Monday, July 26, 2010

Review & Guest Article: The Kitchen Shrink by Dora Calott Wang, MD

The Kitchen Shrink by Dora Calott Wang, MD


Book Description:
Dora Calott Wang is a Yale-trained psychiatrist who began her career as a doctor with great enthusiasm. But after less than a decade of her practicing medicine, that enthusiasm was shattered by the seismic shifts that shook the entire medical profession.

Once a cherished, even sacred, vocation, medicine has become a business driven by profit. What made medicine turn its back on its central tenets? In The Kitchen Shrink, Wang explores what happened, through the prism of her own research and experience. In these pages we watch as she struggles to maintain her professional standards as health care's priorities shift away from the compassionate care of patients and, instead, toward improving the bottom line, and along the way we meet some of her patients, whose stories reveal an oft-ignored human side of our besieged system. As the medical landscape shifts beneath Wang, she confronts depression and exhaustion, and fights to find a balance between work and home, as it become ever clearer that she cannot untangle the uncertain futures of her patients from her own.


Part memoir and part rallying cry, The Kitchen Shrink is an unflinchingly honest, passionate, and humane inside look at the realities of free-market medicine in today's America.


About the Author:
Dora Calott Wang, M.D., is Assistant Professor of Psychiatry at the University of New Mexico School of Medicine. A graduate of the Yale School of Medicine and the UCLA Neuropsychiatric Institute, she received her M.A. in English literature from the University of California, Berkeley, and has been the recipient of a writer's residency from the Lannan Foundation. Her memoir, The Kitchen Shrink: A Psychiatrist's Reflections on Healing in a Changing World was published by Riverhead Books, The Penguin Group.




For more information, view Dora Wang's Web site and follow the author on Facebook and Twitter.


Guest Article by Dr. Wang:
Is Wall Street Making Life or Death Decisions?
By Dora Calott Wang, M.D.,
Author of The Kitchen Shrink: A Psychiatrist's Reflections on Healing in a Changing World


Is your health insurance company traded on Wall Street?


If so, is Wall Street deciding your medical care?


It's hard to recall that for-profit corporations were once kept out of health care -- in fact, for most of the 20th century. During this time, the nation's medical system was built largely by non-profit and charitable organizations, which is why so many hospitals are named for saints. Courts across the country ruled that for corporations to profit from medical care was simply "against sound public policy." In the early 1980's, however, when the financial and airline industries were deregulated, a similar process occurred for American medicine. For-profit corporations became newly encouraged to take leadership of health care. Deregulating health care into the free market was intended to drive down costs and to improve care. After all, medical care in 1980 consumed a whopping 9.1 percent of the nation's GDP.


Never mind that after 30 years in the free market, health care costs have doubled to consume 18 percent of the GDP (with a third of these precious dollars wasted on bureaucracy). Never mind that health care has gotten increasingly inaccessible to the uninsured and even the insured, or that American health care has become an international poster child for reform.


The real issue is that modern medical care has simply, finally, gotten so effective. Today, even cancer and AIDs are no longer death sentences, and if organs fail, you try to get a new one. But prior to the discovery of antibiotics and vaccines in the 1930's, leeches were routinely applied, and medicine was steeped in superstition. Between 1918 and 1920, three percent of the world's population was wiped out -- by the flu.


The fair and effective distribution of life-sustaining resources like food, water and shelter, is the very story of civilization. Yet now, thanks to centuries upon centuries of civilization and scientific inquiry, we have at last, a new life-sustaining resource -- modern medical care, which is less than 80 years old.


How should this powerful new resource be distributed? I believe that medical care shouldn't be considered an ordinary product, like athletic shoes or flat screen TV's. Rather, it is quickly becoming essential, like water. Yet there will be no easy answers when it comes medical care, in this brave new world in which DNA is already being tweaked to grow completely new organs. We are embarking on a new, complex and long chapter of history.


I can't help but think that health care reform isn't over, and wasn't concluded with the signing of the Patient Protection and Affordable Care Act in March.


I believe that health care reform will be our entire future.


In the meantime, for now, how is modern medical care, a new Prometheus' fire, being distributed and decided in the United States?


Physicians and patients sit face to face and discuss medical decisions -- about whether a life-sustaining cardiac bypass surgery is warranted, or whether a new liver should be gotten. But ultimately, the purse strings on medical care are held by health insurance companies.


The new health reform laws will obligate insurance companies to provide "coverage" even when patients become sick or if they have a "pre-existing condition" or what I will call "illness". The PPACA has a provision on "administrative simplification" scheduled to take effect in 2014, which aims to streamline the process of doctors and health care providers asking for approvals from health insurance companies before treatments are rendered.


But even after the new laws are implemented, health insurance companies, many of them for-profit corporations traded on Wall Street, will continue to hold the purse strings on medical care.


Our recent health reform efforts are landmark progress in the right direction.


However, in the last thirty years, the values of Wall Street have so infiltrated the values of American society that seemingly all aspects of life are impacted, even medical care of the human body and mind, even the everyday life or death decisions that happen in doctor offices and hospital rooms.


© 2010 Dora Calott Wang, M.D., author of The Kitchen Shrink: A Psychiatrist's Reflections on Healing in a Changing World








Here's What I Think:
The state of our health care system is something effects us all, even if not directly. It was rather interesting to see the ongoing "crisis" from an insider's point of view. Dr. Wang makes so strong arguments in favor of returning to a much more patient centered practice of medicine. And though I do tend to lean that way, it is also important to recognize that with the profits come the spoils - like advancements in diagnostic equipment and life-saving medicine. We are definitely stuck in point of cultural lag - where our needs are not totally in-line with our wants or our abilities. I think that it will take time for all of the advancements to find their place. Again, this was an interesting read, it is always good to get a different perspective on a current event.










Disclaimer: Although I did receive a copy of this book from FSB Associates, I was in no other way compensated to write this review.


1 comment:

  1. Interesting. As a Canadian, I've been following the health care reform debate in the U.S. with interest. These issues are definitely something that doctors need to speak up about. Unfortunately, not all of them are as brave as Dr. Wang.

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