Healthy Aging

Doctored: A Cardiologist Exposes the Health Care System That Fails Us

doctoredYou’d think cardiologists would be happy enough with their lives. According to recent salary surveys, they rake in, on average, $350K a year and some make much more.

Yet, in a 2008 survey of 12,000 doctors, only 6 percent said the morale of their colleagues was positive.

This gloomy mood is captured in cardiologist Sandeep Jauhar’s new memoir, “Doctored: The Disillusionment of an American Physician.” The book points to the causes of Dr. Jauhar’s personal and professional despair; Jauhar describes it as a “manifesto for reform.”

“Doctored” shines a bright spotlight on what’s wrong with America’s health care.

In the new book (the author’s 2007 memoir, “Intern: A Doctor’s Initiation,” was widely acclaimed),  Jauhar describes how cronyism is at the root of many doctors’ patient referrals, how unnecessary tests are ordered to generate income, how corporate ties (including his own, for a time) may distort decisions and how the system has become specialist-heavy – often with no clear answer about what’s wrong with the patient despite a team of experts.

Other problems include burgeoning paperwork that detracts from patient care and reimbursement cuts leading to over-scheduled doctors who have little time to spend with their patients.

Of course these problems affects patients as well as doctors, especially older people, who tend to have more medical problems, are more likely to have chronic diseases and eventually may need to make life-and-death decisions. Jauhar tells stories of terminally ill patients lobbying in vain to forgo treatment and specialists ordering invasive and expensive procedures unnecessarily.

The story of James Irey is a case in point. Irey was an immigrant from Trinidad, in his late 50s, with congestive heart failure due to a disease that affected his heart and his lungs. The doctors, including Jauhar, recommended a heart-lung transplant as his only hope. He was opposed, thinking he should just enjoy what little time he might have left, but the doctors pushed him to reconsider.  Before getting on the transplant list, he needed to have a catheterization. He was still reluctant, but Jauhar influenced him. On the operating table, Irey had a heart attack. A few days later, he died. The story is in the chapter titled “Good Intentions.” Jauhar says, “It still sometimes amazes me how much power we have to affect patients’  lives, for better or for worse.”

Senior Planet caught up with Jauhar by phone while he was in the middle of a busy workday as director of the Heart Failure Program at Long Island Jewish Medical Center.

 

You paint a grim picture of health care in America. Can you explain why it’s grim, especially for older patients?

The system is good at managing a single acute problem, such as a stroke, something that requires a high technology intervention. But when you are dealing with chronic illness that requires input from many doctors, the system is totally fragmented. When a condition requires multiple doctors’ input, the system – and the care you receive is really very weak and very often fails patients. The specialists tend to interpret problems through their own expertise and they don’t always confer with one another. Nothing beats just picking up the phone and talking to someone.

How can older adults, in particular, improve their care, given the system we have?

I think it’s important to find a good primary care physician. That person can be the driver of your health care. I still have patients come in who have six doctors [specialists] but no primary care doctor. The doctors don’t confer and you end up with fragmented care.

You need someone who can put on the brakes. A primary care doctor can sift through all the recommendations.

How can we  recognize when we need to change doctors or make some other changes because our health care needs are not being met?

It’s hard to know for sure, but trust your instincts. If you feel like you are being rushed, for instance, something is not working.

What are some ways we can improve our medical care and our relationships with our doctors?

I think it’s important to read up on your illness, so that you are informed.

When you go to your doctor, be very direct in giving your history. Sometimes it is helpful to say, ‘Doctor, I know you are busy, but give me two or three minutes to tell you what’s going on so I can get it out.’ Often a doctor will interrupt a patient in 10 or 15 seconds and redirect the history to something else, so a patient is not heard. Prepare before you go in, so you give all the important points.

How can we get involved in health care reform? What’s a good starting point?

There are powerful advocacy organizations for the elderly. That is one way.

Sending a letter to your congressman sounds a little conventional, but individual letters can often help.

As for what to ask for, I think the single most important thing we can do is increase pay for primary care doctors so there are enough of them for aging boomers. There will be a huge increase in the elderly population. At the same time, all these doctors 60-plus are going to be retiring. We need more primary care physicians who understand the unique needs of the elderly, more geriatricians. The elderly don’t need 20 different medications. Sometimes the best thing is to prune down the drug regimens. We need physicians who are aware of the drug-drug interactions, who can keep drug regimens manageable, safe and affordable.

We also have to give doctors more time for patients, and we have to allow doctors to practice with a little more autonomy so they are happier and their patients can get better care.

Read the first chapter of “Doctored” on Amazon.

COMMENTS

5 responses to “Doctored: A Cardiologist Exposes the Health Care System That Fails Us

  1. What about the doctors who send elderly patients for every test they can think – and maybe they have a vested interest? Cardiologists that put elderly people on medicines that likely will not even help them, but make the quality of life that they have left much worse due to side effects. US doctors also do not think outside the box – they believe everything that the drug reps tell them and they rarely give any thought to preventative medicine or to natural supplements that might actually keep the patient from having to take the expensive medicines down the road.
    He is right about fragmented care – you go to a family doctor and it’s like they cannot do anything – they send you to this specialist for this and that specialist for that, and then they either don’t look at records and they cannot all connect the dots and get together on the diagnosis.
    The days of the US being tops in medical care are long over.

  2. How many times are we going to read an article or a book by a medical professional who is disillusioned with his/her profession before the profession as a whole gets it? Dr. Juahar gives the usual glib recommendation that we get a good primary care physician. How does he recommend we do this in the face of the total control our HMO or other provider has over our health care and who we get in to see? He recommends, again glibly, that we take charge of our examination and interview with this remarkable (and fictional) PCP by interrupting to insist that he/she listen to us. Again, how? He is a doctor, so would have little difficulty with this plan, but the average patient gets the bum’s rush if he/she tries to interject her own needs into the conversation. I supposedly get half an hour with my PCP, but he controls the conversation completely, always steering us back to the details of my medication list and paying very little attention to the issues that actually make life difficult for me. But, after a cursory examination during which he ignores any comments I make, he’s right in there with an offer of a referral to a specialist because that gets me out of his hair. And I am once again caught in that vortex among multiple doctors, not one of whom actually knows me. I think medicine (doctoring) is more art than science and I fear that there are very, very few medical artists out there.

    I am not a whiner or complainer, and I try to stay away from doctors as much as possible, but again, they control whether or not you get certain meds for your RA or other problems so you are at their mercy. I have had two or three physicians in my many years on earth who were practicing the art of medicine, so I know what it’s like to have a good physician. But you can’t spread those two or three around to an entire population of elders.

  3. Unfortunately, my comments may not seem practical for most elderly folks (I am 67) but because most doctors spend seven (7) minutes maximum with a patient (unless you are wealthy or well connected), you need to take as much responsibility for your own health as possible. If possible, spend as little time with clinics & doctors as you can get away with. I used to work with older and disabled people & took them to medical appointments frequently. In Boston at least, that’s how I know most doctors flit from exam room to exam room. Also, go online or go to the library and get familiar with all the side effects of all the drugs physicians want you to take! A doctor will put emphasis on the treatment he or she wants you to follow, basedon their own specialty: E..g, surgeons recommend operations, psychiatrists certain drugs, and so forth. Will they be pleased if you say “I’ve been reading such-&-so about my condition and I feel…” ?

  4. The problem with Dr. Jauhar’s premise that seniors need a primary care doctor is that primary care doctors have had their Medicare reimbursements cut so frequently and so much that they are no longer accepting Medicare patients. My excellent primary care physician of 14 years (an internist) is eliminating (deliberately chosen word) M/C patients and can’t find any to recommend to his patients when he drops them. Paul Krugman’s recent column in the NYTimes about the miracle of Medicare is flawed as well since he doesn’t take into account the loss of primary care physicians and Medicare’s cost-cutting coverage of necessary procedures. Basically, the health care system and government are saying, “drop dead, senior.”

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