MD Whistleblower

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Delivering Bad News to Patients - A Primer

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address at this link to receive my posts directly to your inbox. Last week, I shared my thoughts on the essential physician skill of delivering serious medical news to patients. This week, as promised, I share a dialogue between me and a patient with some editorial comments intercalated in italics. This is not a real patient, but the scenario I created is highly realistic and familiar to medical professionals and to many readers. While I welcome reader comments of all stripes, please keep in mind that I did not endeavor to cover every aspect of this issue. I tried to emphasize some major points. Now, onto the vignette. Comments of all stripes welcome on this and every post. Joe is a 50-year-old man who is about to undergo a routi...

Delivering bad news to patients.

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address at this link to receive my posts directly to your inbox. Life changes in an instant. This truth becomes more self-evident as we age, although even the young may have to learn hard lessons before their time. We may be comfortably coasting along in a carefree manner only to have a single phone call or a text shatter our equilibrium. Certainly, every reader of these posts has had this experience. I am referring here to an unexpected change of fortune. It’s quite a different scenario if one has time to prepare for a disruption, such as knowing that you will lose your job in 6 months. In this example, there is time to prepare and to forge an alternative pathway so that when the current job ends, in a best-case ...

Canceling a Patient's Medical Procedure

I spend most of my time these days in the endoscopy suite. Most of these patients are meeting me for the first time. The patients seem quite accepting that a perfect stranger will be performing their medical procedure. This is one of the realities of practicing in an institution that manages an enormous volume of patients. The patients assume that they have been linked with a competent practitioner. This is analogous to a patient who is scheduling a chest x-ray or a CAT scan. The patient has no idea or concern over which physician will be interpreting the films. They assume competence and no longer need an established rapport. What I will state next may seem bizarre to readers, but stay with me on this. From time to time, I have difficulty ascertaining the reason that a patient has been sent for a scope examination. More often than you might think, the patient is unclear why the test was scheduled. “My doctor ordered it,”...

When the doctor is a patient

A few days prior to penning this post, I had an unexpected but valuable educational lesson. The experience was brief but its effects are still lingering with me. Not surprisingly, when a physician becomes a patient, he or she views the medical profession through a different lens. For instance, much of the medical advice that we doctors blithely dispense to patients, feels a little less casual when we doctors are on the receiving end. Consider the following example. Physician Dispensing Medical Advice: So, it’s time for your yearly labs. I see that you are due for your colonoscopy, so I’ll arrange this. And, are you ready to get that hernia fixed? Physician Receiving Medical Advice: So, it’s time for your yearly labs. I see that you are due for your colonoscopy, so I’ll arrange this. And, are you ready to get that hernia fixed? I’ll let my discerning readers decide which of the above scenarios is easier on the doctor. Time for your...

Can Patient Autonomy Go Too Far?

On a regular basis, physicians receive calls or communications from patients who want to schedule their own scope examinations of their colon or stomach regions. These requests are solely from patients without any input from medical professionals. A few days before writing this, a patient contacted our office to ask if we would perform an scope exam (EGD) of the esophagus and stomach regions at the same time as his previously scheduled colonoscopy to evaluate his cough. This was his idea. No physician or medical professional was involved. We summarily decline these requests. If one of my own patients is making a scope exam request, I may acquiesce but only after having a dialog on the issue. I do not extend this leniency to patients I do not know and aim for access onto my scope schedule. I believe that patients should not be permitted to order diagnostic tests and procedures. While this may seem self-evident to readers, I surmise that ma...

Trying to be Thankful in 2025

While folks across the country will gather around their holiday tables, I suspect that conversations won't be focused on the First Thanksgiving when the Pilgrims broke bread with the Wampanoag Native Americans over a 3 day feast in 1621. There was no pumpkin pie or cranberry sauce served then, and it was more likely that venison was on the table than turkey. Sometimes, myths are more fun than facts. The First Thanksgiving at Plymouth The space for thankfulness has narrowed, but it is still there and we must do our best to seek it out. This task, of course, does not need to be restricted to only one day each year. It seems more challenging than ever for us to carve away chaos, polarization and discord so that we can focus more clearly on what we should be thankful for. Yes, there is beauty in the world which we must seek out and celebrate. Yes, there is kindness and generosity in our midst which we must champion and emulate. Yes, there is dialogue and ...