Not long ago, at dinner with a retired physician, I complained about the things doctors complain about today — administrative busywork, overpacked schedules, stagnant income. Embarrassed by my own whining, I conceded, “But, of course, every generation thinks the previous generation had it better.” My older colleague’s response surprised me: “No,” he said. “Actually, we didn’t think that at all. Back in the ’60s and ’70s we knew how good we had it.”
In the first pages of his bold and fascinating new memoir, “Doctored: The Disillusionment of an American Physician,” Sandeep Jauhar, a cardiologist now in his 40s, describes “the halcyon days of the mid-twentieth century” when physicians were “highly admired professionals” who “largely set their own hours and . . . fees.” Medical miracles like the polio vaccine were in the news and TV shows such as “Marcus Welby, M.D.” portrayed doctors as saints. Physicians in that era worked hard at medicine and, in return, enjoyed its perks: autonomy and respect, a comfortable living, golf every Wednesday.
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When Jauhar finished his medical training, he wasn’t expecting a career as idyllic as doctors in that golden age enjoyed. Any romantic notions he’d had about medicine were deflated during his grueling first year after medical school, as he detailed in his first book, “Intern: A Doctor’s Initiation.” But Jauhar couldn’t have anticipated the personal and professional nightmare that his next few years as a practicing physician would become.
“Doctored” covers, more or less chronologically, Jauhar’s first decade as a cardiologist, from 2004 to 2014. A brief prologue finds him in the present, “walking on a muddy path.” Like the dark wood Dante entered in midlife, this path is both literal and metaphorical. Jauhar’s Gap pants snag on a nettled bramble — and he’s thwarted in other ways, too. Anxious and unable to sleep, he’s under the care of a psychiatrist whose prescriptions can’t alleviate the dread with which Jauhar anticipates each workday. In “Doctored,” Jauhar tells how he reached this sorry impasse.
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Recruited by his older brother, Rajiv, to work in the Long Island hospital where Rajiv is on staff, Jauhar’s troubles begin almost immediately. Rajiv, the cocky, favored first son of this family who emigrated from India when the brothers were children, is an interventional cardiologist who rakes in twice what Sandeep earns as a heart failure specialist. Rajiv lives in a big house with a swimming pool and socializes with the doctors who make up his referral network. His younger brother, awkward and prone to depression, barely makes payments on the tiny Manhattan apartment in which he lives with his wife, a physician who’s staying home with their newborn.
Desperate for cash, Jauhar takes a gig shilling for a pharmaceutical company and moonlights reading medically unnecessary cardiac stress tests for a shady physician-entrepreneur. He even consults a guru, in an episode that is, like many in this memoir, at once hilarious and horrifying. Nothing works out for him. The drug he touts on the speaking circuit turns out to be no better than cheaper alternatives and he’s fired from his moonlighting job for his inability to kiss up to referring doctors. He writes an article about unnecessary medical testing in The New York Times, where he’s a contributor, and is shunned by many of his colleagues. In middle age Jauhar is broke and burned out, his marriage is strained and he’s a disappointment to his family. Worst, he’s a disappointment to himself: “I have become the kind of doctor I never thought I’d be,” he admits, “impatient, occasionally indifferent, at times dismissive or paternalistic.” His memoir’s title is a sad pun: Being a doctor has doctored Jauhar, adulterated him such that he hardly recognizes himself.
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Jauhar sets his own mid-life crisis in the context of medicine’s. He interweaves his personal story as well as anecdotes about his patients into a meticulously researched and painfully honest account of a profession that, like Jauhar, has lost its way; in which doctors are incentivized to provide expensive, suboptimal care and, in the process, become so alienated that most actively discourage their own children from becoming physicians.
Jauhar takes a bit of a risk in using his own story to illustrate the many complex problems of early 21st-century American medicine. This beautifully written and unsparing memoir puts a human face on the vast, dysfunctional system in which patients and clinicians alike are now entangled. But many won’t see the conflict between Jauhar’s professional ideals and his desire to continue living in Manhattan and send his children to private school as emblematic, nor will they find a broader solution in his own: a move to the suburbs.
Still, it’s hard to fault Jauhar for focusing too much on himself when his willingness to reveal his own foibles and vulnerabilities — unusual for a physician — is what makes this memoir so engaging. At one point he admits to a patient who’s feeling down that he’s been a little depressed himself. When she asks Jauhar, “Who hugs you, Doctor?” the reader, too, feels both concern and affection for him.
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I’m hoping for a third volume in the parallel sagas of Dr. Jauhar and American medicine, in which, approaching retirement, he finds peace, for his sake, in a medical profession set aright, for all our sakes.
Suzanne Koven is a primary care internist at Massachusetts General Hospital and writes the “In Practice” column for The Boston Globe. She can be reached at www.suzannekovenmd .com.