MD Whistleblower

Many referrals to gastroenterologists originate from emergency rooms.  Patients seen there with all manners of abdominal pain, nausea and vomiting, bowel disturbances and rectal bleeding are typical examples of this.  Chest pain is another common issue that emergency rooms and primary care specialists send to gastroenterologists, which we often find to be vexing to explain.  I have been through this exercise for a few decades now.  Here’s how it goes down. A patient experiences chest pain and seeks care in an emergency room fearful that his heart is the culprit.   Emergency room personnel take a careful medical history, examine him and do all of the necessary testing and confidently conclude that the heart is well.   No explanation for the pain is determined.   Here’s what this patient should be told. ‘Your heart is fine.   We’re not sure what’s causing your chest pain.   Please arrange to follow up with your primary care physician (PCP...

So often, our views on an issue change when we are personally affected or exposed.  When this occurs, I believe it reveals hypocrisy on our part.  Shouldn’t our points of view be the same whether we are affected or not?  Of course, it should be but we all know that this is not the case. Here’s a stark example illustrating my point.   Many of us support a policy prohibiting paying ransom for hostages.   Doing so, we argue, only encourages the taking of future hostages.   However, might our intellectual view on this issue be different if one of our loved ones was taken hostage?   I suspect that it would be.   I could have cited ransomware as another example.   It’s easier to advise a business not to pay the criminals to restore its data and functionality from a safe perch.   There are still millions of people here in America without health insurance.   I suspect that most folks out there with medical insurance who are busy with ...

Here’s a scenario that I face fairly regularly in my endoscopy and colonoscopy practice. As readers know, over the past 5 or so years I have been employed in a rather well-known Cleveland-based health care institution.  Prior to that, I was a private practitioner.  During those earlier days, I personally knew most of our scope clientele as they were our patients.  There was a minority of patients whom we did not know who were referred in by their doctors for routine scope exams.  In contrast, in my current employed role, nearly all the scope patients on my schedule are meeting me for the first time. From time to time, a patient who is scheduled for a colonoscopy will call my office asking if an upper endoscopy can be performed at the same time because their heartburn or some other symptom has been active. Which of the following responses are most appropriate? Yes we will gladly add on the extra scope test to assess your stomach and esophagus as this would be an o...

Patients understandably focus on who will be managing the scope during their procedure.  They expect that the proceduralist – a physician, at least so far – is a highly skilled practitioner.  They want accuracy and safety.  Indeed, from time to time, after I have reviewed the risks of colonoscopy, a patient will query me directly on my complication rate, particularly with regard to the dreaded event of a bowel puncture.  They are hoping to hear, of course, that I have never had a procedural misadventure, but I point out that the only gastroenterologists who haven’t been involved in a complication are new specialists who are just starting out.  This is a mathematical issue.  If the perforation rate is 1/2500 cases, and the GI physician has performed 20,000 procedures, then there will have been some adverse events. As an aside,  the term complication does not imply culpability.  They are blameless events that occur at low frequency despite the med...

As I begin this post, the federal government has been shut down for several days..  Neither the Democrats nor the Republicans were able to reach the 60 vote threshold in the U.S. Senate to advance their respective legislative plans.  The GOP insisted that a ‘clean’ continuing resolution (CR) be passed without conditions. Democrats demanded that the government extend expiring Affordable Care Act (Obamacare) subsidies enacted during the pandemic, and restore Medicaid cuts contained in Trump’s One Big Beautiful Bill Act passed months ago as the price of their CR support.  The GOP expressed willingness to discuss these health issues, but only if a clean CR is passed first.  The Democrats countered that tying their legislative priorities to the CR gives them leverage to achieve their desired health policy objectives.  Interestingly, this past March, many Democrats supported a clean CR without adding on their legislative preferences.  Hmm… By the time this is p...

Kids are smart.  We know this because many of us have kids and all of us were kids.  I’m not suggesting that every kid is an Einstein who regards the laws of physics to be... ‘child’s play’.  But in many circumstances, they punch above their juvenile weights to get stuff done.  At times, they are master negotiators.  Here’s a vignette illustrating one of their master techniques.  Act I, Scene 1 “Mom, can I have ice cream now?” “Johnny, of course not!   You haven’t even had breakfast yet!” Act I, Scene II “Dad, can I have ice cream now?   Mom said it was ok.” “Sure, son.   Go ahead.” Sound familiar?   We parents know that we do better when we speak in one voice to our youngsters.   When we don’t, our wily progeny can exploit this with great skill.   Kid vs parents - n ot a fair fight!   The value of speaking with one voice applies to us adults as well.   Let’s look briefly at some rather conflicting mes...