A Doctor's Diagnosis of the Medical System

Thursday, August 21, 2014

Sandeep Jauhar, MD, PhD, director of the Heart Failure Program at Long Island Jewish Medical Center, author of Intern: A Doctor's Initiation (Farrar, Straus and Giroux, 2009) and now, Doctored: The Disillusionment of an American Physician (Farrar, Straus and Giroux, 2014), exposes the perversities of today's medical system in the U.S.


Dr. Sandeep Jauhar

Comments [11]

kate from Putnam Valley

We were all seduced into thinking that medical care was worth the copay we gave for it..$10-$25. Now that we are having to pick up more of the tab in premiums which have risen steadily as insurance companies became good investments, we are rebelling, and scapegoating doctors for the problem. Where does anyone study for 7-20 years and NOT expect to be well paid?! If we want to maintain the world class medical care we can obtain in the US, we will have to provide incentives to individual doctors...not to insurance companies, or to hospitals, as is currently happening. The first step to change is the reimbursement schedule for doctors, particularly in Medicare and Medicaid. The next step is for government to back off from intrusion into doctor's decision making, and the overwhelming paperwork which burdens physicians' offices. The reason so many doctors are leaving private practice is the overhead they can't meet. When so many of our doctors are now hospital or large profit oriented groups employees, we will certainly lose the kind of top of the line medical care we could otherwise have. These organizations rate their doctor employees on how much business they bring, not on the quality of their relationships to patients. What we are actually developing now is a hybrid of socialized medicine where the capitalist side is all about profit, and the governmental side is the suffocating flow of regulations. And the other part which has escaped any review at all is the legal profession which feeds on both. The writer who calls for a rebellion by doctors is correct, but their target shouldn't be the AMA. They should simply opt out of the system, and return to the system which made American medicine the envy of the world...private practice in which the doctor is the "decider", and where the buck stops. Concierge medicine is a step in this direction. It's now up to patients to decide whether they are willing to support this, and to wake from the $20 copay sleep they've been in. Just as advice is as good as what you pay for it, so it is with medical care.

Aug. 21 2014 06:56 PM
BK from Hoboken

@ ccinjc-
Perhaps you missed the guest discussing the drugs that saved lives and extend our life expectancy by decades in the last century. Brought to you by pharmaceutical companies (admittedly sometimes in conjunction with NIH or other academics and government departments).
Here's the thing to remember as someone who has to deal withi insurance companies for a living: if a pharmaceutical company has a good product that saves or improves lives, it makes money. Everyone wins. When an insurance company decides what to pay for, it has an inherent conflict of interest. The more it does to help a patient, the less money it makes.

Aug. 21 2014 12:09 PM
Mark from New York

I started med school at 38 years old. I'm a Pathologist in the VA system, where bureaucracy is very dense. After 4 years of residency and 2 of fellowship, I'm out of my chosen sub-specialty. One of my best friends from high school, also a late starter, currently despises his job as an urgent care doctor. And...
The more I practice, the more satisfaction I get. It's only been two years, but I will put up with the problems, many of those which Dr. Jauhar describes, admittedly, I don't face in the VA system. As a pathologist, I actively seek out opportunities to interact with patients and clinicians. It's a unique perspective, but I feel that I can always strive to be more involved. Oh, and many doctors don't even consider those in my specialty to be fellow physicians. I try to change that view, not with attitude but through my work.

Aug. 21 2014 11:51 AM
Dr.John from Monmouth County, NJ

Are we on the verge of real reform which will lead to addressing better care through population health management interventions? What will hinder that change?
The unaddressed question is the way we pay for health care and what we must do to assure a change to stop the piecework approach and funding for health care!

Aug. 21 2014 11:44 AM

Insurance and Pharmaceuticals companies took over Medicine.

Our system is expensive and not as effective as most of most other countries.

Aug. 21 2014 11:39 AM

If doctors were genuinely concerned about these issues, they'd band together to pressure the AMA to work towards single-payer instead of against it.

The AMA launched a campaign objecting to MEDICARE. They're a group which is about maximum reimbursement for doctors, not what's best for patients.

Aug. 21 2014 11:37 AM
anonymous from NYC

In the 37 years I have worked as a physician assistant, I have seen an unfortunate transformation in medical care in the US. Since there is so little time alotted for physicians to see patients, patients get tests and prescriptions instead of the actual time that is needed to correctly analyze what they need. The irony of the situation is that having time to spend with a physician is way less expensive than tests or prescriptions, and ensures better medical care.

Aug. 21 2014 11:34 AM
Dr Losack from Manhattan

a broken system
med school tuitions rising
income decreasing
no bed side manner taught
all we worry about are LAWYERS
over 50 percent of ER admissions are psychological
so many tests are done overlooking the real reason that patient is there.

GLenn Losack MD
psychiatrist in MANHATTAN
doing tele psychiatry for the rural poor AMERICA from his apartment

Aug. 21 2014 11:33 AM
ellen from Manhattan

I've lost two excellent doctors - my cardiologist and my primary care physician, to the stress of an alarmingly large patient load and pressure to do tests, procedures, etc. One wrote me a letter saying she had gone into a
Park Avenue practice where she's on a retainer basis because she could not practice the kind of medicine she had always wanted to practice.

My present doctor, a lovely woman, was close to tears as she told me why she might not be as available to me as she has been due to an increase in her responsibilities at the hospital.

But an oncologist I saw had the "freedom" to spend a little more time and got to know me pretty well, though there were days when he just looked so...tired!

Aug. 21 2014 11:33 AM
Steve from NYC

According to The New York Times review of his book and this interview, Dr. Jauhar was willing to do unnecessary tests for which he was well paid and do talks on drugs he didn't really have that much belief in because he was being paid by pharmaceutical companies to do so. I am sorry that Dr. Jauhar believes his ethics are pretty much the same as most doctors. And his rationale that he needed the money can be used to rationalize just about any behavior.

Also if he is so troubled by doing things of questionable ethics, I assume that he would donate the money he made to charity. If not, it seems he wants to have his cake and eat it, too: he wants to earn money by doing questionable things and make more money by saying how bad he feels about having done so.

I have to say that no matter how good a doctor he might be with regard to his technical skills, I doubt I doubt I'd trust him enough to want him for my doctor. He seems capable of doing anything to turn a buck.

Aug. 21 2014 11:29 AM
antonio from baySide

Does the doctor believe we should move to single payer?

Is there a movement to be more personable and pay more attention/time to the patient in the field? Kinda like the locavore movement in food production...

Aug. 21 2014 11:27 AM

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