番茄社区

"Knavish" is a word that surfaces many times throughout the newest book by , director of the heart failure program at Long Island Jewish Medical Center in New Hyde Park, N.Y., and a New York Times contributor.

He uses it to describe his colleagues' behavior: ordering unnecessary tests purely for profit, keeping patients in the hospital longer than necessary in order to bill more, and accepting gifts from pharmaceutical companies while prescribing possibly dangerous drugs.

Most importantly, Jauhar uses "knavish" to describe his own behavior in his memoir "Doctored: The Disillusionment of an American Physician," in which he puts his life on stark display to illustrate harmful financial intrusions into medicine.

Finding that his new salaried job upon graduating fellowship wasn't enough to make ends meet, Jauhar ventured into murky ethical territory while moonlighting and working for a pharmaceutical company. The author compares his personal midlife crisis to what he considers the "midlife crisis of medicine," which has resulted in soaring healthcare costs, decline of public trust in physicians, and burnout among doctors.

Jauhar places much of the blame on what he calls the "perverse incentives" set up by external sources -- but also physicians' willingness to embrace them.

"The government plays a role, malpractice plays a role, third party insurers play a role, but we doctors play a role as well," he told 番茄社区. "We've allowed greed to become a factor in our decision-making."

番茄社区 interviewed Jauhar about his reasons for writing such a deeply personal book, how others have reacted to its confessional nature, and how he ultimately overcame his burnout.

番茄社区: Why did you decide to write this book?

Jauhar: I think it's important for patients to know how medicine is practiced today and some of the difficult choices doctors are being forced into making.

It's also important for doctors to know that we are being observed. We really need to try to retain some of the professionalism that I think has been weakened for the last few decades because of a multiplicity of factors, including how we have allowed our profession to become commercialized.

I want doctors to be reminded that we have a noble profession and can regain some of the professionalism that has characterized that profession for many years, if we decide to make some changes and hard choices.

It's important for doctors to read the book and see what some of the excesses are in the system today. Of course, it's not just greed. It's incentives put into place by third party sources that have totally perverted medical care. It's seeing what the problems are and having patients look at how medicine is practiced in some areas -- and showing the seedy underbelly as well.

When you talk to physicians, you see how they might feel helpless in the current system, where there are so many different forces pressuring doctors to behave in knavish and almost pawn-like ways. They're automatically observing and following external regulations rather than internal codes of conduct. It's a huge problem. And I think policymakers and patients need to recognize that.

I wrote the book to illustrate this. It's not a doctor problem; it's really a healthcare problem. Ultimately, it's a patient problem. We have to help doctors deal with the pressures and the burnout.

番茄社区: The characters in the your story seem to be a select group based in New York. Do you think you can generalize about the rest of physicians based on their experiences?

Jauhar: There's a quote from a character in the book where he said, 'You think this is only happening in New York? No. This is happening in New Jersey, California, all over the place, it's just a matter of degree.'"

I don't think outright fraudulent behavior is all that widespread. I do think there are perverse incentives of our fee-for-service system, which puts pressure on doctors to see more and more patients because of decreases in reimbursement and increases in overhead. There's also an increase in paperwork and having to hire more office staff to deal with all the administrative burdens. All of those things make a perfect storm that creates incentives that can compromise even the best doctor's better judgment.

番茄社区: In the book, you freely mix your personal life and your professional life. Why did you decide to insert so much of your personal life in the book?

Jauhar: I think my professional life fed into my own personal crisis. I entered adulthood where there were major changes, and they all happened at once. I had my first child, I got my first real job, I became more financially responsible.

As a resident, there's always that hope that when you graduate things will be different. But I found that it was just as much of a struggle, even after I got my first job. There were a lot of different forces putting pressure on me and that precipitated a crisis of sorts.

The way I had to resolve some of that crisis in my personal life with financial issues led to a compromise of what I thought were my ideals and what kind of doctor I wanted to be when I finally got out of all that training.

The first two-thirds of the book are about how hard choices in adulthood and middle age can subvert the ideals that you enter adulthood with. A big part of it was I found myself practicing medicine antithetically to the way I had envisioned when I was younger. I thought I had very little choice in the matter because I felt stuck between the proverbial rock and hard place.

番茄社区: You're sharing a lot of personal details about your colleagues, your patients, and your family. What were their reactions when you told them you were writing about them?

Jauhar: Much of the blame in the book rests on my own shoulders. I made certain choices that I regretted, that I hopefully fixed by the end of the book. I think people generally appreciated a person being honest about their own mistakes.

Yes, I do point out problematic behavior in other physicians, but I don't think that's a big part of the book. Most names, characteristics, and details of the physicians involved have been changed, so hopefully they won't be able to identify themselves.

I do think it's important when you're writing a memoir to be truthful about how you perceive certain things. Not being able to write truthfully about the pressures in my personal life is not the way I want to write. If I'm going to write about myself and my journey and my education it would have to be honest.

番茄社区: Where are you now in that journey?

Jauhar: The moonlighting and shady practices, that's all ended. A lot of it is a new phase, started by leaving Manhattan and moving to a new place. I actually feel a lot of career satisfaction today, more than I did when I first started my job. I feel a lot more secure in my place, and I genuinely enjoy seeing patients. I'm in a much better place in my personal life. I have two children, they're doing well, they're thriving. There are a lot of sources of satisfaction now.

Generally I feel very good about the place that I've come to, and I feel good about the choices I've made in out of practice.

I'm still with the [Long Island Jewish Medical Center] heart failure program. I also teach one of the courses for first year medical students at [].

As I go along in my career, I've found different things to pursue that have deepened my satisfaction. I wasn't teaching as an attending physician. For a while, I wasn't doing a lot of writing. I was really busy with establishing my practice and doing all the moonlighting. I think that led to an unhappy place for me.

Now I'm devoting time to writing, teaching, mentoring students, and working more with residents and fellows. Revisiting some of those passions has been really good.

番茄社区: What is your advice for doctors suffering from burnout?

Jauhar: You have to identify the source of your burnout. It's usually not seeing patients. For most doctors it's the extraneous burdens of medical practice and the financial pressure of maintaining a practice. Especially for solo private practitioners in primary care today.

If it's your medical practice, you have to find outlets. For many doctors it's finding an avocation that's engaging, that they're passionate about.

My life is a unique model. But every doctor can find ways of dealing. Getting more immersed in the environment that's causing the stress is not a solution. Finding that outlet is important.

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