New Book Highlights a Fractured Healthcare System & Prevalence of Defensive Medicine

The director of Long Island’s Heart Failure Program has authored a new book that highlights the plight of a fractured healthcare system, in which doctors function more as businessman than health care practitioners. In “Doctored: The Disillusionment of an American Physician,” Dr. Sandeep Jauhar laments the protracted bureaucratic battles and “treadmill medicine” facing U.S. medical providers, and their detrimental effects on the quality of patient care and doctor morale.

“When I look at my career in midlife, I realize that in many ways I have become the kind of doctor I never thought I’d be: impatient, occasionally indifferent, at times dismissive or paternalistic,” reads the opening sentence.  Dr. Jauhar argues that as millions of Americans join the Affordable Care Act, healthcare professionals continue to battle a mountain of redundant paperwork as they struggle to “game a system” already burdened by rising malpractice insurance costs.

More doctors practicing defensive medicine

As an insight to his increasing disenchantment, Dr. Jauhar discusses one of his former patients, a senior who came to him complaining of shortness of breath. The 50-something year old man endured twelve separate procedures, saw 14 physicians and spent thousands in medical bills before being released with only little improvement.

Doctors are not only practicing defensive medicine to stave off possible malpractice suits and milk income from reluctant insurers, they are chronically unhappy with the breakdown in the healthcare system.  The book cites some grim statistics, including one 2008 study where only six percent out of 12,000 doctors reported a positive morale. In fact, Dr. Jauhar reports that more than 40 percent of health care providers say they would chose an alternative profession if given the chance to start over.

Jauhar speculates that this mid-life crisis in medicine has prompted once idealistic doctors to resort to potentially unethical practices, like pushing for needless tests and dragging out patient care just to cash in on reimbursements.  This vicious cycle of defensive medicine, a.k.a. “cover your ass” medicine of unnecessary tests and procedures costs more than $750 billion every year.

Rapid decline in quality patient care

“The physician-patient relationship is the worst it ever was,” says Dr. Jauhar, who expressed his skepticism with the US healthcare system in his first book “Intern.” Given less time to spend with patients  (primary care providers spend a mere 8 to 10 minutes with each), research suggests that doctors are depending more and more on pricey exams, rather than listening to the concerns of their patients. The result: a growing number of malpractice lawsuits involving diagnostic errors, missed diagnoses and other medical mistakes.

Jauhar doesn’t fault the doctors, however, and instead blames a bureaucratic system that lends itself to inefficiency, poor patient care and the rampant practice of defensive medicine. “There is a palpable sense of grieving. The job for many has become just that — a job,” he writes.

Surveys and studies can only estimate the incidence of defensive medicine in US clinics and hospitals, so accurate assessments are incredibly difficult to come by. Malpractice costs have pushed many providers, especially those in the OB-GYN field, to abandon their home states in search of more affordable insurance.

Ironically, unwarranted tests, invasive procedures and surgeries can constitute violations of the standard of care, and form the basis for a medical malpractice claim.