Thursday, January 14, 2016

Book Review - Doctored

"Among my colleagues I see an emotional emptiness created by the relentless consideration of money.  Most of us went into medicine for intellectual stimulation or the desire to develop relationships with patients, not to maximize income.  There is a palpable sense of grieving.  The job for many has become just that - a job."

At the end of my recent pseudo-holiday (home call but no clinics), I picked up the book Doctored:  The Disillusionment of an American Physician by Sandeep Jauhar.  I can't recall now how I discovered this book, but it was in my list of books to read at my local library, and it had been a while since I'd read anything at all medical, so I decided to order it.  The book is the autobiography of a junior physician who is starting his practice as a Cardiologist in New York City.  In the beginning, he is idealistic and has big plans for improving the care of patients with congestive heart failure at his hospital.  As time goes on, however, he quickly realizes that the salary of an academic physician isn't enough to support a wife and a growing family in Manhattan, so he starts taking on more and more work to try to cover his bills.  First it's paid lectures for pharmaceutical companies, then it's moonlighting with a private practice physician reading stress tests and echocardiograms.  Very quickly, he finds himself becoming burnt out and depressed as he spends too much time doing work that he doesn't love.

I loved this book.  Part of it was the perfect timing of discovering a book by a junior physician (especially a nerdy internal medicine sub-specialist) at precisely the time when I'm starting my own career as a junior physician (and nerdy internal medicine sub-specialist).  I could relate to the sense of uncertainty about how to structure one's career and to the testing out of different things (like paid lectures for pharmaceutical companies, which is an entirely different post) .  I understood his desire to finally start seeing the financial payoff for all of the years of training and his cognitive dissonance at suddenly viewing the patients he cared about as sources of income.  In reading the book, I started to forget that I was reading and to feel like I was sitting in a coffee shop commiserating with a friend about how medicine hadn't turned out the way we had hoped it would.

What I liked best about the book, though, was the solution that the author arrived at.  Without giving too much away, I will say that the book isn't just a rant against modern medicine and the failings of the American medical system.  Instead, it's an exploration of what it means to be a physician and of how physicians can find happiness and purpose in an imperfect system.  It's realistic yet hopeful in exactly the way I needed it to be.  I may actually go against my plan to avoid buying books and get myself my own copy so that I can read it again.

At the very least, I'm adding Sandeep Jauhar to the list of people that I'd invite to dinner if I could invite anyone.  I think he, Gandhi, and my Dad would make for some interesting dinner conversation. 

"How to prevent the burnout that is so widespread in the profession?  There are many measures of success in medicine:  income, of course, but also creating attachments with patients, making a difference in their lives, providing good care while responsibly managing limited resources.  It is whether you find that meaning in your work that determines whether you feel successful or not."

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