"The Doctor's Art" is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe/follow on Apple, Spotify, Amazon, Google, Stitcher, and Podchaser.
Navigating the unforgiving hours and ethical challenges of medical training while holding onto humanism; the medical and cultural history of the human heart; the moving journey of a doctor as he wrestles with his duties as a son and caregiver for a father with dementia. These are just some of the diverse subject matters that this week's guest, Sandeep Jauhar, MD, PhD, has written about.
Jauhar is the director of the Heart Failure Program at Long Island Jewish Medical Center and a multiple-time bestselling author whose writings have also appeared in the New York Times, Wall Street Journal, and other publications.
In the first half of his conversation with Henry Bair and Tyler Johnson, MD, Jauhar shares his journey in medicine and struggles with burnout. In the second half, they discuss his poignant experiences caring for his father, the subject of his most recent book, My Father's Brain: Life in the Shadow of Alzheimer's.
In this episode, you will hear about:
- 2:02 How Jauhar's immigrant parents impacted his choice to pursue a career in medicine
- 4:49 Jauhar's reflections on the role of indecisiveness in shaping his path to cardiology
- 12:51 A discussion of a doctor's struggle against a corporate medical system that inflicts moral injury on physicians
- 18:54 Jauhar's advice to physicians on ameliorating moral injury
- 25:10 Reflections on how Alzheimer's disease affects the patient's family, and an overview of Jauhar's recent book
- 36:43 A discussion of therapeutic deception, also known as validation therapy, in which caregivers and loved ones are encouraged to "play along" with the distorted reality of a patient with dementia
- 43:18 The conflicts between Jauhar and his siblings concerning end-of-life care for his father
- 49:05 How the medical system needs to change so that more support is given to dementia patients and their families
The following is a partial transcript (note errors are possible):
Bair: To kick us off, can you tell us what first drew you to a career in medicine?
Jauhar: Well, it was probably my father, actually. He was a scientist, a geneticist, and, you know, put a lot of say on science, but also on pragmatism, for lack of a better word. You know, he wanted me to have a career where I could do well and do good for people. And, you know, my parents were immigrants to this country. Like many immigrants, they had a lot of fear that they wouldn't make it. And they wanted their children to have a secure future.
So, it was sort of in that context that my father would talk a lot about medicine. He actually wanted to be a doctor, but he couldn't afford to go to medical school. So he ended up going into plant genetics and was very successful. But when he came to this country, he sort of butted heads with what he regarded as a racist university tenure system that, you know, didn't really properly value his training and his work done abroad, mostly in India. And so he didn't really want us to sort of struggle like he had struggled in academia.
But I remember one day telling my dad, you know, I went to Berkeley and we were having lunch one day and I said, "Dad, I've decided that I'm actually going to study physics. I'm not going to go into medicine." And he said, "Well, okay, that's okay. That's sort of a second, second best option, if you will."
And so that was the kind of twisted sort of culture I grew up in where rebellion was saying no to a career in medicine, but then going into physics. So yeah, but you know, eventually, I went to Berkeley, I got a degree in physics, and I wrote about this quite a bit in my first book, Intern. I had a lot of second thoughts about creating, you know, a career in physics. I think the problem I was having was not feeling that the work I was doing was really going to make a lot of impact on people. I mean, I know it sounds a bit of a cliche, but I really wanted to help people. I wanted to have an impact on people's lives. And I decided eventually that medicine was the best way to do that. And so I made a switch after graduate school.
Bair: So, as you mentioned, you know, your first book was Intern, which charts your first year right after medical school. And even then, throughout the book, you openly share many of the doubts you had about this career choice. Can you share what those doubts were and how your relationship and feelings about the career of medicine evolved over that time?
Jauhar: I mean, the doubts really were probably biological. I sort of had a predisposition toward second guessing and, you know, a bit of vacillation. My brother, who's sort of the foil as well as exemplar in my first book, was almost a polar opposite. You know, he'd make a decision and he stuck with it, right or wrong.
I think another part was that, you know, my graduate training in physics, there was this sense that I wouldn't be able to react quickly in situations, that I would ponder too much and that maybe I wasn't cut out for a career in medicine because I did have that propensity for, let's say, ponderous reflection. And that doesn't really work very well as an intern where, you know, you have to make sort of snap judgments and a lot of work to be done and you can't kind of think too hard about things. And so that was part of it during internship is when I had to kind of react almost reflexively. And I'd always had a hard time doing that.
There was some of that, and then I guess a small part of it that ended up growing was that I was very interested in writing and I didn't know how I was going to meld a career in medicine with my writing interests. And so, I mean, there were a number of factors that led to, you know, indecisiveness. But I think the biggest was that I'm just an indecisive person.
For the full transcript, visit The Doctor's Art.
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