Doctored Read Free Page B

whether his kidney function was going to get better. “The doctor said, ‘What do you mean?’” my patient told me. “I said, ‘Are my kidneys going to come back?’ He said, ‘How long have you been on dialysis?’ I said, ‘A few days.’ And then he thought for a moment and said, ‘Nah, I don’t think they’re going to come back.’” My patient broke into sobs. “‘Nah, I don’t think they’re going to come back.’ That’s what he said to me. Just like that.”
    Of course, doctors are not the only professionals who are unhappy today. Many professions, including law and teaching, have become constrained by corporate structures, resulting in loss of autonomy, status, and respect. But as the sociologist Paul Starr writes, for most of the twentieth century, medicine was “the heroic exception that sustained the waning tradition of independent professionalism.” It is an exception whose time has expired.
    *   *   *
    This book is not only about the midlife crisis in American medicine, but also about my own struggles as a middle-aged doctor, husband, and father to find equilibrium in my life and my practice. In my book Intern I describe the formative years of my medical training at a New York City hospital. Doctored is the further story of an education, about the loss of ideals and about midlife corrections and solutions. In fractal geometry, there is the concept of self-similarity, in which component parts resemble the whole. As in a coastline, reiteration of patterns occurs at progressively smaller scales. The premise of this book is that much can be learned about how to heal American medicine, forty years old in its modern incarnation, in a midlife portrait of one of its practitioners.
    Everything that appears on these pages actually happened. However, most names and identifying details have been changed to preserve confidentiality; in some places, time has been compressed or the order of events has been changed for the sake of narrative cohesion; and in rare cases I have used composite sketches to better represent my experience. Dialogue is usually based on notes taken at the time, though some has been reconstructed from my memory.
    The practice of medicine today is as fraught as it’s ever been, and the doctor-patient relationship is in serious trouble. One of my goals in writing this book is to understand why. These are not trivial problems. How they are resolved will in no small part determine the future of health care in this country.

 
    PART I
    AMBITION

 
    ONE
    Awakening
    A young doctor means a new graveyard.
    â€”German proverb
    I had been pedaling furiously for nearly a decade—on a stationary bicycle. Medical school, internship, residency, and fellowship: my education seemed as if it would never end. So it was with no small measure of relief that in the late spring of 2004 I accepted a position as an attending cardiologist at Long Island Jewish Medical Center in New Hyde Park, New York. This was the last step in a long and grueling journey. After medical school I’d completed three years of hospital instruction in general internal medicine to earn the privilege to practice independently. After finishing this internship and residency, I’d elected to do a fellowship: three more years of study in cardiac diseases to further specialize. Now, with the fellowship concluded, I’d become an attending physician, the senior level of the hospital hierarchy, with ultimate responsibility for patients and junior doctors. Nineteen years after starting college and a few months shy of my thirty-sixth birthday, I finally had my first real job. The complexities of academic medical training had long since worn thin. I was ready to simplify, consolidate, and perhaps even reap some rewards for all those sleepless nights.
    Cardiology was a natural career choice. I had trained as a physicist before