MD Whistleblower

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Can Doctors Give Medical Advice to Friends?

Quite regularly, I am asked to comment on the care of folks who are not my patients. Often, these are friends or their relatives who are suffering gastrointestinal (GI) distress. “Would you be able to give her a call”? On other occasions, a member of my own family wants me to connect with someone who has a GI issue. This is tricky terrain and I navigate it very cautiously. Obviously, I am not the individual’s doctor and would never assume this role. The individual shares with me only his version of the facts which may not represent the totality of the medical situation. I don’t have the data and have not performed my own examination.. It would be highly irresponsible and unethical for a physician from afar, who has no professional attachment to the individual, to dispense medical advice or to sow doubts about the quality of the medical care rendered. Indeed, a physician who crosses a line here can cause confusion and doubt which can have deleterious health effects. Physici

Diagnostic Tests to Reassure Patients

From time to time, I arrange diagnostic testing to ease patients’ minds. “Could you scope my esophagus? My boss was just diagnosed with esophageal cancer.” “I know I’m not due for my colonoscopy for another 2 years. But I’d like to do it now just to be on the safe side. My wife is worried.” “No, the abdominal pain hasn’t changed since I had a CAT scan for it months ago, but maybe I should have another scan now just in case something new developed?” When these requests are offered, I do not automatically acquiesce. I try to understand better the genesis of the anxiety. Is it rationale? Is it emotional? Is there a true medical indication to justify a diagnostic test? I interpret requests for tests as invitations for dialogue. Very often, the ensuing conversation can settle the issue entirely obviating the patient’s testing request. These patients don’t really want a test; they want to be reassured. Physicians use these skills every day. I can’t count h

Medical Paternalism, Autonomy and Shared Decision Making

In the olden days, physicians had the dominant role in the doctor-patient relationship. During this era of medical paternalism, physicians gave their best medical advice and patients accepted it. If the gastroenterologist felt that his patient’s gallbladder had to go, for example, then surgery was sure to follow. Informed consent – as we now understand its meaning – was not fully practiced. Patients provided consent but were only partially informed. While medical paternalism has largely become extinct, and is inconsistent with today’s societal and medical mores, it was the template for medical practice until only decades ago. And while we regard the subjugation of patient autonomy to be a fundamental ethical breach, both physicians and patients during that era were perfectly satisfied with the arrangement. A patient came to the doctor with medical issues. The doctor -the medical professional - offered advice that the patient accepted. The patient’s condition improved, as

Personal Responsibility for Health

One of the advantages of the computer era is that patients and physicians can communicate via a portal system. A patient can submit an inquiry which I typically respond to promptly. It also offers me the opportunity to provide advice or test results to patients. Moreover, the system documents that the patient has in fact read my message. Beyond the medical value, it also provides some legal protection if it is later alleged that ‘my doctor never sent me my results’. I have always endorsed the concept that patients must accept personal responsibility. Consider this hypothetical example. A patient undergoes a screening colonoscopy and a polyp is removed. The patient is told to expect a portal message detailing the results in the coming days. Once the analysis of the polyp has been completed, the doctor sends a message via the portal communicating that the polyp is benign, but is regarded as ‘precancerous'. The patient is advised to have a colonoscopy repeated in 3 ye

Fecal Incontinence - The Silent Affliction

Gastroenterologists are equipped to assist folks with fecal incontinence (FI) – an awful symptom for reasons that need not be explained. While many of these individuals experience leakage only occasionally, the fear of an impending episode is ever present. They leave home wondering if this will be a day when they will experience a lapse in control. Many remain at home or curtail social activities because of fear and anxiety. So, while the condition is not life threatening, it is an assault on an individual’s quality of life. It’s more common in women and the elderly and is associated with a host of medical conditions. Fecal incontinence is extremely common in extended care facilities which can result in medical consequences. This post is not to discuss the diagnosis and treatment of this condition. Indeed, this blog is a medical commentary site, not an ‘ask a doctor’ site. Here’s the point of this post. More often than not, individuals suffering from fecal incontinence

Lowering Cardiac Risk by 30% - Not So Fast!

The raison d’etre of MDWhistleblower is to give readers a peek ‘behind the medical curtain’. This post is true to this mission. I offer readers a lesson that I have shared with patients, friends and family over the years. I suspect that elements of my point have been covered in prior posts. As I have penned over 800 posts since 2009, I hope readers will forgive me of an example or two of repetition. There is a frequent technique that I’m about to share that misleads patients about the value of various medical tests or treatments. While these communications to the public are technically true, they are misleading. Let me explain. If you saw a product or medical test from reputable organizations that promised to cut your risk of a heart attack by 30%, would you be interested? Odds are that you would be very interested. Who wouldn’t want their risk of a heart attack to be cut by nearly a third? Medicine is riddled with similar promises of benefit for various conditions