MD Whistleblower

A close acquaintance of mine voiced objection to the lighting of the National Christmas tree, which occurred on the first day of this month.  Red, white and blue LED lights were illuminated.  I find no offense in this practice, which for me is a secularized event, even though I acknowledge its connection to the Christmas season.   Kids who visited Santa, as I did decades ago, do so in the days and weeks before Christmas.  Neither Santa nor his elves visit us during Arbor Day, the Fourth of July or Veterans Day.  He is connected with Christmas, although like the tree, his purpose is far removed from the true religious meaning of December 25 th .  A Christmas tree is not quite the nativity scene.  Readers who have more knowledge of the New Testament than I can inform us if a Christmas tree with a star on top and wrapped gifts underneath is mentioned in the Gospels.  Perhaps, Santa truly is a religious figure, since like the three wise men, he comes bearing gifts. Religious i

Jingle bells, jingle bells, Romney’s at the door, Standing there with cup in hand, “Please sir, may I have some more?” Who will be the chief at State? Mitt or Dave or Rudy? How ‘bout tough guy JR Bolton? Isn’t he a beauty? Kellyanne, she’s our man! Smiling like a shark, Oh what fun it is to see Her ever present snark. Hillary, gets shellacked! Trump has doused her flame, Except for Comey, racists, assorted haters, Fox News, deplorables, poor messaging, Russians and Wiki leaks, She freely accepts the blame. How did he win? How did she lose? Did she have disdain For forgotten heartland’s pleas, While he felt their pain? Will we ever see the wall? Mexico pays the bill? Or was that just campaign red meat. A huckster’s ‘sugar pill’? The game is done. We must move on And think of lessons learned. Demonizing couldn’t halt Millions who’ve been spurned.  I challenge you to reach inside And summon your good sense Is P

Even though I am over 40 – by a long shot – I am familiar with the abbreviation TMI.  We are inundated with so much noise, chatter and static.  I feel that we are bombarded with information that we must sift through and ultimately delete.  The news cycle is 24 hours and hits us from so many electronic sources simultaneously.  I am deluged each day with so many unwanted and unsolicited e-mails from organizations that I have never heard of.  One of my favorite words on their e-mails can be found when I scroll to the end.  UNSUBSCRIBE! Another genre of information assault is the panoply of warnings and disclaimers that we confront.  Of course, we are all numb to them since we have been so supersaturated.  I’ll prove it to you.  The next time you are about to take off on an airplane, the flight attendant will review safety information in the event that a catastrophe occurs.  While one might think that folks would be attentive to information that might be useful if the plane loses alti

Most of us are skeptical that insurance companies are devoted to our health.  Answer the following question.  Do you think your insurance company is more interested in your health or in controlling costs?  Pretty tough question, huh? There is a tension between medical quality and medical costs.  If we had a system that offered perfect quality, it would be unaffordable.  If we imposed rigid cost controls, then medical quality would be compromised.  Where do we draw the line?  It is clear to most of us that the medical industrial complex is riddled with waste.  Keep in mind that one man’s medical waste is another man’s income.  For example, physicians define waste as excessive charges by hospitals.  Government officials define waste as excessively high drug prices.  Patients define waste as high co-pays and deductibles.  Drug companies define waste as outrageous legal expenses to get drugs to market and to defend against frivolous lawsuits.  Primary care doctors define waste as

While folks across the country were gathered around their holiday tables, I suspect that conversations were not focused on the First Thanksgiving when the Pilgrims broke bread with the Wampanoag native Americans over a 3 day feast in 1621.  There was no pumpkin pie or cranberry sauce served then, and it was more likely that venison was on the table than turkey.  Sometimes, myths are more fun than facts. The First Thanksgiving at Plymouth I surmise that the many of our Thanksgiving dinners were sites of spirited discussions regarding a recent political earthquake that convulsed this country.  Indeed, over the past 3 weeks, I have departed from this blog’s medical commentary, to offer some thoughts on what occurred and why. The nation is sorely divided, but I sense that there will be healing, depending upon everyone’s ability and willingness to listen deeply and absorb the views of reasonable folks whose opinions differs from ours.  Reasonable people are rarely all righ

Let the whining begin!  Donald Trump, the president-elect, has chosen Mike Pompeo, Michael Flynn and Jeff Sessions to serve as CIA director, National Security Advisor and Attorney General respectively.  Here’s the shocker.  They are all conservative!  Let me offer some guidance to the demoralized and deflated liberal, I mean ‘progressive’, political left.  When the nation elects a president who resides to the right of the political center (leaving aside that where Trump truly resides is an arguable question), he is going to choose personnel who share his philosophy.  Trump ran hard on immigration, trade, anti-terrorism policy and the Supreme Court.  Now elected, he should be expected to assemble a team that will further the objectives that he campaigned on.  Isn’t this what we expect when a candidate gets elected? I think that Trump’s appointments mentioned above – all of whom are qualified – cause the left to hyperventilate in an effort to distract their base from their horre

Many folks talked about the possibility of an October surprise prior to our recent presidential election.  Rumors swirled of an FBI bombshell, more WikiLeaks or a Russian hack attack.  The predictors were off by a month.  We received instead a November surprise that many view as apocalyptic.  The nation was shocked, as were the candidates, despite Trump’s minions’ confident public exhortations of victory.  How did the press and the punditocracy get it all wrong?   Even days prior to the election, many pollsters were placing Clinton’s chances of victory in the 75-90% range.  An Unexpected Guest We are beginning to understand how a man who has never held elective office, who by all accounts is a boorish and vulgar narcissist, could vanquish 17 Republican adversaries to gain the nomination and then handily trounce the Clinton political machine on November 8th.    The brash outsider prevailed over the consummate insider.   We are beginning to understand why his unending stream

Oftentimes, physicians and patients face bad options.  I wish that the choices that patients faced were all good ones, or at least had one option that was likely to yield a favorable result.   This scenario is further complicated as medicine is an uncertain discipline with moving goal posts and changing facts.  We make decisions and recommendations based on the current state of facts and our medical knowledge and experience.  We may counsel a patient against surgery, only to discover days later in retrospect that an operation would have been the right choice.  An adverse outcome may result from an excellent decision.  There are many medical circumstances when the options are equally foreboding.   A man may be suffering frequent episodes of angina, chest pain caused by hardening of the coronary arteries.  He is on maximal medical treatment, but the symptom persists.  This is not only limiting his life activities and pleasure, but also significantly increases his risk of a heart att

Physicians and patients often face tough and agonizing choices.  Sometimes, there are no good options available.  On other occasions, there are two seemingly reasonable choices in front of you, but there may be a very different outcome from each pathway.  For example, a patient may be advised by a surgeon to submit to the scalpel while the gastroenterologist counsels to opt for another 48 hours hoping that the medical situation will improve.  Which physician is correct?  They both may be right.  If the patient were to deteriorate 24 hours later, then the operation that had been favored by the surgeon would have been the better choice.  If, however, the patient were to improve spontaneously a day or two later, then avoiding high risk surgery would be clearly favored. Physicians make decisions based on knowledge and experience.  Often, there is a conflict between knowledge and experience that physicians struggle to resolve.  For example, a doctor may have read in a medical study tha

Cleveland took a major economic hit a few years back when United Airlines cut most of its flights from our city.  An airport is the heart of a metropolis.  Lack of their direct flights means that business meetings, leisure travel, conventions and trade shows will likely opt for more convenient locales. This was a business decision for United which I am sure was rational.  Nevertheless, their gain was our loss. As a result, we have had several low cost carriers who have swooped in to gain market share.  We have Frontier, Spirit, JetBlue and now Allegiant.  Not a day goes by that I don’t receive an e-mail blast from one of them announcing fares so low that it seems simply not possible.  Many of the flights’ stated fares are less than it would cost me to drive to the destinations.  How do they do it? Of course, the fare price that is stated is not what you will pay.  The total cost of your flight has been fractionated resulting in an a la carte payment system where every additional se

Last week, I offered up an argument on why medical judgement means more than medical knowledge.  In other words, being a really, really smart doctor is not the essential qualification for practicing excellent medicine.  I ended last week’s post with some examples of medical ads that are familiar to all of us.  Here are some ads and slogans that you won’t see on highway billboards or in press advertisements. ·        Bring your back pain to our orthopedists.  They probably won’t operate on you since most back pain is not effectively treated surgically.  You don’t want unnecessary surgery, do you? ·        Wanna lose weight?  Consult with our bariatric surgeons who will refer you to one of our certified dieticians so you can endure yet another diet.  Who wants a trigger happy surgeon anyway? ·        Come to our oncology center for a second opinion.  Don’t expect any new treatments, since ‘promising’ experimental treatments are exactly that – experiments.  We’re not roll

Would you rather that your doctor have excellent medical knowledge or medical judgment?  Answer this question before reading on. Patients are drawn to doctors and medical facilities who boast ‘cutting edge’ medical knowledge and techniques.  Medical judgement, which is much more important in my view, is barely mentioned.  Good doctors have great knowledge, but great doctors have superb judgment.  Consider the following vignette that I hope illustrates why judgement means more than knowledge. A patient is comes to the emergency room with abdominal pain.  The physician refers him to two different physicians, Dr. Knowledge and Dr. Judgment.  Which of these physicians would you rather see? Is the gallbladder the culprit here? Dr. Knowledge:  I recommend that your gallbladder be removed.  I have trained in advanced robotic surgery which leaves only one very small scar.  My complication rate is extremely low.  Our operating room team is excellent.  I am the only surgeon

Years ago, I was having dinner with 2 members of The Cleveland Orchestra, one of the finest orchestras in the world.  I asked them, with my kids present, how much time they devoted to their craft.  As many parents know, getting kids to commit to practicing a musical instrument is about as easy as splitting the atom in your garage.  The musicians told us how much time they practiced, which was mind boggling, as one would expect.  Any artist, athlete, Green Beret or similar professional, has to demonstrate extraordinary commitment to maintain a superlative level of excellence and preparedness. I asked one of the musicians, the violinist, how long he could refrain from playing his instrument before he noted some professional slippage.  Guess your answer.   At the end of this post, I will relate his reply. How many hours are enough? How long can you be away from your job before your performance ebbs?For most of us, we can take weeks or longer on holiday and return back to ou

On the day that I penned this post, I rounded at our community hospital.   My first patient was in the step-down unit, which houses patients who are too ill for the regular hospital floor.   I spoke to the nurse in order to be briefed on my patient’s status.  I learned that this nurse was assigned 6 patients to care for – an absurd patient volume for a step-down unit.  “Why so many patients?” I asked.  She explained that some nurses called off work and the patients had to be spread around among the existing nurses. This occurs every day in every hospital in the country.  Nurses are routinely required to care for more patients than they should because there is a nursing shortage on a particular day.  Why do hospital administrators allow this to happen?  If any are reading this post, I invite your response.  Enlighten us.  When a nurse is overburdened, how do you think this affects quality of care and nursing morale? I suppose it saves a few bucks on payroll, but this strikes me

I have already opined on my disapproval of a medical marijuana law recently passed in Ohio.  Once of my points in that piece is that I did not want legislators making medical decisions for us.  They can’t even do their own jobs. I am not against medical marijuana; I am for science.  The currency of determining the safety and efficacy of a medicine should be medical evidence, not faith, hope or belief. Marijuana is a Drug Enforcement Agency (DEA) Schedule 1 drug, alongside heroin, LSD and Ecstasy.  I realize this seems odd since most of us do not believe that marijuana has the health or addictive risks of the other agents on the list.  It doesn’t.  But, danger is not the only criteria used in determining which category a drug belongs in, a point often misunderstood or ignored by medical marijuana enthusiasts.  An important criterion of Schedule 1 drugs is that they are deemed to have no proven medical use. The federal government recently affirmed marijuana’s Schedule 1 status

I work with nurses every day.  Anyone who doesn’t realize how hard these professionals work, has never been in a hospital.  Their job descriptions have expanded along with their work load.  This is not your father’s hospital ward.  Hospitalized patients today are older and sicker than ever before.  It takes a seasoned nursing professional to manage the care of these complex patients.   Their work days are full simply managing the expected tasks of dispensing medications, coordinating diagnostic tests and assessing their patients.  There is no time scheduled for unexpected events, which are expected as sick people’s conditions may change at any moment.  In other words, if a nurse must attend immediately to a patient with chest pain, then his or her other more mundane tasks are delayed or shifted over to another busy nurse. I believe that the most potent barrier that is separating nurses from their patients today is the ferocious documentation mandates that nurses are required to p

Honoring work.