Book Review: The Kitchen Shrink by Dora Calott Wang M.D.

The Kitchen Shrink is a fast-paced memoir that moves through the career of author Dora Calott Wang, M.D. as she transitions in and out of large hospital systems in her work as a psychiatrist. Along the way, she observes the medical profession as it morphs into a health care industry. “When I chose medicine for my career, it felt such a noble profession, devoted to healing the sick and guarding the sanctity of human life.” But she soon finds it is just another business.

Through her years in private practice and working with HMOs and health profit organizations, she sees the effects of corporate decisions influencing patient care. Dr. Wang witnessed what happened when Lovelace, a community-based hospital in New Mexico, was purchased by Cigna, “a corporation whose stock value on the New York Stock Exchange doubled, then quadrupled, and then altogether skyrocketed more than eightfold, all in just twenty years.” Lovelace became a for-profit corporation “taking money out of the community – to pay executives and stockholders around the country.”

As a memoir, The Kitchen Shrink documents Wang’s efforts to practice medicine while fighting the system to protect the needs of her patients. A firm believer in practicing medicine centered on science, the doctor-patient relationship, and on preserving our highest human values, her goals in treating patients were often thwarted by the health care system.

Troubled by her career’s cross-purposes she began to write about it, sharing the powerful story of her career as a physician and psychiatrist. The Kitchen Shrink carries an important message, with the power to enlighten each of us about the American medical system today.

Most of us are old enough to remember the transition to managed care and HMOs. We are aware of today’s health care reform efforts. Not too long ago, as Wang writes, hospitals were named for saints and for the communities they served. We’ve all seen dedicated medical professionals who serve patients without regard to self-sacrifice. When we fall ill, after paying into the health insurance system, swallowing large deductibles, office visit restrictions, and treatment limits, we don’t expect our insurance company to also be dictating what medical care we will receive. It is the doctor who sees us, but an unknown office worker or computer system that determines our treatment.

The Kitchen Shrink draws the reader into Wang’s personal life, and her own health issues. Her extraordinary awareness and passion to change health care’s profit-driven motives must be heard. But what does that do to the life of a dedicated doctor, who worked hard to gain her credentials to help and heal patients? Where is the motivation to excel in patient care, especially in the delicate work of psychiatry, when patients believe what they hear from pharmaceutical companies? What good is a health care system that pays for drugs, but denies office visits and treatment?

As her personal frustration grows, Wang’s poignant observations and stellar writing convey the incongruous logic of a medical system that won’t let a sick patient remain in the hospital but will airlift him back when he gets ill a week later.

Wang’s knowledge of universal health care goes back to Nixon and the 1973 HMO act, intended to grant $360 million to create nonprofit health maintenance organizations that stressed prevention. Nixon’s universal health care bill failed. By the early 1980s, American medicine was transformed into a profit-driven industry. Public policy and profit clashed, and the health care system became a complex, cost-controlled business. Today, we are living with a president who is working to honor the dream of Ted Kennedy to put the health care system back together.

All along the way, Wang’s writing in The Kitchen Shrink  reveals her struggle and her search for answers to her questions about her family, her career, medicine, and the importance of improving the lives of her patients.

Here is Dr. Wang’s message: “How we move forward in this predicament of health care will say everything about who we are as a civilization. At the same time, it will reveal the strengths and weaknesses of the foundational premises of this nation.”