In his 2007 memoir, Intern, Sandeep Jauhar recounted two years of a grueling internal-medicine residency. Doctored, which continues his story through his first five years of practice as a cardiologist at a large teaching hospital, shares with its predecessor its author's gift for precise, observant writing, and it offers an unsettling portrait of the state of American medicine today.
Eight years after graduating from medical school, Jauhar joined the staff of Long Island Jewish Medical Center as a cardiologist specializing in congestive heart failure, the treatment of which is a $40 billion annual business. Almost from the beginning, he was beset by relentless financial pressure, as he struggled to support his wife and newborn son in New York City on his hospital salary. Most of his angst was the product of a system whose financial incentives pit hospitals and physicians against each other and frequently run counter to what he considers optimal patient care. "The constant intrusion of the marketplace," he writes, "has created serious and deepening anxiety in our profession."
Desperate to increase his income, and with the encouragement of his older brother (a successful interventional cardiologist at the same hospital), he grudgingly moonlighted with a cardiologist in private practice, covering emergency-room calls and supervising often-unnecessary nuclear stress tests in satellite offices on weekends. That work only added to his frustration and cynicism. "I tried to practice ethical medicine, but it didn't pay," his harried part-time employer tells him, and Jauhar soon experienced that dilemma firsthand.
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." Whether Jauhar's writing about his nearly catastrophic failure to diagnose the heart attack suffered by a hospital intern or his regret over pressuring a patient to undergo a catheterization that led to his death, he is as unsparing in judging his own conduct as he is that of his profession as a whole.
Jauhar dismisses the oft-expressed claim that the American health-care system is the best in the world as "patriotic (but deeply misguided)." It will take much more than this book to restore the critically ill system to health, but we can thank its author for starting the conversation that may help speed a recovery. --Harvey Freedenberg, attorney and freelance reviewer
Shelf Talker: Cardiologist Sandeep Jauhar's memoir is an often-blistering indictment of the American health-care system.