MDs Memoir Exposes Dark Side of Medicine
Written by Editor   
Wednesday, September 03, 2014 12:00 AM

A new book by Sandeep Jauhar, MD, PhD uses the word knavish 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.  He also uses the word to describe his own behavior in his book "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.  He compares his personal midlife crisis to what he considers the "midlife crisis of medicine," which has resulted in decline of public trust in physicians and burnout among doctors.  

He places much of the blame on what he calls the "perverse incentives" set up by external sources -- "The government plays a role, malpractice plays a role, third party insurers play a role, but we doctors play a role as well.  We've allowed greed to become a factor in our decision-making."

Says 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."  He site a multiplicity of factors including allowing the medical 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."

"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."