MD Whistleblower

Posts

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

Disadvantages of Electronic Medical Records - My EMR Ghosted Me

A few days before writing this, I had an ‘epic’ experience upon my arrival to work. I had 17 procedures scheduled that day and the first few of these lucky folks were arriving. After changing into scrubs, I sat before my computer and was prepared to swipe into the electronic medical record (EMR) system with my ID card. On prior occasions, when I have successfully performed this swiping exercise during office visits, I have joked with the patient, ‘looks like they haven’t revoked my credentials!’ But not today. After 3 swipes I had struck out. No entry. And my password wasn’t accepted. Twelve hours ago, my credentials were solid and I was a physician in good standing. Now it seemed I had become a physician non grata. My morning welcome from my EMR system! What happened? Was I being terminated without notice? Were foreign hackers at work? Was I to expect a ransom ware demand shortly? We use the electronic medical record system called Epic. Our first call to

Inpatient vs Outpatient Care;: Can Doctors Do Both?

Five years ago, I left hospital wards and emergency rooms behind and entered a new & improved medical practice model, at least for me. Since then, I only see patients for office consultations and procedures. Office medicine is a very different trade than hospital practice each having very distinct skill sets. If I were to return to the hospital now to see patients, it would be uncomfortable for me (and them) having not used these skills for years. Similarly, hospital-based doctors might find transitioning to an office practice to be clumsy and uncomfortable. While it might seem that a gastroenterologist or any medical specialist should be able to see patients in any location, this is not the case for most of us. Hospital medical issues are quite different from office medical complaints. Physicians, as in so many other occupations, need repetition in order to maintain high competency levels. There’s a reason, for example, that airline pilots need to maintain specified fl