Book News - June 2011
COLOR OF ATMOSPHERE
Kozel, a graduate of Georgetown University School of Medicine in 1980, spent the first 10 years of her medical career as a physician in the US military, with its universal, single-payer health coverage offering every family the same access to the latest health care. In this memoir for general readers, she recounts with warmth and humor her journey from idealistic young pediatrician to the culture shock of private practice outside the military. Her personal story is told in the context of the changing healthcare system, focusing on how the current method of paying for health care has changed the way doctors practice, not for the better. Kozel, now a high school teacher, argues that the profession is currently shaped by health insurance reimbursements and pharmaceutical marketing rather than by science. The book will be of interest to those working in the medical profession, those considering it, and general readers.
THE DOCTOR IS OUT
By James J. Gillis - The Newport Daily News - March 19, 2011
JAMESTOWN, R.I. — As a little girl, Maggie Kozel imagined herself as a doctor.
After graduating from Fairfield University in Connecticut, Kozel attended Georgetown University Medical School, with part of that paid for through a stint in the Navy. In medical school, she met her husband, Dr. Randy Kozel, a neurologist with a practice in Portsmouth, and she up a South County pediatrics practice.
She and her husband were raising two daughters in a beautiful house in Jamestown. Everything fell into place. Except that Kozel was miserable in her job.
That unhappiness prompted her to leave that profession to become a teacher in Providence.
She recounts the feeling the led her to the career change in a new book “The Color of Atmosphere,” which is subtitled “One Doctor’s Journey In and Out of Medicine.”
In it, Kozel tells of her childhood on Long Island, growing up with a particularly unhappy mother who was an alcoholic. Fighting served as a constant backdrop.
“I was the youngest of four,” Kozel said. “My siblings would be more confrontational with my parents. I stayed under the radar … Maggie the good girl.”
But growing up on medical dramas such as “Dr. Kildare” — and despite experiences with a cranky local doctor and a smoking habit — the teenage version of the former Maggie Keavey saw herself in the future: “An attractive, grown-up me in a white coat, handily diagnosing illnesses, ordering tests, writing prescriptions.”
And there was a good deal of that, but Dr. Maggie Kozel eventually found herself fighting the health care system and dwelling on topics with families that were more involved with good parenting than practicing medicine.
“I could basically do what the health insurers said I could do,” she said. “And I found myself in conversations with parents about naps and should they start peas before carrots. I was spending a lot of time on things that I didn’t need to go to medical school for. It became so frustrating. And we always had to answer to the insurance companies, on almost everything.”
So Kozel quit in 2001, opting for a job teaching chemistry at the private Lincoln School on Providence’s East Side. The job had its benefits emotionally though it dropped her into a new tax bracket.
“I have to admit that I kind of floated into teaching very easily,” she said. “I had the science background, and I loved working with kids (she and her husband have two grown daughters, Caitlin and Molly). It is very rewarding. I do remember that my second day of teaching was Sept. 11, 2001, and that was a bit overwhelming. But I’ve really enjoyed it.”
Kozel wrote a manuscript of her book and found an agent to shop it. For a while, the publishing house sent letters praising the book in the first paragraph and then starting the second paragraph with “But however …’
Finally Kozel landed with the Vermont-based Chelsea Green Publishing. “They pick up about 20 new books a year, so you receive a lot of attention that you might now receive with a larger publishing house,” she said.
Dr. Beach Conger, also an author, praised Kozel’s debut work.
“The chronicle of this intelligent and committed physician — who is frustrated at every turn as she tries to find satisfaction in a profession to which she had expected to dedicate her life — is a powerful indictment of our current system of medical care,” Conger wrote.
Kozel said Obamacare is no panacea, but she likes that more people will be covered than in the past. And it’s made health care a front-burner issue. Improvements to the plan should be made, she said.
“I had experience with the single-payer system in the Navy,” she said. “And I don’t think it led us down any road to communism or socialism. Of course, I don’t know what it cost, but I know it was effective.
“I think the best thing to happen so far with Obamacare is that it’s boosted the conversation, made it a national conversation that we need to have,” Kozel said.
Besides writing her book, Kozel blogs for The Huffington Post. She’s been promoting “The Color of Atmosphere” with public appearances. She’s met with groups of various ages, including a group of twentysomethings in New York City recently.
“They were so young,” she said. “When I mentioned Dr. Spock (the famous author and pediatrician) they thought I meant Mr. Spock from ‘Star Trek.’”
Writing the book gave Kozel a chance to vent about a topic that still riles her up — even after nine years in a new profession. Kozel said she used her teaching time off to write the book and would have found the time if she were still practicing medicine.
“I basically wanted to tell my story and how it relates to the health care system,” she said. “I hope in some small way that I’m contributing to a larger, much-needed discussion.”
Read the original review.
Story Circle Book Reviews - March 3, 2011
Everyone concerned with health care reform should read this book. From President Barack Obama and Speaker John Boehmer to the elderly and uninsured, Americans could learn a great deal from Dr. Kozel's perspective. Maggie Kozel, M.D. practiced pediatrics in the military and in private practice, and she has a clear vision of what's wrong with our private system. She speaks out boldly about those bugaboos politicians wish would go away: universal health care, Medicare and Medicaid, our insurance system, and malpractice.
Dr. Kozel interned and did a pediatric residence in the Navy. After ten years, including stints as a general medical officer on board a ship and a pediatrician at a base in Japan, she and her neurologist-husband left the military for private practices in New Jersey.
In the Navy, Kozel did not have to deal with toilet training, sleeping through the night, or picky eaters. She did what she was trained to do: keep children healthy. Nurses did the child-raising counseling. Cost was never an issue for either patient or physician, eliminating the third-party payer as a middleman and making possible the treatment of small problems before they became huge. The military long ago embraced universal health coverage, and it works well for them.
In private practice, she found that funding dictates medical care. It was morally impossible for her to turn away uninsured patients, yet she was squeezed by the demands of earning a decent living. She found herself practicing medicine in an environment where patients feel that every cold deserves an antibiotic; her lectures on the dangers of too many antibiotics fell on deaf ears. Our culture that wants an instant fix, and parents felt entitled to get something for their money. Pharmaceutical advertising comes into play here too, for patients "know" there is a magic pill for everything, and they don't want to hear about the danger of over-medicating.
Malpractice also rears its ugly head. It is, Kozel says, not about failure but about poor outcomes, devastated families, and lawyers making a lot of money. Some 91% of physicians order more tests and referrals than necessary to protect themselves against malpractice suits, thereby increasing costs to all consumers. Malpractice insurance is outrageously expensive (it varies according to specialty), and that cost is also passed on to consumers and taxpayers.
Insurance policies, decided on by businessmen in board rooms and not physicians, shape patient care. One-fifth of physicians say they do not make decisions based on what is best for the patient but rather on what insurance pays for. As a trained pediatrician, Dr. Kozel found herself discussing toilet training, sleeping through the night, and eating habits—all that a twenty-minute time slot, because insurance won't pay for nurses to fill this role.
Kozel suggests that budget-minded politicians who want to cut or eliminate Medicare and Medicaid don't realize the consequences. Slashing those programs would send patients to the emergency room on the public dime. Medicare and Medicaid patients today account for more than half of those treated for obesity-related illnesses, costing the country about $92 billion annually. Kozel lays the blame on consumer advertising and patients who haven't been educated on nutrition. But as a practicing pediatrician in private practice, she had no time for more than mention of nutrition with the parents of children she saw.
Kozel presents her theories against a backdrop of case histories (names disguised), making it real and immediate. Citing the need for a national electronic health care database, she tells of an abused child, burned with cigarettes, starved for food and affection. The child was hospitalized and treated for malnourishment; dermatologists works on the burn scars on her face. But child welfare officials returned her to her parents, and the family moved, leaving no trace. An electronic record would have followed that child wherever she went.
Eventually Kozel suffered a classic case of burn-out. There were too many high pressure days, too many twenty-minute visits when she needed two hours with the family, too many sleepless nights on call waiting for the phone to ring. Now she teaches high school chemistry to intelligent and receptive girls at the upscale private school her daughters attend. She enjoys more time with her family and sleeps through the night. But in her heart she will always be a pediatrician, and she misses the medicine she practiced ten or fifteen years ago. She would volunteer or work part-time in a clinic but neither would pay for her insurance. She has reluctantly left medicine, driven out by the system. It is ultimately our loss, for how many others like her are out there?
Dr. Kozel's memoir shows that our system drives some of the best, brightest, and most compassionate out of the practice of medicine. Health care reform? You bet!
Read the original review.
Epinions - March 3, 2011
Walk a mile in my shoes. Plenty of teachers would say this to those who teased about the easy money, the long summer vacations, the benefits, the short hours, and not having to worry about driving to work in the snow. A pediatrician might invoke the same invitation when hearing envious comments about the assumed big money with accompanying big car and fancy house, the prestige, the glamour, the country club memberships, the hero/savior potential, and especially those stylish white jackets accented by sparkling stethoscopes and techy otoscopes.
Maybe it's because our life stories are so similar that I enjoyed reading this book so much. We came from dysfunctional families, paid our own way through college, achieved our dreams, and began our careers, she a pediatrician and me a teacher, with lofty expectations tinged by naivety. What happened in the interim to cause such disillusionment, unhappiness, and fatigue that it propelled a successful, competent pediatrician to leave her profession and leave behind the salary and status she had worked so hard to achieve?
In her career's ensuing years the health care system evolved and changed into a big business with decisions dictated by financial concerns and the insurance companies. Maggie Kozel became a health care provider for clients or customers. Malpractice insurance premiums escalated and continue to escalate to such a degree that after leaving her practice, Kozel couldn't afford to volunteer or work part time because of prohibitively expensive and critically necessary insurance.
Kozel doesn't regret her medical career and enjoyed the stimulating challenges and her roles of healer, counselor, detective, and comforter. However the burdens of escalating responsibilities and the demands on her time and patience, the specter of malpractice lawyers watching her every move, just became too much to bear. Her two daughters were growing up with a mother who was more of a ghost than a constant presence, and she found herself dispensing advice that didn't require a medical degree more than actually practicing medicine.
Still hurting from the sting of angry, unreasonable parents reprimanding her in front of office staff and other patients, Kozell surprised even herself by accepting the offer to teach chemistry in a private girls' school. When other doctors learned of the author's impending career change, they confided to her their own feelings of dissatisfaction, regret, and longing for an escape. Mostly because of financial considerations, they carried on dutifully and suffered their burdens in silence.
The Color of Atmosphere is a wonderful read that draws you into its spell like a needle drawing blood. I felt Kozel's pains and discomforts and in the end supported her decision. Before reading her account I had decided that leaving the medical profession to become a teacher was crazy. Ultimately the changing health care system with its maddening inequalities and complexities propelled this exhausted physician from the profession.
Read the original review.
One of America’s Top Pediatricians Leaves Pediatrics
Mothering.com - February 24, 2011
“You have to read this book,” my friend Rebecca urged, handing me back an advanced review copy I had loaned her. “Everyone needs to read this book. We need to get this book in front of every member of Congress. This is exactly what happened to me. This is why I left medicine.”
Even though I’m an avid reader, I have stacks and stacks of unread review copies, sent to me by authors or by their nice PR folks. It was one of these books, Maggie Kozel’s The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine that I loaned to Rebecca. After her wholehearted endorsement, I put Kozel’s book on the top of the stack. I read it in two days.
In the book, Kozel describes growing up one of four children of often sloppy drunk and shouting parents. She escapes the depressed town of Point Lookout, New York to become a pediatrician. She meets her husband, Randy, in medical school (there’s nothing like dissecting a cadaver to spark a romance). Randy chooses a career as a neurologist. Eager to travel and see the world, they both find work at the US Navy Hospital in Yokosuka, Japan.
During her medical training, Kozel is at first resistant to becoming a pediatrician. “…[T]he last think I wanted to do was spend my time locked in mortal combat with screaming kids, digging wax out of their ears while their deranged parents hovered over me, wringing their hands,” she writes. “I had hated pediatrics in medical school.”
But become a pediatrician she does, learning how to intubate a premature baby and distinguish between a life-threatening childhood illness and a simple viral infection. Providing medical care to active duty military personnel and their families, Kozel and her colleagues “saw illnesses we never saw back in the States–typhoid fever, malaria, tuberculosis and many more … There were expert subspecialists a phone call and twelve time zones away, but we were the front line, doing what we were trained to do, and being a doctor was wonderful.”
After working for the Navy for ten years, Kozel, her husband and their two small daughters head back to America. They end up in Rhode Island, where she joins a pediatric practice. Used to the government’s single-payer health system, Kozel has to adjust to the system in the States. It’s demoralizing: Because pediatricians have to bill insurance companies in order to get paid, Kozel details how much of her practice’s decisions on treatment have more to do with how to make sure they will get paid than with what’s in the best interests of the patients. She finds herself working exhausting hours, rushing patients through appointments as fast as she can, and being pressured by parents to prescribe unnecessary medications.
So when a job opportunity at her daughter’s school opens up, Kozel acts precipitously and does the unthinkable: she quits her job as a doctor and becomes instead a high school science teacher.
She’s energetic and funny and the gum-chewing ponytail-wearing 14- and 15-year-olds love her. She works regular hours, is no longer exhausted, and does not have to decide her curriculum based on what the medical insurance companies will reimburse her for.
The Color of Atmosphere tells a gripping story. It’s an important book. It shows, firsthand, what’s wrong with our healthcare system. Kozel has been called a “traitor” by her colleagues on doctors-only Internet sites. I’m not surprised she’s struck a chord. Though so many doctors in America feel demoralized and burnt out, and though most feel that they are no longer delivering an adequate standard of care, it’s totally taboo, and a betrayal of the profession, to admit as much in public.
I applaud Kozel’s courage in writing such an honest book. I hope you’ll read it. And send a copy to Congress.
Read the original review.
Book Review: The Color of Atmosphere
Pediatrician Maggie Kozel's just-published memoir, "The Color of Atmosphere: One Doctor's Journey In and Out of Medicine," is a perfectly measured tale of a career in the trenches of primary care medicine that also says volumes about the declining state of the American health system. Dr. Kozel's personal narrative - that of an initially idealistic doctor who is eventually worn down by the many perverse financial and structural disincentives to doing the "right thing" for her patients - makes this book a compelling enough read. But what elevates it to another level entirely are her unfiltered observations of patient encounters that illustrate much of what has gone wrong with health care in the U.S. This book is not at all a health policy tome, but it nonetheless provides a clearer rationale for the urgent need for reforms than any previous book I've read, period.
The Color of Atmosphere starts with Dr. Kozel's emergence from a difficult childhood to medical school, pediatric residency, and several years practicing overseas with the Navy (where, she observes, "what has been demonized by our culture in general, the specter of universal health coverage, had been fully embraced by that bastion of socially progressive thinking, the U.S. military.") There, in the 1980s, she is exposed to the team-based model of care that is only now gaining traction in private practice, where primary care physicians coordinate teams of nurses and nurse practitioners who provide routine anticipatory guidance, health maintenance, and immunizations at group visits, leaving the physician plenty of time and energy to deal with any remaining concerns.
After resigning from the Navy, Dr. Kozel works at a community health center and a private practice in Rhode Island, where she stubbornly resists the formulas that many of her colleagues use to stay sane and get ahead in medicine. Want to make more money? See more patients in less time; avoid patients with public insurance; avoid those with complex problems; prescribe excessively rather than get into drawn-out discussions of why drugs such as antibiotics aren't really needed. How to prevent malpractice lawsuits? Avoid treating the patients most likely to have bad outcomes, even if you are the on-call physician and an uninsured child is gasping for breath in the local ER. In other chapters, she explores the mismatch between pediatric residency training and providing primary care for children, and the tilting-at-windmills approaches that physicians and medical societies have increasingly taken to addressing complex social problems such as obesity, physical inactivity, poor parenting, and psychiatric disorders.
When Dr. Kozel announces her decision to leave her practice to take a job as a chemistry teacher at her daughters' private school, many of her physician colleagues admit to her that they are just as frustrated by what the practice of medicine has become as she is. Nonetheless, she says, "Medicine had challenged me, thrilled me, frightened me, and humbled me. But it had never disappointed me. It was the system we use to deliver health care, with its inefficiencies, misplaced incentives, and misguided use of resources, that distorted the doctor-patient relationship and exhausted me. ... I would always feel ambivalence about leaving medicine, I knew, but never any about having entered it." Dr. Kozel is a superb writer, and although her departure from the medical profession is surely a loss for her patients, all of us will benefit if this book is read by policy makers, doctors-to-be, and regular people who will advocate for much-needed health reforms.
Read the original review.
Book Review: The Color of Atmosphere
This and That and the Other Thing - January 23, 2011
The Color of Atmosphere: One Doctor's Journey In and Out of Medicine
Thanks to the publisher, via NetGalley, I had the opportunity to read Maggie Kozel's memoir of her time as a medical student and pediatrician. Born in a dysfunctional family, the daughter of alcoholic parents, Maggie decided while a student in a Catholic high school that she wanted to be a doctor. We followed her through medical school, residency, the Navy, work in a community charity clinic, private practice and, finally, out of practice and into teaching.
While mostly a memoir, this book is also a not-to-subtle call for the United States to adopt the medical model used by the US military in the early 1980's. In short, every patient (and at that time this model was used to treat family members and retirees as well as active-duty service people) had an assigned medical clinic or hospital. When you got sick, you went there and were treated. Work was delegated down to non-physician providers when possible. No money changed hands. She could order the treatments she thought best without worrying about being paid or about malpractice. Patients didn't have to worry about paying for it.
Kozel complains about parents who wanted antibiotics for colds or who didn't listen to her when she suggested that "Johnny" needed more playtime and less screen time. She complains about doctors who avoid tough cases because of the time commitment and the risk of malpractice suits. Mostly she complains about the insurance reimbursement system which, in her opinion, rewards the wrong thing. An example she gives is well-baby checks. In the military hospital, kids the same age were scheduled for checks on the same day. First, the nurse talked to a room full of parents going over milestones, discipline issues, and other stuff that gets discussed with everyone at those visits. Then a corpsman would weigh and measure the kids. The doctor would check them over and answer any remaining questions--or send them to someone who would, and would refer the parents to anyone else they needed to see. In civilian practice, she was the one who had to do all the work because the insurance company wouldn't pay extra for the nurse to do it--hiring a nurse to do those sessions would cut into their income.
Read the original review.