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Showing posts from July, 2009

Prostate Cancer Screening: Stop The PSA Train!

About 10 years ago, my dad was to see his general internist. I have always refrained from giving medical advice to my family, for all of the reasons why doctors should not treat or advise their relatives. But, on this occasion, I did give Dad some unsolicited advice, particularly as I knew that his physician fired the diagnostic testing trigger readily. “Dad, please make sure that he doesn’t check the PSA (prostate specific antigen) test.” Dad indicated that he would convey my concern to his doctor, who ran the test on him anyway. Apparently, he includes the PSA test as a matter of routine on all men over a certain age. Twenty-five years ago as a curious, but skeptical medical student, I learned about prostate cancer. I learned that every man will develop it if he lives long enough. I learned that most cases of prostate cancer remain silent and never interfere with the individual’s life. I learned that the treatment for these cancers involves either major surgery or radiation, both of

Tort Reform: Lawyers -vs- Doctors

Over the past week or so, I have been engaged in a colloquy with a presumed lawyer on tort reform on KevinMD’s blog. It has been a frustrating and unsatisfying exchange. I have had many discussions with attorneys over the years, and I am always struck by the gulf that separates us on this issue. I regard myself as a fair-minded individual. I believe that I can separate my own self-interest from the public interest. Indeed, many Whistleblower postings take aim at my own profession and have generated some spirited responses from my colleagues, some of them delivered offline. Although I am a gastroenterologist, I will not defend the value of colonoscopy when a better option for patients emerges. I admit and write that our health care system is riddled with excesses and inefficiencies and that we physicians deviate from evidence based medicine regularly. Lawyers, at least those who I’ve spoken with, express an unwavering fidelity to the tort system. This is why the dialogue between the pr

Medical Malpractice Strikes Home: A Time to Serve

For a while now, I’ve been in between lawsuits. I am now pleased to report that I am a defendant again. Such good fortune, like a lottery win, descends upon doctors without warning or invitation. Nothing else can leaven a physician’s morale more than opening that thick envelope delivered by certified mail. We should not regard a medical malpractice lawsuit as a personal legal assault, but rather as an opportunity to promote truth, justice and the American way of life. (If I had the technical skills, an audio of the Star Spangled Banner would now begin.) We physicians, through our involuntary participation and testimony, can shed light in the darkened corners of the medical world. This is no time for physician anger. This is a time to give back and make others whole. Litigation is a natural extension of our professional mission to serve humanity. When viewed from this perspective, sitting in the courtroom or giving a deposition are important opportunities to heal our injured patients. T

Tort Reform and Medical Malpractice: Ready! Fire! Aim!

We’ve already had a little fun presenting ‘ tort for sport’ for your entertainment, describing a system that is nearly exclusively advocated by trial lawyers and their minions. Beyond their tendentious rhetoric, however, are the inescapable hard facts that the tort system misses most cases of true medical negligence and wounds too many physicians as friendly fire casualties. Let’s put this issue in medical terms. As lawyers so often say, ‘let’s consider a hypothetical’. A pharmaceutical company launches a new medical screening test to diagnose pancreatic cancer at an early stage when the disease is curable. The test can accurately detect the condition in only 5% of cases. Unfortunately, the test causes side effects in most patients, who experience severe fatigue, muscle aches and joint pains. These symptoms last for several months and then gradually resolve. If this screening test were widely adopted as a routine test, then 95% of early pancreatic cancer patients would be missed and m