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Obamacare Unconstitutional!

I begin this post a few thousand feet in the air, in the aisle seat in the rear of the aircraft. I suppose it is fitting that a gastroenterologist would be in the rear section. Fair is fair. Flying is a psychological test of one’s mettle. After enduring the security process, which is designed to find bad stuff instead of bad people, there are other layers of hassle to face. When I reached the cabin door, I was told that there was no available overhead space to store my bag. This development is often tolerable, as gate-checked bags are brought directly up to the arrival gate walkway after arrival, so you can avoid the hand-to-hand combat of the baggage claim arena. Not this time. For reasons, known but to the Almighty, my bag will be directed to the baggage claim, where I hope and pray that I will be properly reunited with it. Meanwhile, I will enjoy the luxury of an airline seat that would be quite comfortable for an average sized 4th grader. If the lady in front of me tilts her seat b

Whistleblower Holiday Cheer 2010!

Readers immerse In my rhymed universe And decide if my verse Is for better or worse. An imam, a rabbi Along with a priest, Were seated together At a holiday feast. They smiled and they laughed And enjoyed swapping jokes. Can you believe They ducked out for a smoke? Was their bonhomie real Or just a facade? Didn’t they pray To the very same God? When together as men Without enmity, Walls can be broken They realized, all three. Can you still scorn a man And give him the blame? When you raise up your glass And toast him by name? When it’s all over And the three of them part Will they remember The warmth in their hearts? Or will the noise and the static And political din, Return them once more To division and sin? Who will you choose To your table this year? Family and friends Who come year after year? Perhaps, there are guests Who could join you this time, Who could sing at your hearth. Together in rhyme. There are friends on

Medical Ethics: President Obama Makes the Right Call

I have always felt that issues should be judged by the context of their times. For some issues, however, context provides no justification. Thankfully, the field of medical ethics has evolved into a robust discipline, and there is an enormous need for it. I have read defenses of prior ethical lapses, and even some recent ones, suggesting that context matters. If a 3 month placebo-controlled study is conducted in the developing world testing a medicine that was highly effective against a serious illness, are the ethical dimensions considered and respected? Were the pharm companies choosing this study locale as a cheap test run for their drug, which will ultimately be marketed in the west? Is it ethically problematic not to provide additional medications to ill subjects after the 3 month trial ends? Can we be assured that a rigorous informed consent process was followed? Sadly, outrageous practices have been reported in the very recent past. Our president and secretary of state recen

Privatizing Medicare: Caution! Highly Explosive!

Photo Credit In response to my recent post where I averred that the cigarette companies were treated as scapegoats, I have had several cyber and actual conversations about personal responsibility. I believe that folks should realize the consequences and the benefits of freely made decisions. While we want American society to be compassionate, we do not want to punish success and reward failure. Our goal is to do all that we can to maximize everyone’s success. We should be ready to assist those who need and deserve our private and governmental assistance, but personal effort and responsibility are necessary elements of these interventions. In our gastrroenterology practice, when we see patients who are in financial difficulty, my physician partners and staff will do all that we can to help them. While it is not our policy to do colonoscopies for free, we will make whatever adjustments that are necessary to make sure that the patient receives necessary medical care. However, when pa

Electronic Medical Records: Medical Malpractice Shield or Magnet?

Several posts on this blog have been devoted to tort reform . More than any other subject, this topic generates more heat than light. Indeed, I describe these debates and commnets on this blog and elsewhere as duels, not discussions.  Many folks on various sides of this issue earnestly believe that they have the better argument. Other viewpoints are not purely held and are clearly contaminated by self-interest. I have written repeatedly that I believe that the current system is unfair and does not serve the public well. The public understands the issues and the controversies. In general, I don’t think most Americans believe that we have too few lawyers or lawsuits in this country. It is astonishing that people can defend a medical liability system that           Misses the vast majority of patients injured by medical negligence           Ensnares many more innocent physicians than negligent ones. Shouldn’t these two inarguable facts be sufficient to demand at least an examinat

Big Tobacco - The Government's Favorite Scapegoat

Smokers of the world unite! It’s strange for a physician to be sympathizing with the tobacco companies, purveyors of the opium of the people. Am I a stealth nicotine addict, an apologist for Big Tobacco who supplies me with my daily fix? This scurrilous allegation can be vaporized in a one-question quiz. Identify which two of the three individuals listed below are cigarette smokers. John Boehner, newly elected Speaker of the House , 3rd in line to the presidency Barack Obama, Commander-in-Chief and leader of the free world Michael Kirsch, Hemorrhoid examiner I’ve never smoked and I detest the habit. It kills people and separates lower income Americans from money that could likely be devoted to more worthwhile endeavors. I remember caring for folks with end stage emphysema as a medical resident and thinking that this disease was worse than cancer. I haven’t changed my mind. Yet, I have felt for years that Big Tobacco is demonized by the press and the government as Big Scapegoa

Health Care ‘Reform’ Reforms Legislature

Thank you, Obamacare. The GOP, demoralized and frustrated, as they endured the Obama liberal juggernaut that trampled across the country these past 2 years, has been resuscitated. It’s more fun to be in the majority, as Nancy Pelosi can recall. Democratic hubris and rising public disapproval provided not just a strong wind, but a tornado, behind the GOP’s backs. Obviously, there’s nothing revolutionary here, as midterm elections tend to favor the minority, with rare exceptions. What is noteworthy here is the depth of disapproval with the current administration’s policies, affecting every demographic. The gains that the Republicans achieved, particularly in the House, have left Democrats numb and glum. Whistleblower readers will not be shocked to learn that I did not vote for Obama in 2008, but I was inspired by him. I wanted to believe that he would be the transformational figure that his campaign promised and that the country desperately needed. In particular, I was moved by his s

Can CAT Scans Prevent Lung Cancer? Smoke and Mirrors

I still marvel at the accomplishments of CAT scans and imaging studies.   These technologies have revolutionized the medical profession.   Imagine foretelling 50 years ago that a new technology would emerge that could perform ‘exploratory surgery’ without an incision.    This prediction would be greeted with disbelief, if not scoffing.   Of course, there would be similar reactions if decades ago other technological feats, such as fax machines, personal computers, emails and internet, were predicted. CAT scans save patients’ lives, prevent surgeries, make accurate diagnoses and refine treatment plans.   This is the good news.   However, as expressed repeatedly on this blog, there is a darker side of the story. Without doubt, too many CAT scans are performed. Accumulated medical radiation has health consequences. Resources expended on unnecessary CAT scans could be devoted to worthy health care endeavors Radiologists suffer from litigophobia and identify every tiny abnormality, whic

Plagiarism and Medicine: Should We Care?

Recently, I wrote a post on plagiarism in medicine. I advocate a stringent code of ethics for our profession. Once our integrity becomes squishy, then the whole tapestry starts to unravel. We physicians are charged to search for and guard the truth. In 1910, Sir William Osler wrote: No human being is constituted to know the truth, the whole truth, and nothing but the truth; and even the best of men must be content with fragments, with partial glimpses, never the full fruition. Of course, we physicians don’t always succeed in enlightening the truth, but we try. Every day, every one of us faces choices that test us. Some are easy. Most of us would not falsify billing submissions. Other choices are murkier. For example, do we coax a symptom out of a patient so that the procedure or visit becomes a covered benefit? Have we informed a patient whom we are recommending a colonoscopy about the radiologic alternatives? When a patient informs us that his primary care physician has referred hi

ABIM Board Recertification Exam: Threat Level Green

Photo Credit Two Thursdays ago, I took the American Board of Internal Medicine (ABIM) recertification examination in gastroenterology (GI).    Whistleblower readers have already digested some of my musings on this event.   The good news is that there was no penalty for incorrect answers.   The bad news is that I submitted many incorrect answers.   Every one of these standardized tests that we all take becomes a mind game, where the examinee (us) tries to penetrate the psyche of the test makers (them).   We’ve all been there.    We torture ourselves between what we think is the right answer, and what we think that the questioners think is the right answer.    Sometimes, I thought that the ‘correct’ answer on the list is out of date, which confused me.   Or, what I felt was the truly correct answer, wasn’t included in the answer choices.   For example, I am a very conservative practitioner, who often advises observation, rather than tossing patients into the diagnostic arena.   In a few

Advanced Cardiac Life Support and Tort Reform

Photo Credit Two days from this writing, I will go mano a mano with a computer screen.    This will be my second gastroenterology (GI) board recertification.    Last week I suggested that the 490 minutes of unfettered fun might not be money well spent.   A reader could infer my view that the $1200 fee has more to do with securing the finances of the American Board of Internal Medicine than it does to enhance my knowledge of GI.    Perhaps, I was hyperventilating about the cost.   When I calculate the GI board CPM (cost per minute), I determine that the exam only costs $2.45 per minute    In other words, a full minute of quality board testing time costs about the same as a slice of pizza.   Clearly, the test is a bargain, and I retract any prior Whistleblower whisperings that contradict this.   Yesterday, I took another exam, this one to recertify me as a qualified Advanced Cardiac Life Support (ACLS) practitioner.   An excellent paramedic instructed me and my 2 GI partners on new

Board Recertification in Gastroenterology: More Fun than Colonoscopy

Photo Credit This coming Thursday, I will have the joy and pleasure of taking the gastroenterology (GI) board recertification exam.    There will be many entertaining elements to the experience, as other board certified physicians already know.   Although there will be many fun delights, some will clearly be more amusing than others. Which of the following features of the GI board examination will be most fun?   While more than one answer may be correct, choose the best answer . (1)     A 490 minute all day exam is a thrill, by definition (2)     Losing a day of income (3)     Paying the American   Board of Internal Medicine (ABIM) $1200 (4)     Pleasing my partners who will cover my practice (5)     Having my palm vein recognition scan to verify my identity every time I reenter the room During this exam, each giddy examinee will be provided with a computer station.   I am nostalgic already for the proctor of yore announcing, ‘pencils down!’, as there will be no pencils permitted in

The Myth of Electronic Medical Records

Painting of Paul's Damascus Road Conversion Electronic Medical Records (EMR) promises to be the holy grail of modern medicine.    It aims to deliver us from the Smith Corona era into the digital age.    I’m a gastroenterologist who has already been practicing digitally for two decades.   I guess I am way ahead of my time Is EMR progress?      Consider these two hypothetical   patient assessments.   The assessment is a critical section of the medical record where the physician shares his thinking on the patient’s condition.    The assessment answers the question, “What do you think is going on here and why?”   The Old Fashioned, Archaic, Fossilized and Sclerotic Assessment The quality and timing of the patient’s abdominal pain is strongly suggestive of mesenteric ischemia (lack of blood supply to the guts), as the pain consistently develops   45 minutes after meals.   The patient has numerous risk factors for this condition.    Peptic ulcer disease is unlikely as the patient ha