What made you decide to write your new book, Doctored? What were you hoping to accomplish?
When I was growing up, my mother wanted me to become a doctor. She told me, “I want people to stand when you walk into a room.” When I started my first job as a cardiologist, I realized I had been isolated from the changes occurring in medicine. I was a fellow in cardiology; I was learning about the human body, the heart, the physiology, and the therapeutics, but not about the culture of practice. I was shocked to see how unhappy many of my colleagues were. The unhappiness wasn’t just about paperwork, patients going on the Internet, malpractice, the usual things you hear about – it was a deeper, more existential problem. The problem was the systems of medicine didn’t allow them to be the kind of doctor they wanted to be – the same kind I wanted to be. When I entered medical school, I had this fantasy that I was going to reform the profession somehow. I didn’t know how, but I thought I would, somehow. When I got out, I started seeing physicians who were unhappy. I think their unhappiness was a response to this loss of ideals. I think a lot of physicians have had to compromise their ideals because of a diseased system. That’s why I wrote the book. I wanted to write about it and put it out there.
One of the book’s strengths as a memoir was the honesty with which you talked about your struggles – thank you for such an authentic, personal account. Was writing it difficult for you?
Yes, in many ways it was. The book was publicized as an exposé, but I don’t really think that is what it was. It was a basically introspective account of my struggles in a certain period in my life after I started medical practice. Most of the issues and moral quandaries involved me; I wasn’t really pointing the finger at too many people. Most of my struggles were with my own behavior and what I thought were my own shortcomings, and what I thought was a loss of my own idealism. People don’t like to have the finger pointed at them, but most don’t mind if you criticize yourself and point out your own mistakes. In that sense, I feel like the book was fairly well received.
How did the book affect your interpersonal relationships? Did you have to burn bridges to write it?
When you’re in crisis mode, you don’t really care that much about preserving relationships exactly as they are. I was in that frame of mind. All of my personal family relationships remain strong and intact. All of those struggles I wrote about came as no surprise to those in those relationships with me; there was nothing new there. I wrote the book largely after the struggles had resolved themselves, from 2011-2013. I had terminated the moonlighting work in 2009. All that work I had done was over, so it was really a retrospective look at what I’d been through.
What has the reaction to your book been – whether from colleagues, readers, or those not in medicine?
The book has been well-received and it’s been a largely positive response. The response from colleagues has been sort of dichotomous. There was a subset who basically said, “I can’t believe you wrote about this, this is just your experience, this isn’t going on everywhere,” things like that. Then there were others who basically said, “I can’t believe your book got on The New York Times best selling list because everyone already knows this is going on.” Some people thought there was nothing new, that it was all well-known. I think the feedback was for the most part positive about the honesty, about the courage in coming out about unsavory practices. Quite a few did give me flak for participating in those practices for the years that I did. My goal wasn’t to whine about my problems, though some thought it had that overtone; the goal was to present a moral struggle at a time in my life.
In the book, you seemed overwhelmed – there are references to “spinning wheels”, depression, feeling like you have no way out. There is somewhat of a turn at the end of the book, and while there is not really resolution there does seem to be hope. Has your outlook changed at all?
Yes, my outlook has changed so much. I am genuinely enjoying practicing medicine today. I had to reorient myself to what was important. The key has been to focus on taking care of patients and developing relationships with them. I am focusing on being the kind of doctor I always wanted to be. Getting out of moonlighting, in part by changing my lifestyle, has allowed me to focus on what I enjoyed about medicine.
Medicine is a wonderful profession. My son shows a predilection for medicine and I totally encourage it. In spite of the changes, I believe it’s going to remain a profession that is highly valued by the American public. It is a profession with ample rewards. It has taken me some time to come around and reacquaint myself with that kind of idealism; that’s why I called my struggle a midlife crisis. I think I came out of it in a positive way.
I have lived in the Midwest in my whole life, so I am admittedly unfamiliar with the New York City context. Do you think geography makes a difference? Do you think you saw the worst of it?
I think there is probably some truth to that. I happen to be working in Queens, [which is a] region with many physicians competing very seriously for patients and for procedures. I had a conversation with a doctor who said, “You think this is only happening in New York? This is happening everywhere, just to a different degree.” I think there’s some truth to that too. I got responses from all over the country, with doctors saying that this is happening in their communities. I think it is worse here with glut of doctors that might not be in other places.
What about specialty differences? Is cardiology particularly bad?
Cardiology is a specialty with many procedures, which are very highly reimbursed. That’s why there is financial motivation to do as many procedures as possible. Some of it is revenue driven, but some is cultural, and there are a lot of different motivations. Certainly every specialty has its share of criticism.
Do you have regrets about choosing cardiology?
No. I was interested in the heart from a young age. Both of my grandfathers died of a heart attack, so I was fascinated by the heart growing up. I always wanted to do cardiology; my fear was only whether I had the personality and the quick thinking to deal with cardiac emergencies. Overall I am very happy in cardiology.
A lot of the issues you talked about in the book, whether personal or systemic, seemed to stem from not having enough time. Because of this you’ve had to make sacrifices, especially with family time. Do you regret the sacrifices you’ve had to make?
It was difficult. In retrospect, it felt like there was very little I could do about it then. My relationship with my son is not any worse because of weekends away moonlighting. But it did bother me. The problems with moonlighting were a lot deeper than not seeing family; it was more the moral quandaries.
How long have you been writing? When did you first start to see yourself as a writer as well as a doctor?
Before medical school, I did a PhD in physics. I went to medical school because I wanted to help others, especially a friend of mine who had lupus. The summer before medical school, I did a science journalism fellowship with Time magazine. The journalist I worked with told me to go to medical school; he said, “You don’t want to be an ink-stained wretch like me.” In medical school I got an internship at The St. Louis Post-Dispatch and later with The New York Times. I’ve been writing for them since 1998.
What are some of your favorite things to read?
I recently read “The Heart”, which was a French novel. I really enjoyed that. I enjoy reading Abraham Verghese, he is a great writer and a friend.
How do you find time to write? What is your work schedule like when you’re writing?
I just have to find time to write – on the weekends, sometimes at night, sometimes in the morning. When I signed the contract for Intern, the editor gave me two pieces of advice: look at your writing to see what you can use, and write a little bit every day. I try to do that. Even if it’s just making notes or editing a paragraph, I try to do a little bit every day.
What does your family think of your writing?
Before Intern was published, my dad said, “it’s fine if you write, but focus on medicine.” He sees now it’s become a bigger part of what I do. He’s proud. My wife also realizes it’s something that’s important to me. Everyone is supportive of what I do.
What new projects are you working on?
I have an idea for a new book project, but I’m not sure if it will go anywhere, so I guess it isn’t really worth talking about. I am writing a lot of op-eds for The New York Times, so that has been taking up a lot of time. Writing has become an increasingly larger part of what I do. When I did the internship at Time and when I started medical school, I never really dreamed I would be writing as much as I do, but I do enjoy it.