MD Whistleblower

I’ve had two jobs since I completed a fellowship is gastroenterology over 20 years ago. For the first decade, I was a salaried physician. Afterwards, I promoted myself to private practice. Each model has its advantages and drawbacks , but for me the private practice model wins out. The climate in Cleveland is extremely inhospitable to private practice, because of two mega-medical institutions that incinerate private practices as their boiling lava flows across the region. So far, our practice is still viable, but the prospects for its long term health and welfare are questionable. One of the advantages of working for a straight salary is that income dies not depend upon productivity. (My employer maintained that we had a productivity bonus, but in reality there wasn’t much the physicians could do to adjust their salaries in either direction.) One of the disadvantages of private practice, particularly where I practice, is the need to hustle aggressively for patients, a task I neithe

Electronic medical records (EMR) were supposed to rewire the medical grid.  It would increase efficiency, reduce redundancy, improve quality and reduce costs.  On  these measures I offer a grade of 0 for 4.  Ask any practicing doctor how EMR has impacted on his practice and be prepared for some remarks that differ from the government’s Kool Aid talking points.  EMR, thus far, hasn’t been ball bearings for the system.  More often, it gums up the works. The EMR Maze - Enjoy! The government spent billions of dollars with cash payments  to induce hospitals and doctors like me to jump on board the EMR express.  The Rand Corporation helped to fuel this euphoria in 2005 when it predicted exaggerated benefits of EMR.   By the way, this study was financed in part by EMR companies whom, I politely suggest, had a vested interest in the study’s conclusion.  Rand denies that they were unduly influenced by their backers, and I don’t claim that they caved on their principles.  Nevertheles

I saw an elderly patient a few months back for a gastrointestinal issue that fortunately led to a benign outcome.  He was a modest man who spoke softly and used few words.  As has been my custom for as long as I’ve sat across patients, I was interested to learn something of the man beyond the issue that brought him to see me.  Indeed, it is these vignettes that I regard as the gems of my practice.  Without them, I would be left only with the practice of medicine, and this would not be sufficient. He wore a military baseball style cap, emblazoned with a U.S.M.C. label.  To those who do not immediately recognize what these letters stand for, then I suggest that you apply to medical school, become a physician, see patients so you also will have the opportunity to learn stuff that really matters. I learned that he served in the Pacific theater in World War II and asked him about his service there.  While my father served in the war for 39 months, he remained in the United States,

There is a steady push to change the way that physicians are paid.  No compensation model is ideal.  The fee-for-service (FFS) model has become Public Enemy #1 as it is felt to be responsible for overtreatment generating excessive costs and utilization.   Salaried physicians may be freed from the FFS conflict of interest, but it has other drawbacks including a diminished incentive to provide exemplary service to patients and to referring physicians.  Since physicians did not initiate compensation and health care reform decades ago when we should have, we are now being squeezed hard by external forces that will overcorrect on the system’s deficiencies.  It’s always better to fix your own house.  There should be a lesson here for other professions who are in need of some reform and repair.  Teachers, in my view, were dragged into the education reform arena, and will suffer because of it.  Attorneys have been smug and cavalier about the legal profession’s obscene excesses and I believe

Last week, I posted on whether physicians should modify their medical advice in response to patients who cannot afford the recommended care.  A hypothetical patient was presented who had no medical insurance.  The clinical particulars suggested that a CAT scan of the abdomen was the ideal diagnostic test, but the patient would not be able to afford this.  I, therefore, offered readers several choices of medical advice, some of which was tailored to the patient’s financial situation.  Here’s my view.    While there is very little in medicine or the world which should be absolute, medical advice must remain pure.   It should depend only upon the physician’s best medical judgment regardless of the patient’s financial situation.    A millionaire and a pauper who present to the doctor with an identical medical issue should receive the same medical recommendation.   Yes, I realize that patients are not interchangeable and that there are cultural, personality and religious differenc

I treat uninsured patients and insured folks who face high deductibles who are under financial strain because of the sagging economy and other personal pressures.   These folks need care that may be unaffordable.   Medical diagnostic testing is expensive.   Even routine laboratory testing can be very costly as those without insurance may be forced to pay the ‘retail cost’, which is quite different from insurance company discounted pricing.   This absurdity is often seen in the emergency room where an uninsured patient can be billed thousands of dollars compared to an insured person who has received identical medical care whose insurance company will pay a fraction of this amount.   Crazy. Because I am a human being, I try to be sensitive to my patients’ financial concerns.   Does the uninsured patient before me really need a CAT scan or a colonoscopy?  Couldn’t we just watch and wait for a week or two and spare him from the expense? Consider this scenario.   A 50-year-old

My personal paradox is that I have railed against the intrusion and dehumanization of technology, and yet I am tethered to my iPhone.   Do I feel differently when it’s my technology and not someone else’s?  I hope not or I might be forced to add hypocrisy to my list of flaws.  I’ll have to monitor myself in a fair and balanced manner.  Will I conclude that my phone call while at a restaurant is of monumental importance while another patron’s phone use is a selfish and unforgivable threat to world peace that should be prosecuted?  Purple Heart - Read on... This morning, I was halfway to work when I felt for the phone in the inside pocket of my jacket.  Not there.  I palpated other pockets none of which contained the desired item.  The car seat was bare.   I did not fear the most dreaded explanation, that being that the phone was mistakenly left in Starbucks and purloined by a Frappuccino felon.    As a U-turn seemed hazardous on the highway, I took the next exit and heade