Khaas Baat : A Publication for Indian Americans in Florida
Health & Wellness

Doctored’ – A book about our ailing medical system

Dr. M. P. Ravindra Nathan

By M. P. Ravindra Nathan,

Are you concerned about the skyrocketing costs of healthcare in USA? Would you like to know what drives these costs up and what can we do about it? If so, you must read the recently published book “Doctored – The Disillusionment of an American Physician” by Dr. Sandeep Jauhar (Farrar, Straus and Giroux, New York, 268 pages), head of the Heart Failure Program in Long Island Jewish Hospital, N.Y. It is a riveting memoir of his own life as a fulltime cardiologist struggling with the many challenges, problems and frustrations in his practice. Unfortunately, all these have had an impact on his family life and personal finances as well. As a sincere cost- conscious physician, he is concerned with the unhealthy trends in the current day medical practice that include physicians doing unnecessary tests to fatten their wallet, cronyism determining patient referrals, HMOs not giving preauthorization in deserving cases, rampant practice of defensive medicine and more. Ever the conscientious, idealistic and hardworking physician, Jauhar finds all these quite distasteful.

DoctoredAmerican doctors are increasingly unhappy with their once-vaunted calling, and its hurting patients. But the medical profession can heal itself,” says Jauhar. One senior internist who has a big practice in town constantly complains: “New reimbursement is so low, I have to see at least 30 a day. If I stay in the room for more than 10 minutes, my assistant will tell me to hurry up!” A busiest cardiologist with high earning grumbles: “Sandeep, you have to understand, running a big show costs a lot of money. If I am not doing 10-plus nuclears (special stress tests) on a given day, I am losing money.” And here’s how his nuclear technician, justifies it: “Amir is a businessman, you understand, that’s the way you have to be if you want to survive today.”

In a recent survey of 12,000 physicians only 6 percent described their morale as positive. That certainly doesn’t bode well for patients or our health system. The state of health care needs a lot of improvement. Physician burnout is becoming more common because of the demands of practice with diminishing returns.

Some of Jauhar’s observations are right on the mark: “A doctor who owns a nuclear scanner is seven times as likely as other doctors to order a scan.” “Queens (one of the main offices of a high volume cardiologist) was like a black market, where the currency was referrals and health-illiterate patients were traded back and forth like commodities.” Unfortunately, this phenomenon is pervasive throughout the nation and prevalent among all specialties as well. No wonder health care expenses are escalating to astronomical heights.

Medical spending is highest when 100 percent of the costs are covered by the insurance company. This is what Dr. Jauhar calls “moral hazard hypothesis.” Maybe all of us are all a little guilty of taking advantage of the system. Even Jauhar, the exemplar of idealism transitions briefly into a proponent of realism till he reverts back to his original philosophy. However, I must also tell Jauhar is not doom and gloom at the medical front. Most physicians are ethical in their practices and there are checks and balances to follow. And the blame for rising health care costs should equally shared by hospitals, insurance companies and patients themselves.

Authored by an outstanding academic cardiologist, “Doctored” is an explosive, no-holds-barred, candid portrayal of the current events and business practices in health care today – a true eye-opener. He points fingers at the "collective malaise" that’s all too prevalent in the American medical profession. This bold and critical narrative of the way we practice medicine interwoven with his own personal story, and annotated with patient stories, is truly arresting. Although it may offend a few practicing physicians, the facts cannot be refuted and the presentation is outstanding.

Doctored” is a must read for all those connected with the practice of medicine and health care debate as well as non–medical public. I consider the book a valuable contribution to the medical and literary world.

Eye Care

DROP the Eye Drops: Eye drops can become a thing of the Past


The mainstay of drug delivery for any eye problem has been eye drops, so why change?

The main problem with eye drops has always been inconsistent dosage since each person may drop differently and may even miss it completely (elderly patients with tremors for example), additionally, the drop may have variable penetration (reach and concentration) to the final target tissue in the eye (for example a drug which may be needed to reach the retina for macular degeneration) and then of course the repeated need to apply the drops.

We have been fortunate to be involved in futuristic drug delivery systems in the eyes, which try and combat these very issues of dependable and consistent dosage along with effective reach to its specific target.

My wish list to eradicate eye drops includes the following criteria:

  1. Ability to reach the specific affected tissue of the eye (example ciliary body in Glaucoma or macula in retina) so lower dosage is required and less toxic actions are observed;
  2. Be consistent in dosage so there is no fluctuation from varying drug levels leading to inadequate control of a disease;
  3. Be sustained-release meaning allow for one application that could last 6 months to a year;
  4. Non-toxic to adjacent tissues in the eye’
  5. Serve associated functions in delivery mode, i.e. Lacrimal plugs impregnated with the drug can correct dryness (from plugs) as well as treat glaucoma with the drug being released from the plug.

Today’s technology allows us to inject drugs in the eye exactly where they are needed to provide best concentration as well as avoid unaffected tissue therein. This is effectively seen in intra-vitreal injections such as Avastin/Lucentis for macular degeneration cases.

New development in this direction are the Microneedles, ranging in length from 400 to 700 microns (almost too small to be seen with the naked eye may). A painless microneedle injection made once every three to six months — potentially during regular office visits — could improve treatment outcomes by providing consistent dosages which could overcome patient compliance issues.

We do in fact use injectable drugs during cataract surgery so most patients may not need to use eye drops. This also provides added security since we have ourselves during surgery applied the medication thus making sure the required medication (no guesswork of what patients may be using at home) is at the required site in the required dosage for the required duration

I personally always like for every surgical action to be elegant and multipurpose and hence like the recent study we performed where the lacrimal plugs (used for dry eyes: Previous Khaasbaat edition) can have the medications in it so it slowly releases it into the eye while also helping dry eyes and additionally decreasing the amount of drug entering the body (via the lacrimal system).

If I had it my way, I would also have the drops perfumed so it would address one more function in our daily routine

Before I take on the perfume industry in this fashion, we will let time pan out the final frontier in medication delivery to the eyes so these eye drop bottles could become an historic relic on a museum shelf somewhere someday.

Arun C. Gulani, M.D., M.S., is director and chief surgeon of Gulani Vision Institute in Jacksonville. He can be reached at or visit

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