Dr. Sandeep Jauhar says that after years of training he was relieved, in 2004, to start his career as a cardiologist at Long Island Jewish Medical Center in New Hyde Park, where he is director of the Heart Failure Program. But as Jauhar, 45, of Glen Head, chronicles in
"Doctored: The Disillusionment of an American Physician" (Farrar, Straus and Giroux, $26), he soon found himself practicing a medicine far from what he had trained for. Jauhar, who in 2008 published "Intern," an account of his training at a Manhattan hospital, has written an eye-opening description of modern medicine from the inside. He spoke with Newsday recently; the interview has been edited and condensed for clarity.
What prompted you to write this book?
The American health system is in serious crisis. The only way to fix things is to shed light on the system and its dysfunctionality. The book observes the midlife of American medicine through my personal story as an attending cardiologist after finally reaching the end of my medical education.
I found myself being sucked into the commercial maelstrom of American medicine. I found that my salary at an academic teaching hospital wasn't enough to keep up with expenses. To make ends meet I had to take a job as a cardiologist in Queens to learn how medicine is really practiced.
You chronicle how many doctors routinely prescribe tests or procedures that patients might not need -- what is often described within health care as "overutilization."
Everyone knows that in the U.S., 1 out every 6 or 1 out of every 5 dollars is spent on health care and roughly one-third to one-quarter of that is wasteful spending. And a lot of that is driven by overutilization. Private practition-ers are more susceptible to perverse high volume incentives. They are paid piecework: If you see five patients a day, you are paid for five patients; if you see 10, you are paid for 10. A lot of doctors are seeing 30 to 35 patients a day to pay overhead.
But what you describe is not just doctors seeing more patients, but sending them to specialists they don't need and/or ordering unnecessary tests.
Doctors are running on a gerbil wheel. Someone complains of lower back pain -- in most cases the patient is going to be fine with rest and Motrin. You have 10 minutes. The first two minutes is just saying hello and about four minutes is spent on the complaint and a little bit of history. You hardly have time to get him on the table and examine him. There's also fear of lawsuits ... so you refer him to an orthopedic surgeon and order an MRI that the patient didn't need. Lack of time is the single biggest problem in medicine.
You say that "better informed patients might be the most potent restraint" on tests and procedures they don't need. But patients don't know when they need a specialist or test.
It's not going to be easy. Many people turn to the Internet but it's very hard to sift through what is good and bad. A lot of elderly patients in my practice don't have access to the Internet. And when you're having chest pains or feeling bad, it's hard to have the presence of mind to know what you need. I think it's a joke to say that health care has to become more of a free market. That depends on an educated buyer and the cards are stacked against patients.
In some cases tests can be harmful, but the real problem is false positives. Maybe the mistake is ordering that first test, and there's an abnormality and then no one knows what to do with that information. And so you order another and that test doesn't clarify things and the patient ends up basically flattened by a steamroller of tests. Once an abnormality is found, no one wants to discount it for fear of harm and a lawsuit.
Do you think the Affordable Care Act will change this?
The Affordable Care Act has some good aspects to it and I do firmly believe the health care system has to be reformed. Whether we should be tinkering with it or if it should be a more radical overhaul is hard to say. Something radical like a single payer system ... is politically not viable. It probably doesn't go far enough in bending the cost curve.