Med School. However, that was not it, Sandeep Jauhar actually also started working as a writer and began to develop a passion not only for medicine but also for literature. Sandeep Jauhar finished Med School and began working as a resident in the New York Hospital, which is from where he wrote his first book Intern: A Doctor's Initiation.

Plot
This book starts where Intern: A Doctor's Initiation left off. Sandeep Jauhar had just finished his years as a resident and started to look for jobs as a cardiologist. He got a job as a cardiologist at the New York Hospital and also was introduced by his brother Rajiv to another cardiologist, who owned a clinic in Queens, New York. He was just starting a family at this point and needed to get his life together, so he worked for many hours a week. Dr. Jauhar was already a little disappointed with his profession from his first years as a resident, he saw how doctors were fast pace and didn't have too much time to interact with patients or even with other doctors. He also experienced the increasing amount of work that doctors had to do for every patient and how medicine was getting each time more complicated.

Dr. Jauhar beginnings as a physician were as shocking as they could possibly be. When he was studying medicine, his mother will tell him that she wanted him to be a doctor, so everyone would respect and take as an example. However, in his book, Dr. Jauhar explains how this isn't applicable anymore for doctors and that nowadays been a doctor is like any other profession and does not have any of the privileges it used to. He expresses how doctors from the '60s to the '90s were viewed as really important figures in the society, but that this prestige started to gradually decrease. He expresses that medicine is a career that could possibly bring insecurity, discontent, and anxiousness about the future due to errors might end up your career as a practitioner. Dr. Jauhar also talks in his book about memoirs about very ill patients and how he had to deal with them. He also mentions that the world of cardiology is very cruel because many of the procedures are very painful and not just for a few hours, but for a few weeks. He mentions how patients with Coronary Heart Disease had to suffer for about a month after surgery was performed and they were being put through rehabilitation. Sandeep explained how he proceeds to talk to the patients and family and explained how the procedure is going to be, which is something that every doctor must do.

On his book, Jauhar talks about how some patients have to ask him to let them dies and how he had reacted to it. At first, he mentions that he didn't really know what to do when this lady with heart disease asking him to help her go! He expresses that he had to go to other physicians and ask for advice. He got told that there were not moral problems with her request, so she was sedated with morphine and got rid of most of her pain until she passed away there in the hospital. Dr. Jauhar mentions how this female told him something that he would never forget: "my husband always told me that the hardest thing to do in life is to die, I always thought it would be easy''. He says that is always very difficult to see death and that it was really hard for him to assimilate that because he saw many people died in his first years as a medical physician.

Dr. Jauhar mentions how he also made mistakes with a patient and this took him to a new level in his profession. Dr. Jauhar develops this special relationship with a female patient that had heart disease and check with him several times a week to see how she was doing and if the treatment was working. Suddenly, Dr. Jauhar got a notice that she was in the ICU one day and when he went to check on her and got told that she had kidney failure due to poor blood flow. He had an argument with her doctor at the moment because he didn't want to do dialysis on the 80 years old patient just because she had not salvation. Dr. Jauhar ended up taking the patient to another ICU and she died a few days later. He realized that he had made some mistakes and that he was looking at the patient like family and that led him to take irrational decisions. On the other hand, he learned his lesson and after that, he became a better doctor, who would think radically about the decisions he should make.

Themes
Dr. Jauhar complains about how patients are treated for most doctors. He explains how many doctors work and how they overlook patient most of the time and send them to have an unnecessary test that end up costing a lot of money to patients. Dr. Jauhar says how most of these tests are just to protect doctors from making mistakes or assumptions and how many times this overused test are just done in order for doctors to financially benefit from them. Some of the factors he says are very influential in the difficulty of practicing nowadays are workload, medical advance, financial reward, and the medical system.

Workloads
Sandeep Jauhar mentions how doctors have to see an excessive amount of patient daily and how their salary is most of the time-dependent of how many patients doctors see. Dr. Jauhar says that usually, doctors see 20-30 patients on a daily basis and that this number could increase depending on the profession and demand at the hospital. He mentions in the book, how for every patient, doctors have to create a medical history of patients and then send these patients to have multiple tests in order to rule out a number of diseases that the patient could have. Also, he mentions that because doctors have to see many patients daily, they try to spend the least time as possible and don't really listen much to the concerns of patients. They rather focus on symptoms and send the patients to have a test that sometimes could be necessary and others they just do it to obtain money out of it.

Medical Development
Dr. Jauhar also explains that practicing medicine is much more difficult today than 20 or 30 years ago because the medical equipment, tools, and medicine, in general, is much more sophisticated. He mentions how today people are leaving longer than they have ever lived before and is amazing. Even though this is amazing for us as people, it has become very difficult for doctors to keep them alive because people are leaving longer than ever with chronic diseases. He also mentions how preventive care has become a huge time problem for doctors. A study has proven that doctor with a normally sized panel of patients spent around 4 hours a day just on screening for preventive care. Dr. Jauhar mentions how patients with chronic diseases have to be prevented from having new diseases that could actually worsen the patient's conditions. For example, people with HIV used to die really soon after they contracted the virus; however, nowadays, people are leaving their entire life after their contract the disease. They have to take a cocktail of drugs daily but still, survive for most of their lives. In order words, Sandeep Jauhar refers that people who live longer with chronic diseases are more likely to suffer new diseases and therefore required more work and knowledge from patients.

Financial Situation
Dr. Jauhar mentions how doctors' salaries are not proportional to the amount of work and studies doctors go through today and for that reason many of them see themselves obligated to work in several places in order for them to make up for that money shortage. He talks about the health economy in the US and how 1 out every 6 dollars is spent on health care, which translates to three trillion dollars annually. He mentions how most of this money goes to the medical institutions and just a small part of it goes to the ones that actually do the work (physicians). He actually blames the medical systems and hospitals for the differences in salaries and the driven inequality of treatment among patients. For example, He claims that private doctors are making about 30-40% less money of what they would make if they were actually employed by a hospital. So, it is very complicated for private doctors to become independent since their financial status is not even close to what it would be if they worked for a hospital. He started working for a cardiologist on Queens both in the hospital, ER, private and satellite office where he was receiving a fix supplemental salary. Since the beginning of working for this cardiologist, he was told that seen patients wasn't really financially beneficial because treating a patient for around 30 mins was translate to $80-90. However, sending them to have a nuclear stress test or an EPG was much more profitable because it would cost $800-900 dollars and $300-400 dollars respectively. He mentions how he never ordered a test if it wasn't really necessary for the patients, but he had to see how other physicians order these unnecessary tests in order to make more money and he had to present them, which make him feel pretty dirty about these situations. Therefore, he claims that hospitals are implementing this method in order for them to become richer and richer, which is detrimental to patient care and doctor's socioeconomic status. He mentions that nowadays is way more difficult to open a private business due to the big financial power of hospitals and government institutions. Again, Jauhar refers in his book how the financial aspect of the US drives many of the health procedures. He mentions how surgeons don't get paid by offering nonsurgical procedures to patients, so they tend to suggest the need for surgery even though it could cause an unbelieving amount of pain and stress. He mentions in his book how many individuals had great suffering in the last part of their lives because of wrong decisions taken by the patient's family and even physicians.

Medical System
In his book, Dr. Jauhar also blames the medical system for the lack of interaction between doctors and patients because he refers that doctors have to be extra careful due to that they could lose their license if mistakes are made. He mentions how doctors are humans and how they make mistakes, but insurance companies and liabilities rules make doctors over tested patients just to make sure they won't be committing a mistake that could cost them thousands of dollars as well as their reputation as doctors. Therefore, he mentions in the book how malpractice liability plays a very important role in how doctors treat patients. He mentions how it is estimated that defensive medicine causes over one hundred billion dollars to be spent on testing every single year on US health care. Dr. Jauhar says that there are many diseases that need to be ruled out and in order for a doctor for not missing the spot, he or she has to order a serious test. He also, says that it becomes even an easier choice for doctors to order a test if they get a financial reward, and that is basically what it is happening nowadays. Jauhar explains how his father was a victim of this when started suffering from numbness's arm, so he went to the ER and the Neurologist there order him a CAT scan because at his age and with his condition, it was very clear that he was having a stroke, he says. When the Cat scan came out negative, he ordered an MRI and another bunch of tests; however, they all came out negative, so he was sent home and ordered to take blood thinners for his "supposed stroke". Unfortunately, the numbness came back, and he was ordered the same tests by the same neurologist and again it all came back negative. Thankfully, a nurse noticed that the Jauhar's father only had this numbness when he moved his neck in a certain way, so she told Sandeep about it. Therefore, Jauhar's father was finally diagnosed by Sandeep Jauhar with benign slit disk. Sandeep mentions how no one including two neurologists examined his dad properly because it was so much easier to order a test. Sandeep doesn't really seem to blame the physicians, but the system because it pushes doctors to see 30-40 patients a day, which cause them to take the easier way of ordering tests for most situations. Another example mentioned in his book is how a primary physician had a patient with shortness of breath and he called 15 different specialists for this case. After analyzing the patient and going through 12 procedures, the patient was set up for followed up appointments with seven different of these specialists. Dr. Jauhar mentions how even though 15 physicians of different specialties try to solve the case, no one was able to figure out the issue with this patient. He actually believes that a family doctor would have done a better job at treating this patient because he or she would have ordered a more generalized procedure. He mentions how having several specialists can be bad for a diagnosed because everyone has its own opinions and because most of the time the diagnosed and treatment is not well coordinated between these doctors. He actually blames the systems for the miscoordinations between doctors and the lack of professional work due to doctors trying to achieve financial benefits.

Critical Reception/Reviews about the book
“Bold and fascinating. . . [Jauhar] interweaves his personal story as well as anecdotes about his patients into a meticulously researched and painfully honest account of a profession. . . This beautifully written and unsparing memoir puts a human face on the vast, dysfunctional system in which patients and clinicians alike are now entangled.” —The Boston Globe

“In this absorbing memoir-cum-analysis, Sandeep Jauhar traces his years as a fledgling cardiologist against the backdrop of a health-care system in peril. . . An impassioned call to action.” —Barbara Kiser, Nature

“Arresting...Dr. Jauhar's book is often moving, especially when he focuses on his patients...this thoughtful telling provides a service in itself. Because the first step toward healing is, of course, getting a good diagnosis.” —Susannah Meadows, The New York Times

“In this searing critique of overtreatment, cronyism and cover-your-ass medical care, a cardiologist confronts the 'collective malaise' infecting the American medical profession as he opens a vein to reveal his own complicity and shattered ideals. Jauhar offers, if not a cure, a prescription for restoring dignity to patient and healer alike.” —More

“Precise, observant...Doctored features many vivid accounts of Jauhar's encounters with patients and colleagues, illustrating the high-stakes ethical and professional decisions physicians face daily. These stories, often deeply personal, bring a human dimension to his sharp critique of a ‘system that makes us bad, makes us make mistakes.'” —Shelf Awareness

“Highly engaging and disarmingly candid. . . Dr. Jauhar does a service by describing eloquently the excesses and dysfunctions of patient care and the systemic distortions responsible for them.” —The Wall Street Journal

“An extraordinary, brave and even shocking document. Dr. Jauhar's sharply observed anxieties make him a compelling writer and an astute critic of the wasteful, mercenary, cronyistic and often corrupt practice of medicine today.” —Florence Williams, The New York Times (Science)

Awards
- Named as a New York Times bestseller

- Named a New York Post Best Book of 2014