As a medical school student in the 1980s, Dora Calott Wang expected to practice Marcus Welby medicine that would lead her to intimate, long-lasting relationships with her patients. Instead, she found herself a helpless bystander to the disintegration of the doctor-patient bond by a profit-driven health insurance industry.
In her book The Kitchen Shrink, Wang delivers an insider's view of what your doctor is really doing while you are waiting for your appointment, why most physicians seem more interested in paperwork than in having a conversation with you, and why some patients get better medical care than others.
In a series of heart-wrenching narratives plucked from her 20-plus year career, Wang, a psychiatrist, creates a stark portrait of the American medical industry: There's Selena, an 18-year-old girl who died after her insurance company refused coverage for a liver transplant; there's a colleague, overworked by a hospital that had to demand more from its doctors so it could afford to keep the doors open, who neglected her own health to tragic consequences; and there are stories of how a failing and ignored mental health system is leaving the ill with nowhere to turn for help. (Read an excerpt from The Kitchen Shrink.)
AARP Bulletin talked with Wang about her experiences as a doctor, her views on managed care and her hopes for the future of medicine.
Q. You came of age in the medical profession as it was transitioning to managed care. Can you compare the way doctoring was when you were in medical school to what it is now?
A. I started medical school in 1985. Each life was considered equally precious, regardless of insurance status or social economic class, and I don't think that is the way it is now. In the early 1980s, medicine got deregulated, along with the airline industry and the financial industry. Wall Street and for-profit corporations were encouraged to get into medical care. But profit and medical care are just not compatible.
Q. In the book, you tell the story of Selena, an 18-year-old liver failure patient suffering from depression. How does her experience illustrate what you believe to be wrong with health care today?
A. I realized that the patient and the doctors were not in charge of final medical decisions anymore. The ultimate decision lay with the insurance company because they held the purse strings. The health care reform bill signed into law a year ago is tremendous progress, and certainly I applaud the people who are brave enough to actually address the issue.
Q. What about health care reform addresses your concerns?
A. Mostly I am encouraged that finally everybody knows it's a problem. Health care reform has made it illegal for insurance companies to cancel coverage when patients get sick. This was happening, and now that's illegal.