Wednesday, August 25, 2010

The Kitchen Shrink

Amazon Product Description. 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.

Review. No matter what side of the healthcare debate one is on nearly everyone agrees that the current medical system is unsustainable: soaring health care costs; overworked medical staff; and incomprehensible paper work -- to name just a few of the issues. The Kitchen Shrink by psychiatrist Dora Calott Wang explores the healthcare crisis as reflected through her personal career.

Wang argues that the healthcare is unlike any other industry and does not fit into the corporate for profit model. Sick patients are notoriously unreliable for getting well on an insurance company’s timetable. Moreover, on a philosophical level, Wang muses, “Should everything need to make a profit?” The author convincingly contends that it is to everyone’s detriment (apart from the insurance company’s shareholders) that medical services have been taken over by for profit companies. In particular, Wang explores the evolution of the psychiatric field from the Sigmund Freud psychoanalytic model to the modern day psychiatrist as solely a prescription writer. On the personal front Wang, a Yale educated psychiatrist trained in psychotherapy, fights to keep a limited amount of counseling into her practice, but has largely transitioned to writing ‘scipts in fifteen minute appointments.

While I enjoyed The Kitchen Shrink and found Wang’s story interesting, I do have several reservations about this book. First, at the end of the book the author acknowledges that “all patients in this book are composites of many persons, including actual patients, as well as people I have known outside my professional life.” This disclosure should have been noted in the beginning pages. Also, as a personal preference, fictious people and non-fiction don’t mix. I appreciate the need to change names and identifying details, but composite characters are fodder for novels not memoirs. Also, Wang's arguments occasionally derive from professional nostalgia. For instance, she laments the laws restricting medical interns’ work schedules to a maximum of 24 consecutive hours. Wang contends that these laws cause doctors to act as shift workers, rather than professionals who follow their patients care for days on end without sleep. While the shift worker analogy may be valid, the answer seems to lie in making better transitions between medical staff, not a return to sleep deprived doctors making life and death decisions. Lastly, at times, Wang’s descriptive writing seems a bit curious. For example, the author describes a friend as having “a sparkling lemon-wedge smile.” Yellow teeth do not usually strike most as “sparkling!”

The Kitchen Shrink is an interesting memoir of Wang’s professional evolution and a sad commentary on the present healthcare system.

Publisher: Riverhead Hardcover (April 29, 2010), 368 pages.
Review copy provided courtesy of the publicist.


  1. LOL....sorry, but the "lemon wedge smile" cracked me up. I think I'll pass on this one.

  2. Perhaps not for me in the end, but then all books can't be

  3. I totally agree with you that composite characters do not belong in non-fiction, so I think I'll skip this book.