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Whistleblower Holiday Cheer 2015!

Jingle bells, jingle bells, Cruz is ridin’ high, Jeb is lagging way behind, But tells us he’s our guy.  Trump is here, Trump is there, Trump is everywhere, Promising we’ll be as great, As his golden hair.  Walker’s gone, Perry’s out, And Jindal, “Not my time”. Lindsey Graham is begging us, “Please send me a dime.” Carly has a pretty face, Christie’s slimming down. Pataki sports a comb over, Santorum wears a frown. Huckabee, with a smile Gives fire and brimstone ash, Carson says, “I stabbed a guy!” Kasich trolls for cash. Who among these flapping jaws, Will be the next to fall? Who can make the case for ‘Prez’? Pataki or Rand Paul? Hillary’s in the catbird seat. Bernie just can’t hit. The GOP in unison ‘Oh where, oh where is Mitt!’ Wishing you Joy and Peace!

Was Granny Sent Home from the Hospital Too Soon?

Over the years, I have heard families bemoan that their relative who was just readmitted to the hospital was sent home too early just a few days ago.   Are they right? Was Gramps Kicked Out Too Soon? First, let me say that in some instances they may be correct.  It is certainly possible that the hospital, under increased pressure to kick folks out, may have pulled the discharge trigger too soon.  The hospital is not always right even if their ‘discharge check list’ seemed to be in order.  Of course, patients are not adequately represented by a check list any more than physicians’ quality can be fairly measured in the check off, cook book method that the government and insurance companies are now championing. The hospital discharge check list may indicate that a patient with pneumonia can be safely discharged home as she has no fever or need for supplemental oxygen.  However, this patient may be 89 years old, riddled with arthritis and needs to attend to a spouse sufferin

Am I Too Old for a Colonoscopy?

Most of us are familiar with the concept of medical guidelines.  These are sets of criteria that are supposed to ‘guide’ physicians facing certain medical circumstances. As physicians know, and often lament, guidelines over time morph to become mandates.  Even though by definition, a guideline is voluntary, many hospital oversight committees and insurance companies require physicians who deviate from guidelines to explain their actions. The U.S Preventive Services Task Force guideline states that folks 75 and older should not receive screening colonoscopies.  The  reason is that medical studies have demonstrated that the benefits of colon cancer screening in this age group is not justified by the risk and expense of the effort.  Of course, there is an age when colonoscopy does not make sense, but I’m just not sure what this magic number is. Too Old for a Colonoscopy? Consider these two hypothetical patients. (1)   A 78 year old man in excellent health has never had a scre

Why Do I Have to Work on Thanksgiving Day?

I began this past Thanksgiving Day seeing patients at two local hospitals.  Yes, I was working on Thanksgiving, as I have done on many holidays over the past 25 years.  Many folks have the luxury of jobs that offer every weekend and holiday off automatically.  Many don’t.   For example, on Thanksgiving, the hospitals were staffed by nurses, secretaries, security personnel, housekeepers and cafeteria workers.  And, of course, every patient was seen by his attending physician and various specialists.  If any of us contemplated complaining that we had to work, a quick glance at any of the patients confined to their hospital beds would have quickly set us right. It’s not only medical care that must be available every day of the year.  Law enforcement, firefighters, utility companies, and national security institutions simply can’t clock out on Friday afternoons.  If you call 911 on a Sunday, you will not be greeted by a recorded message.  The day is a national opportunity to expre

Is E-mailing with Patients a Good Idea?

Physicians speak with patients every day on the phone for a variety of reasons.   Our practice now uses a portal system, giving patients access to some of their medical data and to us.  Although I was resistant to having e-mail communications with patients, I have come to appreciate the advantages. It relieves our ever congested phone lines It relieves patients from a state of suspended animation as they hope and pray that a living breathing human being will return to the line after being placed on hold It saves our staff time who no longer have to triage calls as the patient directly reaches the doctor While this streamlined cyber communication system is useful, it does have limitations.  It can’t solve every problem.  Indeed, some issues are not appropriate for either a phone call or an e-mail. Calling his doctor? Consider the following scenarios.  Which can be appropriately handled on the phone and which merit a face to face encounter with a physician? I was in the

Gadzooks! There's Gluten in my Cheerios!

Gluten is in the news again.  Gluten and probiotics are among the two dietary issues that most consume my patients.  I am asked for my opinion on them several times each week.  Although my opinion is solicited, these patients have largely already made up their own minds as they are often avoiding gluten and swallowing zillions of ‘good bacteria’ with zeal and enthusiasm. Why do they do this in the absence of corroborating medical evidence?  Why do millions of voters support Donald Trump’s mantra that he will ‘make America great again’?  Both of these groups do so on faith.  When our need to believe something is overpowering, our demand for proof recedes.  Many of us need to believe that gluten is the agent responsible for our vague medical complaints that have stymied our doctors.  Similarly, our frustration with so many aspects of our society and conventional candidates makes us believe that Trump will turn the nation into yellow brick roads leading to Emerald Cities everywhere.

How to Increase Medical School Enrollment

Lawyers and physicians have so much in common, despite some benign grievances that occasionally reach the level of homicidal rage.  Just kidding.  Calm down, juris doctors.  Consider the similarities.  Both professions serve a public who needs help.  Both wield professional advice and judgment that must be tailored to an individual’s unique circumstances.  Neither professional is ever 100% certain of anything, and an outcome cannot be guaranteed.  Both are charged to put their clients' and patients' interests above their own.  (Snickering permitted here.) Let's see what our legal brethren are up to.  Law schools in America are having a serious problem that they are struggling to remedy.   They need more students.  Of course, they could fill their classrooms by recruiting qualified candidates to apply to their institutions.  This strategy apparently couldn't fill the seats, assuming that it was even considered.  So, here is their plan, brilliant in its simplicity.  I