Doctored: The Disillusionment of an American Physician

In his 2007 memoir, Intern, Sandeep Jauhar recounted two years of a grueling internal-medicine residency. Doctored, which continues his story through his first five years of practice as a cardiologist at a large teaching hospital, shares with its predecessor its author's gift for precise, observant writing, and it offers an unsettling portrait of the state of American medicine today.

Eight years after graduating, Jauhar joined the staff of Long Island Jewish Medical Center as a cardiologist specializing in congestive heart failure, the treatment of which is a $40-billion annual business. Almost from the beginning, he was beset by relentless financial pressure, as he struggled to support his wife and newborn son in New York City on his hospital salary. Most of his angst was the product of a system whose financial incentives pit hospitals and physicians against each other and frequently run counter to what he considers optimal patient care.

Doctored features many vivid accounts of Jauhar's encounters with patients and colleagues, illustrating the high-stakes ethical and professional decisions physicians face daily. These stories, often deeply personal, bring a human dimension to his sharp critique of a "system that makes us bad, makes us make mistakes." The "us" is key: Jauhar is as unsparing in judging his own conduct as he is that of his profession as a whole.

It will take much more than this book to cure the critically ill American health-care system, but we can thank its author for starting the conversation that may help speed a recovery. --Harvey Freedenberg, attorney and freelance reviewer

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