Jack Spenser, M.D. begins Medicine Goes Corporate, his fourth book, in a therapy session. His psychiatrist is encouraging him to write a book about the crushing corporate structure that makes it all but impossible for doctors and health care providers to do their jobs. The quotas, the expensive digital systems, the rapid pace that prevents them from spending adequate time with their patients. Spenser deflects, saying that no one would care. But the psychiatrist pushes back:

Dr. Conner said, “My husband’s radiology group just got bought out by a national company, a huge corporation. Now they have all these metrics in place, which are monitored to make sure they are productive, and to make sure that there is no way any of the radiologists is not working hard all the time. He wants to quit. I suggested he just work at his own pace, and when he doesn’t meet his quota, well, they can fire him—no big deal. He wants to retire anyway. And my daughter, the pediatrician, same thing. When she finished her training, she went to work at her med school, and she has all these quotas in place, like how many patients she has to see in a certain amount of time, which works out to, like, five minutes a patient! That’s not enough time. She can’t do her job the way it’s supposed to be done…Everything in medicine is going corporate, and no one is telling that story. You need to.”

Spenser, of course, ended up agreeing with her that his story was worth telling. And the resulting book, Medicine Goes Corporate: My Tale of Corruption, Injustice, and Greed is a semiautobiographical story that Kirkus Reviews calls “a taut amalgam of medical thriller and convincing exposé about medical industry kingpins and exasperated physicians.”

Although “Jack Spenser, M.D.” is a pseudonym, the man behind the name is a real doctor who lives in the Southeast. He’s written memoirs before, but Medicine Goes Corporate is identified as a work of fiction in the opening pages, with the usual legal disclaimers about there being no relation to actual living persons and events. But as Spenser points out, “fictional” doesn’t mean “a lie.”

“The important thing for me, though, is that to write, I need data,” he says. “I need data both for my fiction and nonfiction. I chose to label Medicine Goes Corporate as fiction because I wanted to tell a story; I didn’t want to be bogged down, checking and rechecking every fact and memory, like I did when I wrote my memoirs. I just wanted to just let it rip. For example, I let Spenser ( the fictional main character) think, say, and do some things that Spenser (writer, real life person) would prefer to keep to himself. There are plenty of nonfiction books out there about the state of medical care in America, and I didn’t think another nonfiction book, even a memoir, would add much, and probably would not be that entertaining.”

That entertainment factor is important to Spenser, which might be surprising given his scientific career and the fact that his writing is about such heavy issues as health care infrastructure. Spenser notes that most people spend an enormous chunk of their lives striving to do their best in the workplace, finding dignity and purpose through doing the best they can in their careers. One of the cruel effects of corporatization is that health care workers are prevented from doing the very things that make them good doctors. And, of course, they’re demoralized in this huge portion of their lives.

“Plenty of books are written about families, romances, and coming-of-age stories,” says Spenser. “But not many are written about the drama, love, competition, conflict, etc. that happens in the workplace. And such stories are important! In Medicine Goes Corporate, big corporations and institutions make it impossible for health care workers to do their best, to perform the functions they are called to do. The results affect patients and their families; I hear bitter stories of suboptimal care from my friends and family members.”

Spenser notes that people have written plenty of nonfiction accounts of the horrors of the American health care system, but he hoped that fictionalizing his own experiences would add valuable moments of humor and sadness that function best as beats in a fictional story. The workplace, which Spenser focuses on in his writing, may not be a place where people can freely express their emotions, but that doesn’t mean they don’t happen.

“My contention is that drama, conflict, passion, and pretty much any other part of the human condition occurs at work,” says Spenser. “I have no idea how to take these boring settings and write stories that are interesting and compelling for readers. All I can do is try. I find that if I am interested in what I write, or even laugh out loud as I write, then the words on the page will probably resonate with readers.”

Kirkus describes Spenser’s accounts of the hospital as a place riddled with “smoldering frustration, whirlwind corporate corruption, surprise audits, and, eventually, aggressive push back from Jack and his associates, which threatens to bankrupt them financially and emotionally.” Kirkus also notes that “the best aspect of Spenser’s book is its believability and how convincing Spenser’s protagonist becomes as the story progresses.”

Spenser says that these aspects of fictional writing—creating compelling, emotional journeys for the reader—took a long time for him to master. When he was younger and struggled to craft stories, he thought that his difficulties meant that he wasn’t meant to do creative work. After all, the great writers of the ages simply needed to put pen to paper and let their genius flow, right?

It wasn’t until he came across Anne Lamott’s book Bird By Bird that Spenser realized that writing is hard for everyone. “Then, amazingly, at first the words came out like crazy,” he says. “It was like I had all these experiences built up over my whole life, tons of data waiting to be turned into stories. I took an evening course on writing at our local community college that met weekly, and I wrote a short story for the class to read every single week. I didn’t think anything of it. That writing was not very good, and none of it got produced or published. But I was learning. It was my apprenticeship. And I kept at it.”

Finally, Spenser learned that he could take the same approach to writing that he took to becoming a physician: working hard and getting better, bit by bit.

Now, Spenser uses his creative skills to amplify the issues that matter most to him. By using his artistic toolbox to make complex issues more accessible for general readers, he hopes to shine a light on how the American health care system thwarts doctors and harms their patients.

“Those bitter stories of suboptimal care from my friends and family members…they also affect health care workers, who can’t provide the best care their patients need. In my opinion, nothing I do is more important than writing these books. And I know that in the grand scheme of things, the effects of my efforts, and of most others’, are negligible. Which is kind of discouraging, but also heroic. Such stories need to be told.”

Chelsea Ennen is a writer living in Brooklyn.