Doctor takes on his toughest case

Niantic physician Robert A. Linden discusses his retirement from medicine and his new venture as an author. His book, 'The Rise and Fall of the American Medical Empire' is due out early next year.
Niantic physician Robert A. Linden discusses his retirement from medicine and his new venture as an author. His book, "The Rise and Fall of the American Medical Empire" is due out early next year.

Lots of people say that once they retire, they'll finally write that book that's been welling up in them during their workaday life.

But, like so many New Year's resolutions, many a would-be author's literary intentions fall by the wayside of unfinished manuscripts, or ram into the seemingly impenetrable wall of the publishing house.

Not so for Dr. Robert Linden of East Lyme.

Two years after his retirement from general practice medicine, he's accomplished what he said he would do: write a book about what ails modern American medicine. Not only that, he's found a publisher - a significant feat for a first-time author of a book about health care - and awaits the book's release next month.

The publisher, Minnesota-based Sunrise River Press, has begun marketing the book, which will be available directly from the company, through and at independent and chain book stores. Linden said he was actually courted by another publisher as well, but ended up choosing Sunrise because it would produce a paperback available to the general public, instead of the limited edition, hardcover volume intended only for libraries and universities that the other publisher would have produced.

"This book is not for universities and academics," said Linden, interviewed in his home office, where he did most of his research, writing and revising, surrounded by copies of medical journals and books such as "Idiot's Guide to Writing Well," "1001 Ways to Market Your Books," "Physicians' Desk Reference" and "Harrison's Internal Medicine."

He had been up until 3 that morning sending final revisions to the publisher, but still spoke with passionate energy about his book.

"It's for the American public," he said. "It's a tool for patients."

At 244 pages of text, plus another 62 pages of glossary, bibliography and index, "The Rise and Fall of the American Medical Empire" isn't exactly light reading. Its subtitle, "A Trench Doctor's View of the Past, Present and Future of the U.S. Healthcare System," may not sound inviting to the casual reader, but, Linden hopes, will appeal to those who consider themselves educated consumers.

"Writing this book was really like a public health project to me," Linden said, "and as a doctor, I've always liked explaining things."

Topic remains timely

In the two years since Linden, now 60, began writing, the problems of the U.S. health care system have become one of the dominant topics of debate and news coverage, with Congress closing in on an agreement on a reform bill. He finished writing a year ago and spent 2009 on the revision and publishing process.

Six months ago, he said, would have been the perfect time for his book to be released, just as health care issues were starting to become the hot topic. As the months went by and he waited for the finished book to work its way through the publishing process, Linden said, he sometimes thought that "life was passing this book by."

Coming out next month, it will still be timely, though, after Congress' recent passage of health care reform, and the public's interest has been piqued.

"This book will open a lot of people's eyes," said Dr. Daniel Bendor, a Waterford psychiatrist and assistant clinical professor at the Yale School of Medicine. Bendor, a friend of Linden, read the manuscript four months ago. Every member of Congress and health policy wonk, Bendor said, would benefit from reading Linden's frank assessment of what's wrong with the U.S. health care system and how it stacks up against other industrialized countries, because Linden's is the authentic voice of a self-described "trench doctor" too often unheard by decision makers. Linden did give a copy of the manuscript to Second District Congressman Joe Courtney, who ended up writing an endorsement that appears on the back cover.

Section titles bespeak the book's hard-driving message that something is very wrong in American medicine: "The Death of Primary Care," "Health Care in Disarray?" and "The Pharmaceutical Industry and its Infiltration into the Science and Practice of Medicine."

"I'm bothered that doctors aren't learning from impartial sources any more," Linden said of the pharmaceutical industry's influence in medical schools, journals, studies and workshops. "It's dangerous."

He uses his children
as examples

Linden draws on examples of real (unnamed) patients he treated in his 30 years as a busy primary-care doctor with a loyal following to make his points about problems with malpractice law, health insurance and other issues.

His three grown children also show up in the book, with descriptions of their differing health and insurance situations. Two have had diabetes since childhood, but one is insured through the law firm where he works, and the other is an itinerant film industry professional without insurance and unable to buy it on the private market because of her pre-existing condition.

"It would take only one serious motor vehicle accident on a Los Angeles freeway with an ensuing two- to three-week hospital stay for Beth to exhaust her entire medical expense limit for the year," he writes of his daughter's situation.

His third child's life is also made financially precarious due to insurance. He has a job that provides a stipend for insurance but, even though he's healthy, he is still vulnerable to being dropped if he develops an illness that an insurer would deem was a "pre-existing condition" he failed to report.

Linden also describes his own situation. He's healthy and takes no medications, but ended up being "rated" for insurance purposes because of a hip replacement in 2006. For Linden and his wife, who has mild hypertension, private insurance would cost an unaffordable $20,000 a year. Instead, he was able to strike a deal with his former medical practice to be insured under the firm's policy after retirement.

A rower since his college years at Cornell University, Linden has ramped up his rowing and exercise regimen in retirement - he lives a short distance from the Niantic River, where he keeps his rowing scull - and has lost five pounds.

He feels re-energized, he said, perhaps even ready to resume practicing medicine, once the book comes out and post-publishing book signings and the like are done. If he does go back to taking care of patients, a profession he loved and to which he dedicated himself to the point of near exhaustion, he would look to work in a clinic that serves the poor and uninsured, like the Tennessee hospital where he did his residency as a young man.

His decision to retire at 58, he said, came out of a feeling that "if I kept doing what I was doing, I was going to die in my office. I knew I wanted to get out when I was on top."

Among Linden's former patients, Rosalyn Kline is one who still laments his retirement. Both she and her husband, former East Lyme residents who now live in Florida, are friends of Linden as well as former patients, and were among those who read his manuscript.

"I do recommend it," she said, "because I know the author, and I totally believe everything that's in the book, because I know what kind of doctor he was. He's saying what he really thinks is wrong. It's very enlightening."

The back story

At the end of December 2007, Dr. Robert Linden retired after 30 years in private practice in Niantic, seeing 25 to 30 patients a day, many of whom had been with him for decades.

Then 58, he said he was burned out and saw his as a profession in crisis. Known as an outspoken advocate for his patients, he said one of the first things he wanted to do in retirement was write a book in which he would be just as outspoken about what was happening to primary care and health care in the United States.


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