What do you think?
Rate this book
The Kitchen Shrink: A Psychiatrist's Reflections on Healing in a Changing World
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.
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.
368 pages, Hardcover
First published April 29, 2010
5 people are currently reading
103 people want to read
Ratings & Reviews
Friends & Following
Create a free account to discover what your friends think of this book!
Community Reviews
Displaying 1 - 28 of 28 reviews
November 17, 2010
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.
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.
September 24, 2010
From my book review blog Rundpinne...[return][return]....Thought-provoking, The Kitchen Shrink by Dora Calott Wang is a look at the changing, oftentimes for the worse, field of medicine. Wang ‘s memoir details how she began her career with enthusiasm and soon the realities of health care for profit had changed the way medical professionals are to treat their patients. A shocking and thought-stimulating memoir, Wang takes the reader into her life explaining the struggles she as a psychiatrist faces with knowing what a patient may need verses what insurance will allow. The Kitchen Shrink is more than a memoir about one doctor’s experience, it is a wake-up call to society to take notice of the lack of care, the high medical premiums, and the sudden push of medication instead of therapy. I recommend The Kitchen Shrink to anyone interested in medical care or to those who merely enjoy memoirs.
February 23, 2012
The Kitchen Shrink is a must read for anyone wanting a more intimate view of how the for-profit medical insurance system has changed medical care in general, especially now, as our nation is locked in a debate over health care reform. But it’s Wang’s and Zoe’s and the other personal stories that she courageously shares that will really pull you in and tug at your heart. Wang looks at this industry from all perspectives: as a medical professional, colleague, caretaker, daughter, wife and mother. Ultimately her road becomes very much like our own; caught within a system that sees no faces and hears no heart beats but only responds to the bottom line.
July 25, 2018
Pretty saddening, though I think it makes a good counterpoint to God's Hotel which I read earlier this year. Caught up in the changing health industry, Wang keeps trying to slow things down and give more time to her patients. Changing jobs and cities tends to only buy a temporary fix.
It is sadder to realize that a lot of these problems could have been helped by the Affordable Care Act, or especially by health care reform in the 90s, but we keep throwing that away in ways that are destructive for doctors and patients.
It is sadder to realize that a lot of these problems could have been helped by the Affordable Care Act, or especially by health care reform in the 90s, but we keep throwing that away in ways that are destructive for doctors and patients.
February 25, 2016
There was a lot of good stuff in this book. I was very excited about it at first, but it ended up taking me a long time to read it and I confess to reading segments of it out of order. Usually, we don't spend that much time thinking about how hard it is to be a doctor when for profit systems are in place to make consistent, personalized care unlikely. However, the patient does suffer in all of this and it is good for us (all) to know about it.
June 1, 2011
This is an intriguing look into the changes in health care (and specifically mental health care) over the course of about fifteen years, seen through the lens of a particular practitioner (also trying to figure out how to balance changing demands against a reasonable desire for a personal life, professional ethics, and generally being helpful rather than harmful.)
November 8, 2011
If you want to know exactly why healthcare in America has gone off the rails, this highly personal account from a doctor who witnessed it first-hand and struggled within the system to continue to put her patients' care first is a must read. A lovely combination of memoir and medical history that is accessible to all."
November 20, 2011
Nothing surprising here, but the first-hand perspective of a psychiatrist whose career has tracked the changes in psychiatry (and health care in general) over the past 20 years was interesting. I think the memoir format would make this more readable than some of the other nonfiction on America's health care crisis. I recommend it.
March 4, 2012
This book wasn't at all what I expected, but it was brilliant. Until now, I'd never understood what's really going on with American healthcare, both psychiatry and in general. Now I do, and the truth is rather depressing but very important. Everybody who has any interest in health and medicine--so basically, everyone--should read this.
October 23, 2013
Excellent personal insight into our current for profit health care system. Only downfall is that it would have been nice to know what she thought of the Affordable Care Act.. but, this was written before it passed and was implemented..
December 6, 2011
The tragic truth of how insurance managed care has raped and ruined the practice of therapy.
August 14, 2012
If you want to know why I no longer practice medicine-read this book! Preaching to the choir.
September 28, 2022
This book was amazing! I highly suggest it for anyone that is in medical school or is thinking about going to medical school.
This book points out that the medical profession was shifted to the medical "industry" and notes one psychiatrist's experience in the changing field.
With many good examples used and a wonderful style of writing, I can undoubtedly give this book a 5/5 stars.
The only mild complaint is the small amount of repetitiveness in regard to Dr. Wang's direct opinion, but this is to be expected of a book that is written about someone's personal experience and the emotions behind the nature of this topic.
Little Bit of a Spoiler, but good for perspective as to what this book is about:
The medical "industry" is definitely taking precedence with the for-profit model and it is harming health care quality and costs. Physicians are also under increasing pressure from multiple fronts.
I hope that one day we can figure out a solution to our health care issues.
This book points out that the medical profession was shifted to the medical "industry" and notes one psychiatrist's experience in the changing field.
With many good examples used and a wonderful style of writing, I can undoubtedly give this book a 5/5 stars.
The only mild complaint is the small amount of repetitiveness in regard to Dr. Wang's direct opinion, but this is to be expected of a book that is written about someone's personal experience and the emotions behind the nature of this topic.
Little Bit of a Spoiler, but good for perspective as to what this book is about:
The medical "industry" is definitely taking precedence with the for-profit model and it is harming health care quality and costs. Physicians are also under increasing pressure from multiple fronts.
I hope that one day we can figure out a solution to our health care issues.
This entire review has been hidden because of spoilers.
April 2, 2024
I enjoyed this book more than I'd expected. The author talks in a comfortable way about her career. She explains how the medical field has changed, so that now insurers dictate to doctors what procedures can be done. Doctors have been removed from their prior position --which was earned from their lengthy education & experience!
September 15, 2025
Splendid. Dora Wang uses the memoir form very tastefully, painting wonderful scenes through her own thoughts and experiences. She writes about health, societal change, and human dignity in a way like no other. I feel honored to have met her.
May 13, 2021
Strongly recommend this book to anyone currently working in Mental Health/Behavioral Health services as well as those studying to do so!
August 4, 2010
Dora Calott Wang, M.D., Author
The Kitchen Shrink: A Psychiatrist’s Reflections on Healing in a Changing World
Riverhead Books, ISBN 978-1-59448-753-8
Non-Fiction-psychiatry, medicine, health care
354 pages
August 2010 Review for Bookpleasures
Reviewer-Michelle Kaye Malsbury, BSBM, MM
Review
Dr. Wang is a graduate of Yale School of Medicine and University of California, Berkeley. (inside back cover, 2010) She is a psychiatrist by training and has worked in private practice, as university professor, and on numerous hospital staffs. She and her family currently reside in New Mexico. For more information about this author please visit her website www.doracalottwang.com .
Doctor Wang writes about the changes that have occurred with regard to the inception of managed health care across this country. She describes scenarios where she was helping patients to get better and live healthier lives, but also scenes where insurers stepped in and began rationing care and dictating the time that medical professionals were allowed to spend with new and revisiting patients. She opens our eyes to the push by pharmaceutical companies for medications masking symptoms over preventative care that transpired as managed care became big business. Doctor Wang said, “…the insurance company has long replaced the doctor as a patient’s primary medical relationship.” (2010, p.2) And that medical care “…now seems an impersonal assembly line.”
Doctor Wang recalls with fondness how doctors used to treat their patients from cradle to grave and how that relationship was a personal one, quite unlike today. Toward that end she states, “Here the deep healing of patient’s mind and body occurred without machines or medicines, but through the doctor patient relationship, with the doctor as the instrument of change.” (2010, p.5) That doctor patient relationship changed in the late 1980’s to early 1990’s. American medicine had just been deregulated like the airlines and financial sector. Private for profit corporations began to nibble up our health care system that had previously been run by charitable organizations with emphasis on prevention and treatment. About these changes she said the following: “Insurance companies also started calling the shots, preferring to pay psychiatrists to prescribe medications, leaving psychotherapy for counselors, if at all.” Gone were the days where the psychiatrist spend time evaluating the patient and inquiring about incidents that may be precipitating factors in their current demise replaced by meeting or exceeding the bottom line.
Some of the vital statistics that Doctor Wang wrote about in The Kitchen Shrink have to do with percentage of our GDP (Gross Domestic Product). In 1980 health care costs took up 9.1% and were easily budgeted for. However, by 2001 health care had ebcome 18% of our total GDP. (2010, p.50) And, according to Dr. Wang, that the “…American medical system consumes one sixth of the national economy, more than any other nation…”. A major portion of time under managed health care is allocated to filling out forms and making calls to the insurers because without such paperwork the physicians will not get paid. (p.69)
Today’s hospitals resemble “assembly line medicine, where each doctor cares for only one body part…”. (2010, p.14) “Discharges are earlier and riskier…”. (p.23) Medical care is now a team based approach handled on the various world exchanges with profit for their stockholders as the motive to see more patients and deny more care as cost cutting/profit boosting measures. “The insurance company, not the family, physicians, ...” or the patient, “decide.” (p.41) Doctor Wang asks, “What kind of system is this?” And I totally agree.
I do not have health insurance and am waiting to see what changes occur under the newly legislated national health care. I found Dr. Wang’s book a very eye opening experience down a dark, entirely profit motivated, path that nobody should be forced to walk. I would recommend this book to all persons considering or currently enrolled in medical school and all medical professionals, as well as, all patients, who I am sure can sympathize with the plight of our current health care system and the sad direction it has taken since deregulation. Thank you Dr. Wang!
The Kitchen Shrink: A Psychiatrist’s Reflections on Healing in a Changing World
Riverhead Books, ISBN 978-1-59448-753-8
Non-Fiction-psychiatry, medicine, health care
354 pages
August 2010 Review for Bookpleasures
Reviewer-Michelle Kaye Malsbury, BSBM, MM
Review
Dr. Wang is a graduate of Yale School of Medicine and University of California, Berkeley. (inside back cover, 2010) She is a psychiatrist by training and has worked in private practice, as university professor, and on numerous hospital staffs. She and her family currently reside in New Mexico. For more information about this author please visit her website www.doracalottwang.com .
Doctor Wang writes about the changes that have occurred with regard to the inception of managed health care across this country. She describes scenarios where she was helping patients to get better and live healthier lives, but also scenes where insurers stepped in and began rationing care and dictating the time that medical professionals were allowed to spend with new and revisiting patients. She opens our eyes to the push by pharmaceutical companies for medications masking symptoms over preventative care that transpired as managed care became big business. Doctor Wang said, “…the insurance company has long replaced the doctor as a patient’s primary medical relationship.” (2010, p.2) And that medical care “…now seems an impersonal assembly line.”
Doctor Wang recalls with fondness how doctors used to treat their patients from cradle to grave and how that relationship was a personal one, quite unlike today. Toward that end she states, “Here the deep healing of patient’s mind and body occurred without machines or medicines, but through the doctor patient relationship, with the doctor as the instrument of change.” (2010, p.5) That doctor patient relationship changed in the late 1980’s to early 1990’s. American medicine had just been deregulated like the airlines and financial sector. Private for profit corporations began to nibble up our health care system that had previously been run by charitable organizations with emphasis on prevention and treatment. About these changes she said the following: “Insurance companies also started calling the shots, preferring to pay psychiatrists to prescribe medications, leaving psychotherapy for counselors, if at all.” Gone were the days where the psychiatrist spend time evaluating the patient and inquiring about incidents that may be precipitating factors in their current demise replaced by meeting or exceeding the bottom line.
Some of the vital statistics that Doctor Wang wrote about in The Kitchen Shrink have to do with percentage of our GDP (Gross Domestic Product). In 1980 health care costs took up 9.1% and were easily budgeted for. However, by 2001 health care had ebcome 18% of our total GDP. (2010, p.50) And, according to Dr. Wang, that the “…American medical system consumes one sixth of the national economy, more than any other nation…”. A major portion of time under managed health care is allocated to filling out forms and making calls to the insurers because without such paperwork the physicians will not get paid. (p.69)
Today’s hospitals resemble “assembly line medicine, where each doctor cares for only one body part…”. (2010, p.14) “Discharges are earlier and riskier…”. (p.23) Medical care is now a team based approach handled on the various world exchanges with profit for their stockholders as the motive to see more patients and deny more care as cost cutting/profit boosting measures. “The insurance company, not the family, physicians, ...” or the patient, “decide.” (p.41) Doctor Wang asks, “What kind of system is this?” And I totally agree.
I do not have health insurance and am waiting to see what changes occur under the newly legislated national health care. I found Dr. Wang’s book a very eye opening experience down a dark, entirely profit motivated, path that nobody should be forced to walk. I would recommend this book to all persons considering or currently enrolled in medical school and all medical professionals, as well as, all patients, who I am sure can sympathize with the plight of our current health care system and the sad direction it has taken since deregulation. Thank you Dr. Wang!
March 21, 2014
An easy to read and fascinating look at the field of psychiatry through the lens of a practitioner during the take over of health care by "for profit" entities. As a nurse with 45 years of experience in health care I have seen the changes she relates and how it has impacted the care of patients. I sympathize with the plight she found herself in while trying to give the care she knew was right but being stymied at every turn. I can certainly understand the reason she had for turning to a different career.
She explains in very easy to understand ways the reimbursement complexities that hospitals, medical schools and clinics have had to deal with since the 80's. The book also reflects on the reason (because it is not profitable in monetary terms)for the violent outbreaks by mentally ill individuals: they have been denied the care that would have helped them cope with their illness.
I also enjoyed the way she wove her personal life into the book, although it did not always flow well, it was pertinent to the story. It made the subject more enlightening. It also gave witness to an individual's dealing with diagnosis, coverage,and change in the field of medicine. By relating her personal difficulties with her parents and own health the story gave the reader a look into the problems that even well connected individuals go through trying to get good medical care.
She explains in very easy to understand ways the reimbursement complexities that hospitals, medical schools and clinics have had to deal with since the 80's. The book also reflects on the reason (because it is not profitable in monetary terms)for the violent outbreaks by mentally ill individuals: they have been denied the care that would have helped them cope with their illness.
I also enjoyed the way she wove her personal life into the book, although it did not always flow well, it was pertinent to the story. It made the subject more enlightening. It also gave witness to an individual's dealing with diagnosis, coverage,and change in the field of medicine. By relating her personal difficulties with her parents and own health the story gave the reader a look into the problems that even well connected individuals go through trying to get good medical care.
August 21, 2011
I was very disappointed in this book. The title, "The Kitchen Shrink" is misleading. I was expecting a book about psychiatry. The author is a psychiatrist, but works with transplant patients. Her basic argument is that everything in medicine was fine until for-profit insurance companies came in and ruined it for everyone. This may be true, but I am sure that there are better books that make a more compelling argument. The author bases her argument entirely on her own personal experiences. Her anecdotes of patients denied coverage simply failed to connect with me. I returned this book to the library after reading the first 100 pages. For a much better understanding of how psychiatry has changed I would recommend "Unhinged" by Daniel Carlat.
July 13, 2014
I confess, I found it a waste of my time to read 356 pages of ranting about how health care is not the same as it used to be, primarily because of insurance companies and the limitations they place on appropriate care. I thought everyone who has needed serious medical care already knew this. And in a world of Obamacare, the arguments have changed.
I bought it because of the title. I love stories about mental health therapy and that's what the book seemed to be. Maybe I should have questioned it when I realized the book was an Amazon remainder.
Nonetheless, the writer is good and the book was interesting, up to that point when I realized the title was different than I thought the book would be. So this one I am not going to finish.
I bought it because of the title. I love stories about mental health therapy and that's what the book seemed to be. Maybe I should have questioned it when I realized the book was an Amazon remainder.
Nonetheless, the writer is good and the book was interesting, up to that point when I realized the title was different than I thought the book would be. So this one I am not going to finish.
January 4, 2015
It's an interesting read, but it's such a downer to the direction of healthcare in the United States. It leaves one with the feeling of little hope. The loss of the physician / patient relationship is tragic due to managed care.
June 23, 2010
How her own career, the profession and patient care have all changed as a result of managed care. Interesting, and a tad depressing.
March 21, 2011
Beautiful sharing.
April 17, 2011
Fascinating read about medicine today and about how for-profit insurance companies are obstructing the realationship between docs and patients. Never finished it completely but learned a lot
January 10, 2012
This book was such an interesting look at the other side of health care and how it's affecting our nation. A very fun but sobering read.
August 11, 2013
The content and subject matter were enough (minus the mother sections) to keep reading this book, but the actual writing was weak and disappointing.
Read
December 15, 2014"Psychiatrists use no blood tests or MRIs to guide a diagnosis. Conversation is our x-ray."
December 21, 2014
Five words: everyone needs to read this.
Displaying 1 - 28 of 28 reviews