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I had been bitten by multiple ticks in my adolescence, a few years before I started having symptoms, but no one had ever before thought to test me thoroughly for Lyme.

Until then, facing my doctors, I had simply thought, What can I say? Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. Behind the scenes, many doctors feel the same way. And now some of them are telling their side of the story.

A recent crop of books offers a fascinating and disturbing ethnography of the opaque land of medicine, told by participant-observers wearing lab coats. These inside accounts should be compulsory reading for doctors, patients, and legislators alike. They reveal a crisis rooted not just in rising costs but in the very meaning and structure of care. She may also emerge, as I did, pledging in vain that she will never again go to a doctor or a hospital. The same could be said of our oddly bloodless debates about the future of health care. Nor is there any effort to focus on the deeper reality of disease, as Atul Gawande, a surgeon and professor at Harvard Medical School, writes in his astute new exploration of geriatric medicine, Being Mortal.

Despite our virtuosic surgical capacities, our cutting-edge technology, and our pharmaceutical advances, the patient-doctor relationship is still the heart of medicine.

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And it has eroded terribly. Terrence Holt, a geriatric specialist at the University of North Carolina at Chapel Hill, describes the situation in Internal Medicine , fictional fables based on his residency:. The subjective experience of illness has always been all but impossible to convey. But systemic changes have intensified a disconnect between patients and doctors that was less glaring some 40 years ago, before technological advances and corporatization began to transform the comparatively low-tech, localized postwar medical system.

The broad contours of the situation are familiar. Health care in the United States operates predominantly on a fee-for-service basis, which rewards doctors for doing as much as possible, rather than for offering the best care possible. But sophisticated new surgical techniques, and tools like the CT scan and the MRI, led to a surge in high-tech specialization. But along with new checks and balances came added bureaucracy, and frustrated doctors and patients.

In Doctored: The Disillusionment of an American Physician , Sandeep Jauhar—a cardiologist who previously cast a cold eye on his medical apprenticeship in Intern —diagnoses a midlife crisis, not just in his own career but in the medical profession. Doctors today are more likely to kill themselves than are members of any other professional group. The demoralized insiders-turned-authors are blunt about their daily reality.

To rein in costs, insurance companies have set fees lower and lower. And because doctors tend to get reimbursed at higher rates when they are in a network hospitals and large physician groups have more leverage with insurance companies , many work for groups that require them to cram in a set number of patients a day.

Paperwork compounds the time crunch. The rest of the time is devoted to processing forms, reviewing lab results, maintaining electronic medical records, dealing with other staff. Try adding nuts, seeds, or crisp veggies -- such as jicama and carrots -- instead. Cheese has calcium, but it also packs roughly calories per ounce. If you really want some, opt for a low-fat one, like feta or Parmesan, and add just a sprinkle. These sweet toppings are often made with added sugar and oil. For example, an ounce of candied pecans can pack in a 4 grams 1 teaspoon of sugar. And dried fruit has less water and volume than the fresh kind.

That means you get less: One serving is half a cup, or half that of fresh fruit. The fruit adds sweetness and antioxidants. The nuts give you protein, fiber, and healthy fat.

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This mix of nutrients makes your salad more satisfying and healthy. In fact, research shows that eating nuts regularly can help fend off heart disease and cancer. Try pairing berries with almonds, apples with walnuts, and peaches with pecans. Some of these pack in more calories than a burrito. This salad can weigh in at calories or more! Get all the flavor of a taco salad without the extra calories by topping it with black beans and avocado. The beans are a good source of disease-fighting antioxidants, and they have protein and fiber, as well as energy-boosting iron.

Avocado adds creaminess and fiber. The word "salad" in the name doesn't make it a healthy choice. For a healthier version, use a small amount of light mayonnaise and some fat-free sour cream or plain yogurt.

And a bit of mustard -- which has no fat or sugar -- can kick it up a notch. Many restaurants load their salads with cheese, fried onions, bacon, or croutons. Then they douse them in dressing. Even a simple Cobb salad can clock in at nearly 1, calories and 85 grams of fat. And ask for those toppings on the side.

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Pamela Wible MD | America's leading voice for ideal medical care

Another time an acquaintance of an acquaintance knocks on my door, a tired son in tow. Students pondering a career in medicine, I have always welcomed. Parents who do it on behalf of their child, I am increasingly wary of. The students are largely altruistic; the parents aspire to status, money and job security. Some years ago I interviewed a young man who was obviously bored, even in our eight-minute high-intensity interaction.


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I was left reeling but I was told that no selection process can filter out pushy parents; we wait for the students to find their voice. Doctors are often asked if they would recommend the profession to their children. A survey of American doctors by the Physicians Foundation found that more than half say no, citing the triumph of paperwork and bureaucracy over time with patients.

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When I talk to my Australian colleagues, I hear similar sentiments. Doctors sign up to help people but are faced with growing mountains of paperwork, mindless compulsory modules and maddening meetings to satisfy performance indicators that make a mockery of patient-centred care. Many doctors are burnt out, bullied and demoralised. Work is stressful and demanding. A Beyond Blue survey put paid to the notion that these are merely the groans of a self-indulgent, richly rewarded profession.

Australian doctors have a substantially higher rate of high psychological distress compared to the general population and other professionals. An astonishing quarter have considered suicide, double the comparable figure in other professionals.