“Doctored,” meaning restored to good condition, comes from the world of medicine, though it’s commonly used today to mean being made impure, in order to trick or deceive, as in “doctoring the evidence.” In his new medical memoir, Doctored, Dr. Sandeep Jauhar, a cardiologist who directs the Heart Failure Program at Long Island Jewish Medical Center, plays on both senses of the word. But the emphasis is clearly on the negative meaning, as if you couldn’t tell from the subtitle of the book: “The Disillusionment of an American Physician.” Jauhar’s earlier memoir, Intern, recounted his first year out of medical school – he already had a Ph.D. in Physics – as he confronted what he saw as the brutal, competitive, wasteful world of medical practice. If his experiences then were an eye opener for him – and for us – what can be said about this new medical expose eight years later? For one, that it’s even more depressing – and disturbing. It’s a diagnosis of failures in both private practice and hospital care.

(Jauhar) continues to target the "rising commercialism" of the medical industry and what he sees as its disastrous effects. - Joan Baum

It is also, however, well written and well argued. In his columns for The New York Times and The New England Journal of Medicine, the good doctor - dedicated, desperate to be a humane caregiver – continues to target the “rising commercialism” of the medical industry and what he sees as its disastrous effects: ballooning costs all around, harm to patients, the “fraying of the traditional doctor-patient bond,” constant money-driven anxiety particularly for doctors who elect academic medicine or public service. And, most of all, what he sees as the harm marketplace medicine is doing to doctors themselves. In 2008, only 6 percent of doctors described their morale as positive. Doctored is filled with examples of burn out, collusion with greedy administrators, over-testing, over-consultation and costly hospital readmits. “A tragic cycle” in which doctors, hospitals, politicians, insurers, drug companies and patients are locked in a system that’s become more corrupt and impersonal.

And yet, Jauhar’s still in there trying to do the right thing, though he confesses to cutting corners, even signing on to perform dubious services. He still wants to lead with his heart though and he still prefers being a salaried hospital doctor to going into private practice. But over the years he's changed. He’s no longer opposed to technology, and he understands what drives cynics like his older brother, who's an intervention cardiologist and knows how to play the game.

Although he probably didn’t intend it to be taken metaphorically, the book has an intriguing opening line: “I am walking on a muddy path.” He is. Literally, a muddy road. But he’s also caught in a mire, aware that he’s strayed from the idealistic prompts that led him into medicine in the first place. The memoir allows him to reassess his goals and practices. And point the way to future doctors to beware the muddy path and, if they can, as much as they can, keep to the straight and narrow.