MD Whistleblower

The week before writing this I saw a couple of patients for 2 nd opinions.  This can be very tricky terrain and I do my best to navigate skillfully.  A casual remark on my part could damage the relationship between the patient and the doctor of record. Here are examples of remarks that I believe are best left unsaid. “Your doctor did what ???” “We don’t recommend that surgery anymore.” “Sounds like you need a new doctor!” “Have you considered hiring an attorney?” “I agree with you that the doctor’s office was unprofessional.” You get the idea.   Other physicians who offer patients second opinions may have a different view on this.   They may believe it is their role to make highly detailed medical recommendations as best they can which may represent an acute therapeutic course change.   They may even offer to take on the patient formally, a suggestion that would be expected to be welcomed by the dissatisfied patient. Trapped in a Medical Labyrinth...

I spend more than half of my work week performing endoscopic procedures, the majority of which are colonoscopies.  Many of these colon exams are screening colonoscopies, meaning exams performed in the absence of any symptoms, an effort to reduce colon cancer risk.  This is in contrast to diagnostic colonoscopies which are performed to evaluate symptoms or abnormal lab values such as a low blood count or anemia.  Whether I am performing a screening or a diagnostic exam has no effect on the patient’s experience.  However, it may make a huge difference to the insurance company and your out-of-pocket financial obligations.   But I digress… Many of my procedure patients have previously seen me in the office for consultations.   In other words, they are my patients.   It’s likely that after their procedures that they will be advised to return to my office for continued conversations on their condition.   However, many procedure patients are unkno...

Is Medicaid on the chopping block?.   Will Social Security be trimmed back?  Are the knives out for Medicare? These are huge concerns for Americans who depend upon these entitlements for health care and survival.   Those who have enthusiastically championed massive cuts in the federal government are now reflecting on how critical the Medicaid program, for example, is for their constituents and local economies.   Imagine the harm done medically and economically when rural community hospitals would wither without these federal dollars. A large measure of public angst on these issues is derived from distrust in our politicians.   We have seen them engage in flip-flopping, backtracking, u-turning, ‘evolving’ and other iterations of political gymnastics.   Can we really be reassured by what they are saying today or when on the campaign trail?   (Hint:  W e can’t.)   When they reassure us that there will be no cuts in (insert government pr...

Last week, I presented some of the top frustrations that patients have with the medical profession.  As promised, here is a sampling of physician frustrations.  This is hardly a scientific survey but is taken from my own experience and conversations with colleagues over the years. The Electronic Medical Record (EMR) Industrial Complex.   Odds are very high that if you query your physician about the most frustrating aspect of their professional, that EMR will be in the top 3.   It continues to sap hours away from face-to-face time with patients.   A glitch in the computer system can paralyze the office.   And nothing strikes fear in medical providers more than a looming EMR upgrade. An upgrade means that whatever processes I have barely memorized will become null and void. The Electronic Portal.   This is the computer’s ‘in basket’ into which all communications, test results, patient inquiries, pharmacy issues, medication refill denials, notes from b...

What frustrates patients with the medical profession? What follows is not a scientific survey but merely my recollection of patient gripes over the years. Why is my doctor always late? Poor access to doctors and medical professionals.   This vexes patients more than the other challenges that they endure.   They simply cannot get in to see their doctors who are booked out for months.   What good is having a great physician if his or her schedule is locked down?   Sending these patients to an Urgent Care or an Emergency Room might be a convenient play by the doctors and staff, but this does not serve patents well. Rushed office visits.   I hear this all the time.   I’m sure that I’ve been culpable of this offense at times myself. The doctor is running behind and is under pressure to move the visit along efficiently.   But not all patients operate in this mechanized manner.   They need time to collect their thoughts, and we should permit them to ...

Here’s a great power word for readers to casually toss around with friends.  Iatrogenic . This refers to a medical condition or complication caused by a medical treatment.  For example, if a person undergoes a knee replacement and suffers blood clots afterwards, this complication is considered to be an iatrogenic illness – it is a direct result of a medical intervention. The volume of iatrogenic illness is enormous.   I am not suggesting that the medical profession is culpable, although adhering to strict safety guidelines and best practices can lower the case load.   Indeed, many such safety practices are in place today that were not present when I entered the profession.   Among the most common iatrogenic conditions are medication side effects.   On a regular basis, every physician and health care practitioner has wondered if a patient’s new or worsening symptom might be the result of a medication.   Sometimes this is an easy call.   For exa...