Jauhar applied the “Page 99 Test” to his new book, Doctored: The Disillusionment of an American Physician, and reported the following:
Page 99 of Doctored: The Disillusionment of an American Physician is actually quite representative of my book, which is about the blatant cronyism, corporate ties, and unnecessary testing that have become routine in American medicine.Learn more about the author and his work at Sandeep Jauhar's website.
An elderly woman I’ve been taking care of in the hospital is about to be taken to the operating room for surgery to replace a damaged heart valve. The woman, Mildred Harris, is 74 years old, frail, and virtually bedbound. I’d previously decided that surgery would be too risky for her and that I was going to send her home. But the evening before she is to be discharged, I receive a call at home from a colleague asking me if I know that my patient is scheduled to go to the operating room the following morning. Stunned, I immediately phone the surgeon, who explains that he is being pushed to operate by Ms. Harris’ outpatient cardiologist, Richard Adelman. “It’s a very political situation,” the surgeon tells me apologetically. “Adelman is a big referrer.”
I tell the surgeon that I am the only cardiologist leaving notes on Ms. Harris, and that I have been recommending no surgery for days. The surgeon explains that Dr. Adelman called him directly. “Adelman sends me a lot of business,” he says. “I don’t want to lose it.”
The story continues on pg 99:A group of us had an urgent meeting in Rajiv’s office the following morning before the operation. “Just let them do it,” a colleague told me. “Medically, it may or may not be the right thing, but politically— well, if she goes back to Adelman with shortness of breath, he’s going to say, ‘What the fuck, we sent her over there for an operation, and those guys didn’t do anything.’”
Rajiv agreed. “You did what you thought was right,” he said. He reminded me that there were differences of opinion over whether mitral valve surgery was warranted in elderly patients like Mildred Harris. How could I be so sure that my judgment was correct? I told him that at the very least there should be another opinion in the chart. How could I agree to send my patient for surgery now when I had dismissed the idea in all my previous notes?
“No one is going to blame you,” Rajiv said coolly. “If they take the patient to surgery without your permission, the burden is on them.” He smiled slyly. “If anything, you may be subpoenaed to testify, but that’s all.”
When I went upstairs to talk to my patient, transporters were already there with a stretcher to take her to the OR. I asked Ms. Harris how she was feeling. “I couldn’t sleep all night,” she said, as the orderlies transferred her to the narrow transport gurney. “I thought you told me I could go home.” I told her the decision had been changed.
The Page 69 Test: .