THE KITCHEN SHRINK

A beautifully written memoir about the author’s frustration with the transformation of the profession of medicine into the business of health care, and the unraveling of the doctor-patient bond.

As a leading psychiatrist, Wang has witnessed how “the insurance company has replaced the doctor as a patient’s primary medical relationship.” During her time as chief of the Psychiatry Consultation-Liaison Service at the University of New Mexico Hospital, her caseload was more than 1,000 new patients each year. She documents how this kind of pressure has been created by insurers with deep pockets who have driven independent doctors out of business by undercutting their fees, refusing to authorize necessary treatments and underpaying doctors for care that is authorized. In the 1990s, Wang welcomed the introduction of the new generation of anti-depressants. However, she soon realized that insurance companies would refuse to pay psychiatrists for treating patients with therapy—“Prozac, even at three dollars a pill, costs[s] far less than regular sessions with a highly trained psychotherapist.” Even though dedicated doctors work long hours at lower pay, tragically their efforts are undermined by profit-mad insurance companies, a transformation that began with the Reagan administration’s flawed argument that the free market would drive down escalating medical costs. The author recounts a number of tragic stories: e.g., a young woman in need of a second liver transplant who could not receive it because the facility where she was originally treated had closed down; an overworked physician so dedicated that she didn’t take time to get her own symptoms checked, and died suddenly of “acute complications of leukemia.” Even though Wang has recently cut back her practice in order to care for her young daughter, her commitment as a healer remains: “Every life is precious. Each life is worth our best effort. Each life lost is an alternate, possibly better world that didn’t happen.”

A thoroughly compelling message—without an ethical commitment to the value of every life, “the very humanity of our society” is at stake.