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An Overly Pessimistic View of Medicine

doctored book cover

Sandeep Jauhar wrote Doctored: The Disillusionment of an American Physician to express his frustration with the modern system of medical care in America. I found the book profoundly disturbing. If his experience is representative, I can understand why so many people have been criticizing doctors for only caring about money. His experience was so different from mine that I wondered if I had led a sheltered life as a military physician and was oblivious to what was going on in the civilian world. After further reflection, I think Jauhar is unduly pessimistic. Whatever the opposite of rose-colored glasses is, he’s wearing them.

His personal experience of medicine

Dr. Jauhar is a cardiologist who works in a large teaching hospital, where he had been hired to develop a program for patients with heart failure that would implement the most up-to-date medical knowledge and provide the best possible medical care. After long, grueling years of school, residency, and fellowship, he is elated to have finally finished his training and started a job where he can accomplish something good. But he soon sinks into despair. He is appalled by the realities of life as an attending physician, the many ways in which the “system” interferes with his efforts to provide the best care to patients, the unethical behavior of other doctors, and his inability to support his family.
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Paternalism Revisited

Paternalism is out of fashion. Doctors used to have a parent-child relationship with their patients: they concealed the truth if they thought it was in the patient’s best interest, they dictated the treatment and did not have to justify it to the patient. “You have to take this pill because I’m the expert and I know what’s best; don’t ask questions.” Sort of like “You have to go to bed now – because I said so and because I’m the mommy.”

Some time in the 20th century we evolved to a different doctor-patient relationship, an adult-adult one in which the doctor shared expert knowledge and information with the patient and they cooperated to decide on the best treatment plan. The principle of patient autonomy became paramount and the patient gave informed consent to the chosen treatment.

It is generally accepted that this is all for the good. But is it really? In his book Intern: A Doctor’s Initiation, Sandeep Jauhar says, “Over time, my views on informed consent have evolved. I no longer view paternalism as suspiciously as I once did. I now believe that it can be a core component of good medical care.” (more…)

Posted in: Medical Ethics

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