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Doctor-Patient Relationship Needs John Adams

In 1770, in Boston, British soldiers fired into a crowd of colonists who were taunting the soldiers.  Several colonists died and several soldiers were arrested and charged with murder.  This event known as the Boston Massacre was a seminal historical episode that contributed to the colonists’ growing desire to separate from the British Crown. Boston was a cauldron of the independence movement.   Hatred against the British was prevalent.  Who would be willing to defend the accused soldiers at trial risking opprobrium or worse?  John Adams, our future second president, defended the soldiers believing that every accused deserves adequate representation.  To this day, America distinguishes itself with our belief and practice that an accused man is presumed innocent and is entitled to a competent legal defense.  As we all know, lawyers are often assigned or volunteer to defend unsavory individuals to protect their clients’ constitutional rights, ensure that the legal process is being r

Has Coronavirus Infected our Politics?

Have you heard enough about Coronavirus yet?    If not, feel free to tune in to the Coronavirus News Network, also known as CNN. I have zero medical experience in virology and public health, so read no further if you are looking for a Whistleblower travel advisory or if it’s safe to pet Scruffy if he develops a fever. I’m also not here to gripe about our nation’s response to this incipient pandemic.     Although we have a first class team in place now, even they admit that they stumbled initially.  I'm more interested in making progress than in racking up debate points. My observation is that there is no issue or event that is immune to politicization, a reality that depresses me.   We all agree that prior to the virus’s emergence from China, we were already rabidly hyper-polarized and hyper-partisan in the zero sum game that now defines our political landscape.   I won’t add to this sentence so as not to waste readers’ time in reading what we all know and agree on.  

Can Sherlock Holmes Teach Today's Doctors?

To Sherlock Holmes, she is always the woman.    Thus begins Conan Doyle’s, A Scandal in Bohemia published in 1891.   In this gripping tale, Holmes is bested by a woman who proves to be the detective’s equal in intelligence and deception.   For reasons I cannot explain, I restrict my exposure to Holmes and Dr. Watson to podcast listening when I am airborne.  Years ago, I did love watching the classic movies starring Basil Rathbone and Nigel Bruce who defined the roles for me.  Conan Doyle, a physician, was a superb story teller, who wove his tales with texture, plot and humanity.  I think he wields words with surgical precision.   I admire his skill. I wonder to what extent Conan Doyle’s medical training influenced his writing?  Certainly, the stories often discuss arcane medical conditions that provide the detective with important clues.  In The Adventure of the Blanched Soldier, Holmes suspects that the protagonist is suffering from leprosy, a diagnosis that is revised af

Can Doctors Help You Lose Weight?

As a gastroenterologist -a trained specialist in digestive issues - I should have expertise in obesity, nutrition and weight loss strategies.  I really don’t.  While I have knowledge on these issues that likely exceeds that of most of my patients, I received inadequate formal training on these subjects during my gastroenterology training.   It is inarguable that digestive doctors – and indeed all physicians – should bring a high level of expertise on these medical issues into their exam rooms.  The impact of obesity reaches nearly every medical specialty.   Obesity is linked to heart disease, stroke, cancer, arthritis, diabetes, sleep apnea, high blood pressure and many other illnesses.  Most of my overweight patients tend to remain so.  Many of them are simply resigned to a shape and size that they feel they cannot alter.   Some are not motivated to engage in the hard work and long journey that can lead to a leaner dimension.  Some do not recognize that successful weight loss req

The White Coat Wall of Silence

We’ve all heard about the blue wall of silence that describes a belief that law enforcement personnel will refrain from reporting misconduct of their colleagues to the proper authorities.  Physicians had similarly been accused of hiding behind a white coat wall of silence , as I have on this blog.   This describes the belief that physicians do not reliably turn in colleagues who are incompetent and impaired.  Personally, I have never knowingly participated in the care of a patient with an impaired colleague.   Competency is a murkier issue and is, of course, variable in the medical profession.  In addition, it’s not easy to define or to measure.  It is this very fact that has made me so hostile to the Pay-for-Performance schemes that claims to be a quality metric, but is truly used as a cost cutting tool. 'I Know Nothing' I am aware of physicians in my community who do not have a strong reputation of medical skill.  Yet, many of these physicians are beloved by their

Do You Need a Patient Advocate?

I wish I could write that medical care today is an optimal, cost-effective and efficient system that consistently provides appropriate and sterling medical care.  I wish I could write that pharmaceutical companies, hospitals and extended care facilities all view patient care as their primary and overriding mission.  I wish I could write that physicians all share the highest ethos of patient advocacy. It is not possible to achieve these idealistic goals as the individual professionals, corporate entities and the government that comprise the medical profession are imperfect and face numerous conflicts of interests.  Indeed, this blog as devoted considerable space to highlighting these issues. Here’s a representative vignette from my world.  I was asked to see a hospitalized patient for an opinion on her low blood count, or anemia.  This is a common request for gastroenterologists as internal bleeding is a frequent explanation for anemia.  This is when we gastroenterologists

10 Mistakes Democrats Made on Impeachment

I am not going to offer an opinion if the Senate’s anticipated acquittal of the president in the impeachment proceeding will be correctly decided.    I have nothing to add to the millions of words that have already been said, written and dreamt on this issue.   And, even if I had divine inspiration to contribute a new thought, would it change anyone’s mind? Leaving aside the merits of the case, I do think the Democrats have committed a series of errors that contributed to the GOP’s victory and made it more palatable for senators to support the president. Flag of the U.S. Senate House members and others have been clamoring for the president’s impeachment since his inauguration.   Indeed, a resolution for impeachment was submitted to the Republican controlled House in December 2017.   This feeds the narrative that the Democrats were fixated on the impeachment outcome long before the Ukraine imbroglio developed. Democrats and others in print and the airwaves were warn