The Kitchen Shrink: A Psychiatrist's Reflections on Healing in a Changing World

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The personal story of how a psychiatrist confronts the profound changes sweeping the medical establishment as they reshape her life and career.

In the past two decades, a seismic shift has occurred within the walls of our nation's hospitals and doctor's offices. The medical profession- once considered a sacred, cherished vocation-has devolved into a business motivated by a desire for profits. Even psychiatry, once the mainstay of the human interaction between doctor and patient,...

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The Kitchen Shrink: A Psychiatrist's Reflections on Healing in a Changing World

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Overview

The personal story of how a psychiatrist confronts the profound changes sweeping the medical establishment as they reshape her life and career.

In the past two decades, a seismic shift has occurred within the walls of our nation's hospitals and doctor's offices. The medical profession- once considered a sacred, cherished vocation-has devolved into a business motivated by a desire for profits. Even psychiatry, once the mainstay of the human interaction between doctor and patient, has fallen victim to rising costs and dictates by insurance sources.

How has medicine strayed so far from its roots? In The Kitchen Shrink, psychiatrist and lecturer Dora Calott Wang delves into what happened.

Through the prism of her own story, Wang elucidates key events in her professional life-the declining state of hospitals and clinics, the advent of managed care, and the rise of profits at the ex­pense of patient care-that highlight the medical profession's decline. Along the way we meet some of her patients, whose plights reflect the profession's growing indifference to the human lives at risk. There's Selena, whose grief over her mother's death and lack of family support make it difficult for her to take the medicine that keeps her body from rejecting her new liver, and Leonard, a schizophrenic with no health insurance who develops peritonitis and falls into a coma for three months. Each new story brings additional compromises as the medical landscape shifts under Wang's feet. She struggles with depression and exhaustion, witnesses the loss of top doctors who leave in frustration, and attempts to find a balance between work and home as it becomes ever clearer that she cannot untangle the uncertain future of her patients from her own.

Part personal story and part rallying cry, The Kitchen Shrink is an unflinchingly honest, passionate, and humane inside look at the unsettling realities of free-market medicine in today's America.

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Editorial Reviews

Kirkus Reviews
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 ofleukemia." 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. Agent: Michael Carlisle/Carlisle & Company
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Product Details

  • ISBN-13: 9781594487538
  • Publisher: Penguin Group (USA) Incorporated
  • Publication date: 4/29/2010
  • Pages: 368
  • Product dimensions: 6.50 (w) x 9.32 (h) x 1.23 (d)

Meet the Author

Dora Calott Wang, M.D., is psychiatrist who has degrees from the Yale School of Medicine and the University of California-Berkeley. She has been in private practice, served on hospital staffs, and been a medical school instructor. She also has a master's in English from Berkeley and lives with her family in New Mexico.

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Sort by: Showing all of 3 Customer Reviews
  • Posted November 17, 2010

    more from this reviewer

    Revealing and sad

    At first I thought that The Kitchen Shrink was going to be some sort of self-help book on how to find happiness at home, possibly meditating while doing dishes. I even put off starting it, because I feared it would be full of psychobabble and platitudes like "bloom where you're planted". I was wrong. Yet again.


    Wang describes herself as "a doctor working in the medical profession as it became the health care industry." Trained as a psychiatrist, her training involved talk therapy, face to face communication, and a personal connection with patients that were seen over a period of time in order to determine what help would be best for their particular problems. However, as she admits "all my jobs since my training in 1994 have been to prescribe medication only." Wang uses this book to explore the processes of what used to be medicine and now could be considered nearly only a pharmaceutical business. While in the past, doctors would look for alternatives to prescribing medication, now the only question is what kind of medication to supply. It's basically a matter of time: talk is expensive, sending a patient off with a prescription is cheap.

    She demonstrates, effectively, how the changes in the treatment of patients, due primarily to the influence of insurance companies that act like bullies, has harmed the most fragile of patients: those with mental problems and who need personal attention and interaction. According to Wang, "Insurance companies started to call the shots" in medicine, not only suggesting doses but also withholding approval of treatments that might aid the sufferers. In fact, at times their logic was so flawed that they'd refuse to cover a preventative procedure, which would save the money in the long term.

    Wang describes the changes and problems with many anecdotal details that make it a fascinating read, and you can't help but see that medicine in other specialties is also likely to be turned into assembly line health-care, controlled by health insurance companies that not only lack medical degrees but also simple compassion and reasonableness.

    One big player in the game that is as insidious as the insurance companies are the pharmaceutical companies. Wang notes with irony that her fridge is covered with Zoloft magnets, and that she writes on a Paxil notepad. While recent laws have cracked down on the practice of pharmaceutical companies providing free "goodies" for doctors, such as pens, clocks, scales, and vacations, the influence still remains strong. Incentives to prescribe their medications, rather than what the patient most needs, is a problem that doctors have to face. Additionally, with their face time with patients dramatically decreased, and the paperwork authorizing visits and procedures increasing, some doctors are leaving their practices out of frustration.

    This book is eye-opening and at times, it makes you mad. Some cases of poor medical supervision has cost lives for no other reason than greed. Besides revealing this mess, though, Wang offers concepts to ponder in what your own medical care may be, and helps you see ways to benefit yourself by asking the right questions. This book would be a great supplement to How Doctors Think by Jerome Groopman, Mariner Books, 2008.

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