Skip to main content

Posts

Showing posts from 2017

Whistleblower 2018 Predictions

Here are some predictions that I pray will come true! Nancy Pelosi, James Clyburn and Steny Hoyer will step down in order to pass power to younger Democrats. Donald Trump will be invited to speak at a Planned Parenthood Convention. Mitch McConnell will recommend that Merrick Garland be placed at the top of the list if a U.S. Supreme Court justice vacancy develops. Kim Jong Un decides to denuclearize his country. Debbie Wasserman Schultz declines to run again in 2018 when facing poll numbers that predict she will be thumped. Putin gives back Crimea to Ukraine stating, ‘My bad!’ Chuck Schumer responds to a GOP legislative proposal stating, “Wow, that’s a great idea!  Why didn’t we think of that?” The NRA demands that congress close loopholes on background checks before all firearm purchases. Amazon decides to close down to allow for the resurgence and thriving of small shops and businesses.  Millennials will put aside their smart phones and recreat

Merry Christmas in the Hospital Wards

Tomorrow on Christmas I will be working.  I’ve worked on December 25 th for as long as I remember.  Our offices are closed but the hospitals are open.  I have chosen a profession that must be available to serve at all times.  If I want a day off, then I am obligated to make sure that there is a doctor in my place. Many professions share this reality.  Nurses, law enforcement, military personnel, hospital workers, firefighters have all worked on holidays when most families were relaxing together.  We accept this responsibility.  But, at times I do suffer a tincture of envy thinking of folks who never have to wonder if they are working on Thanksgiving since they are off on every holiday.  I remind myself during my Yuletide rounds that the last place that these patients – at least most of them - want to be is in the hospital.  Yes, I will be spend some hours treating them, but I will return home and not face surgery, medical testing and the various indignities of hospital

Whistleblower Holiday Cheer 2017!

Dashing through the swamp Through caves of muck and mire Where folks are much afeard That someone wears a wire. Repeal, replace went down Mitch played a losing hand Which traitor killed the bill? Susan, John or Rand? Now, onto tax reform, With just a minor glitch, It crushes us with debt Excepting all the rich! Does Rexie have to go, For someone with more steel, Who believes with heart and soul. In Art of the Deal? The Dems kicked Franken out Of this they were so sure, They needed to stampede To prep for Judge Roy Moore. The Dems and GOP Whose mantra is ‘Attack’! Sometimes face to face, Or sometimes in the back! Soon this year will end, Will next year be duller? I doubt this will occur Once we hear from Mueller! Some want Trump to go. But does this move make sense? Would they really want President Mike Pence? Joy and Peace!  W

Reducing the Federal Deficit - A Monumental Approach

This past week President Trump reversed protection for millions of acres in two national monuments in Utah.  Bears Ears National Monument and Grand Staircase Escalante will be halved as a result of the major surgery just performed by the Chief Executive.  These moves will likely result in job security for scores of environmental lawyers. Teddy Roosevelt is growling in his grave. As expected, there were howls from the left, most of whom have probably never visited the sites.  How many people are against opening up the Arctic National Wildlife Refuge for drilling who have never been to Alaska?  Keep in mind that the folks who actually live in Utah, and the legislators who represent them, argue that they should have control over their own lands.  Shouldn’t they have the right to determine the fate of their own state and to resist federal encroachment?   Should the feds compensate states for the economic losses that they suffer when lands are deemed to be federal monuments? When d

Does Patient Autonomy Improve Health?

It used to be that doctors knew best.  We told you what to do and you obediently complied.  The world has changed and the paternalistic system of yore has given way to the shared decision model where patient autonomy is respected.   The Old Way:   “Well, I’ll be setting you up for surgery soon.” The New & Improved Way: “Let’s discuss all of the reasonable options with their respective advantages and drawbacks.  Then, you make the call.” To paraphrase the mantra of Fox News:  D octors Report – You decide! Has our current fidelity to patient autonomy improved medical outcomes?  I have no idea.  It has certainly changed patient’s (and our) experience, but I do not know if it has improved patients’ health.   I wonder if doctors and patients who have experienced both systems believe that the current system have improved medical outcomes. Has anyone measured if the new system is better? Not every patient wants this level of authority.  I cannot count how ofte

Thanksgiving 2017

The nation pauses to give thanks for health and family and freedom.  As during any holiday or celebration, some of us are in the valley or have been there.  There is always a way forward, even if the pathway is obscured.  We gather together. The First Thanksgiving We converse amiably. 'I'll kill you!' We dine. Blessed with bounty... We talk turkey. Pardon me?

When Electronic Medical Records Crash

The computerized era has introduced all of us to a genre of errors that never existed during the archaic pen and paper era.   The paper medical chart I used during most of my career never ‘crashed’.  Now, when our electronic medical records (EMR) freezes, malfunctions, or simply goes on strike, our office is paralyzed.  Although I appear to the patients as a breathing and willing medical practitioner, I might as well be a storefront mannequin who appears lifelike, but cannot function.  We cannot access the patients’ records, write a prescription or enter a new office visit.  Mannequins appear lifelife but don't function well. Of course, like any business who faces this crisis, we expect instantaneous rescue from our IT professionals, as if we are their only client and they are permanently stationed in our waiting room just waiting for us to sound the alarm. This is among one of the most frustrating aspects of EMR for medical professionals.   We simply don’t have

Why Curbside Consults are Dangerous

One of the skills and stresses about being a doctor, is giving advice to or about patients we have never seen.  If readers think these are rare events, it happens nearly every day.  Often during weekend or evening hours when I am on call, my partners’ patients will call with questions on their condition or about their medications.  Radiology departments contact me during off hours with abnormal CAT scan results of patients I do not know.  Or, a doctor may call me during the day for some informal advice about one of his patients.  These physician-to-physician inquiries are called ‘curbside consults’, which are appropriate for simple questions that do not require a formal face to face consultations. Physicians must be cautious when providing a curbside opinion on a patient he has not seen as even informal advice could result in legal exposure if the patient later files a medical malpractice claim.  Consider this hypothetical example. An internist contacts a gastroenterologist fo

Polypharmacy in the Elderly: Who's Responsible?

There's a common affliction that's rampant in my practice, but it's not a gastrointestinal condition.  It's called polypharmacy, and it refers to patients who are receiving a pile of prescription and other medications.  I see this daily in the office and in the hospital.   It's common enough to see patients who are receiving 10 or more medications, usually from 3 or 4 medical specialists.  Of course, every doctor feels that he is prescribing only what is truly necessary.  If an individual has an internist, a cardiologist, a gastroenterologist, a urologist and a dermatologist – which is not unusual - and each prescribes only 2 or 3 essential medicines, then polypharmacy is created.  Each day, the patient swallows a chemistry set. First of all, I don't know how these patients, who are often elderly, manage the logistics of taking various medicines throughout the day and evening, before meals, after meals and at bedtime.  Who can keep track of this?  Nurs

Patient Navigators Climb Your Mountain of Medical Bills

To accomplish certain tasks, we need a little help from our friends.  No one can do it all, although many of us are more resourceful than others.  Some folks are adventurous and dive into a new arena with excitement.  They may be tinkerers who aren’t afraid to play with new gadgets.  Sure, they might break some china, but they are apt to widen their skill set and enrich their lives.  Others, eschew this dive bomb approach and prefer to wade cautiously into new experiences.  Their comfort zones are narrower.  They never break the china, but their personal growth is likely more stultified.  For some activities, we should simply call upon the professionals straight away.  Here are some examples of jobs that we should pay others to do for us. Cut down a huge dead tree on our front yard.          Replace damaged roof shingles. Investigate why smoke is seeping out of the hood of our car. Prepare our last will and testament from www.DIEWITHCASH.com or some similar website.

The Curse of Medical Records Documentation

Let me post a question that neither I nor readers can answer. How much of what I do during the course of a day directly benefits patients? Perhaps, I don’t want to really know as I would be dismayed at how much of my effort benefits no one. Ask a nurse who works on a hospital ward, how much of his or her effort is directly applied to patient care.  I would recommend that you have a double dose of antacid in hand – one dose for you and the other for the nurse.  Just today, I was gently reproved by a hospital physician administrator for a lapse in one of my recent progress notes, which I write after seeing every hospital patient I consult on.  Which of the following transgressions do you think I was cited for?  Only one answer is correct. I did not perform an adequate physical examination I failed to address the results of an abnormal CAT scan I neglected to write the time of day along with the date of the note. I did not discuss the case with the patient’s family.

I'm Taking a Knee on Journalism

Thanks to NFL players, our national anthem is getting more attention than ever.  Keep in mind that many of us could not recite its words without error, and fewer of us have the range to sing it.  Even fewer can cite the historical event being described.  This is the latest, but not the last, example of a solvable issue that is being exploited to divide us.  I lament that so many of controversial issues ricocheting in the public square are similarly solvable, and yet remain combustible. The media stokes these conflicts, in my view.  Listen critically to how CNN and other networks package and deliver the news.   Not only is the reportage suffused with editorial content and slant, but it sows overt division and partisanship by design.   Consider the following two hypothetical questions from a TV reporter.  Which one would the network be likely to air? “Senator, what is your plan for tax reform?” “Senator, the leader of the opposing party attacked your tax policy as a cruel

Why Are You Seeing A Gastroenterologist?

I write to you now from the west side of Cleveland in a coffee shop with my legs perched upon a chair.  Just finished the last Op-Ed of interest in today’s New York Times.  Do I sound relaxed? I rounded this morning at both of the community hospitals that we serve.  There is not a day that goes by that doesn’t have blogworthy moments.  If I had the time and the talent, I would post daily instead of weekly.   Read on for yet another true medical insider’s disclosure. Gastroenterologists, as specialists, are called upon by other doctors to address digestive issues in their patients.  For example, our daily office schedule is filled with patients sent by primary care physicians who want our advice or our technical testing skills to evaluate individuals with abdominal pain, bowel issues, heartburn, rectal bleeding and various other symptoms.  The same process occurs when we are called to see hospital patients.   If a hospital admitting physician, who is usually a hospitalist, want

Does Secretary Tom Price Deserve Forgiveness?

What is the explanation for Tom Price, a physician and current Secretary of Health and Human Services, taking private charter flights costing taxpayers hundreds of thousands of dollars?  Keep in mind that when Price was a conservative congressman from Georgia, he would have railed against such fiscal profligacy.  Is it hubris?  Entitlement?  Or, do folks who ascend to positions of power simply rationalize that such excesses are absolute necessities for getting the job done? By the time this piece is posted, Dr. Price, an orthopedic surgeon, may have been surgically excised from the government without anesthesia.  While his behavior is not quite Watergate, it was wrong.  And, if it was not wrong, it demonstrated impaired judgment.  And, if was not simply a repeated exercise of misjudgments, then it exhibited bad optics.  And, if it somehow passed the optics test, it was just dumb.  Would Price have been able to explain these expensive charter flights to average folks, half

Why Graham-Cassidy Bill to Replace Obamacare Should Fail

The Graham-Cassidy bill – the latest Repeal and Replace iteration - still has a pulse, but its prognosis is grave.   While we physicians generally avoid predicting outcomes, my sense is that this bill will be buried in the coming days.  I presume that once its passage becomes mathematically impossible, that the bill will be pulled. Of course, failure to Repeal and Replace is a horrendous embarrassment and exposure of the Republicans who have been campaigning and crusading against Obamacare with religious zeal these past 7 years.   These patriots knew they could safely rail against the Affordable Care Act (ACA) – throwing red meat to their base – knowing that the bills would never pass while a Democratic president occupied the White House.   How ironic it is that now that the GOP have congressional majorities that they couldn’t get it done.  Not only could they not run the ball into the end zone, but they repeatedly fumbled at every opportunity into the hands of waiting Democrats. 

Why Are Drug Prices So High? Explanations Welcome

Most of us do not know the basics of economics, although we should.  It impacts every one of us every day that we are alive.  Yet, for most of us, once we get beyond the law of supply and demand, our knowledge of the subject starts to vaporize.  I can't explain fiscal or monetary policy.  While I regard economics as a science, it seems that experts routinely interpret data differently, which confuses beginners like me.  What are novices to think when one expert hails our continued job gains while another laments our anemic recovery? The Puppeteers I have a general feel for market forces.  If consumer demand for an item rises, then I will expect to pay more.  If I want to make a purchase at an independent appliance store, then I will expect to pay more in return for superior customer service.  If the item is manufactured in China, it will likely cost me less as this factory is not burdened with worker protections, environmental regulation and union wages. The above

Hospital Acquired Infections and C. diff. Is My Hospital Safe?

If any reader has heard of C. difficile, affectionately known as C. diff, than I presume you have had closer contact with this germ than you would have liked.  It’s an infection of the colon that can be serious, or even fatal.  There isn’t a hospital in the country that isn’t battling against the infection.   We are not winning the war against this crafty and cunning adversary.  We Need Better Weapons Against C. diff While the infection is not new, the strength and seriousness of current strains of the germ have tilted the odds against doctors and our patients.  The infection usually is a ‘side-effect’ of antibiotic treatment, but it can also be contracted from infected surfaces and people that reside in hospitals and extended care facilities and nursing homes.  For example, nowadays a patient can be admitted to a hospital and pick up the germ from hospital personnel who are contaminated from contact with an actual C. diff patient.  For this reason, C diff patients are k

Labor Day 2017

Couldn't cover every tool or trade here, but a shout out to all.   All work is honorable. Warm wishes from the Whistelblower.

Jury Blames Talcum Powder for Ovarian Cancer - No Evidence Needed!

I have written about talcum powder previously.  Indeed, I have not only opined on the slippery substance, but I am also a regular consumer of the product.  Talcum powder has become magic legal dust that brings forth zillions of dollars to those who have been attacked by the poisonous toxin.  Just last year, I informed readers of $55 million and $72 million judgments to cancer victims who used powder against the manufacturer Johnson & Johnson.  Earlier this year a Missouri woman was awarded $110 in damages.  Recently, a jury in California, where the cost of everything is stratospheric, ordered J & J to pay damages to a victim of ovarian cancer.   The jury clearly wanted to send the company and corporate America a monetary message that went beyond the pinprick judgements that were issued against J & J last year.  Readers at this point are invited to consider what would constitute reasonable damages if it were proven true that the product caused the cancer and th

Yikes! There's Food Stuck in My Throat! The Steakhouse Syndrome Explained

While I typically offer readers thoughts and commentary on the medical universe, or musings on politics, I am serving up some lighter fare today.  Hopefully, unlike the patient highlighted below, you will be able to chew on, swallow and digest this post.  If this blog had a category entitled, A Day in the Life of a Gastroenterologist, this piece would reside there. I was called to the emergency room yesterday to attend to an elderly woman who had steak lodged in her esophagus.  While this sounds life threatening to ordinary folks, it poses no mortal danger.  The airway is uninvolved and normal respirations proceed without interruption. These patients, while fully alive, are rather uncomfortable.  This is one of the tasks that gastroenterologists are routinely called to undertake, often at inhospitable hours. Sometimes, these folks have known esophageal narrowed regions where food that is not masticated with enthusiasm can hold up.  On other occasions, a person with a t

The Heartbreak of Psoriais - Guilt by Association

I was asked this week for an informal opinion by someone who was advised by his dermatologist to take a biologic medicine for psoriasis.   Now, my knowledge of this disorder is barely skin deep, yet knowledge alone will not set you free in the murky world of medicine.  Knowing something is not as significant as knowing when to do something. Can guacamole really cause cancer?  Read on. Biologic medicines, which have surpassed in frequency the nearly omnipresent TV ads for erectile dysfunction, are expensive medications that have risks of serious, albeit uncommon, side effects.  And, unlike chemotherapy for cancer, which has a finite course, biologic medicines are administered forever, that is without a clear stopping point.  The individual who questioned me was not suffering from insufferable psoriasis and was satisfied with the conventional topical treatments he has been using for years.  His dermatologist offered the biologic in an effort to reduce his risk of heart d

Will Genetic Engineering Save or Sink Humanity?

We cannot let the anecdote rule over us.   We don’t make sound policy if we are swayed by isolated emotional vignettes.  Of course, a vignette describes a living, breathing human being, but we must consider the greater good, the overall context and the risk of letting our hearts triumph over our heads when making general policy.  Consider these examples. If an expensive drug treatment program keeps 5 addicts clean for 6 months, do we champion this success in asking for funding to be renewed while omitting that 400 enrolled addicts failed? If an experimental medical treatment seems to be effective in one patient with a stubborn disease, should physicians lurch toward it leaving aside standard treatments which have been subjected to Food and Drug Administration approval and years of clinical experience? If a high school student attends an SAT prep course and achieves a near perfect score, do we conclude that every student should enroll in this course? It is natural to b

Is America Ready for a Single Payer Health Care System?

Each morning, as I read the newspapers in view of 3 birdfeeders, I send excerpts of news morsels to various individuals in an effort to stimulate a dialogue on issues of the day.  I am mindful how deluged we all are with a tsunami of unsolicited material.  I will not contribute to the cyber pile-on.  First, I’ll never forward an article that I have not read in full.  Secondly, I will send an item to an individual only if I have judged beyond a reasonable doubt that this person will feel that the time investment in the material will be judged to be time well spent.  I engage in an active colloquy with one of my good pals, who is among the millions of Whistleblower readers who ponder these posts each week.  To my knowledge, he has never left a comment on the blog, which is somewhat unexpected of this rather voluble individual.   As he has opted to remain anonymous, I will not ‘out’ him here, although perhaps this post may be the catalyst to morph him from spectator to participant.