MD Whistleblower

Organ donation is a white hot medical ethics issue. In the last month alone, there have been two scandalous reports alleging criminal and immoral donation practices. First, we read about a man, a rabbi no less, arrested for trafficking in kidneys. He referred to himself as a ‘ matchmaker ’, not quite the Fiddler on the Roof image of the wizened Yenta character who arranged marriages. The second story exploded after an article appeared in a Swedish newspaper that accused the Israel Defense Forces (IDF) of harvesting organs from wounded or killed Palestinians. Unlike the arrested rabbi, the Israeli Prime Minister vociferously denied the scurrilous charges. I suspect that the rabbi is guilty, by his own statements, but I do not believe the diabolical allegations against the Israelis. Charges of this nature should never be publicized in the absence of sufficient evidence. The reason that organ trafficking exists is because there is a shortage of available organs. We need a legal and ethica...

We have spent many dinner discussions with our kids discussing plagiarism. This infraction was verboten even when I was student back when, according to our kids, ‘I used to take the dinosaur out for a walk’. While I don’t think the offense is more serious today, it is much more prevalent. Educators report that there is an epidemic of it in our schools and universities. Perhaps, the practice even crosses national boundaries, which might mean that we are in the midst of a plagiarism pandemic. Unlike ‘swine flu’, there’s no vaccine available for this disease. Of course, the offense is so much easier to commit today, with expansive information on any imaginable subject available with a keystroke. I’m sure I could cut & paste a 10 page term paper on nearly any topic during half-time of a televised football game. Some of these rule-bending kids grow up to be adults who still misunderstand the importance of owning work that appears under their name. Joe Biden, historians Doris Kearns Good...

Consider this hypothetical vignette. Tiger Woods accepts my challenge to play 18 holes. Obviously, the gallery would be packed with golf enthusiasts who would cancel job interviews, vacations and even worship services in order to witness this historic competition. Spectators would be permitted to place bets at even money. Perhaps, my mother would bet on me, but no other sane person would. They would properly conclude that even my best performance against Tiger’s worst would be inadequate. There is nothing I could do to change the outcome. All of my efforts would be futile. Futility cannot be proved with mathematical certainly. After all, Tiger could develop acute appendicitis on the fairway and have to forfeit. He could be arrested. Lightning could strike. Killer bees could take him down. Nevertheless, the overwhelming odds are that I would be vanquished and humiliated. Medical futility is a more serious issue that exists in every physician’s office and hospital in the country. Example...

Medical politics has dominated the news for months. Each day, we read about the machinations of various congressional committees and our legislators who are dueling over health care reform. We learn about deals that the president has forged with various medical industry stakeholders. We watch as many liberal Democrats angle to put the ‘Blue Dogs’ in a secure kennel. We read about town hall meetings across the country being disrupted by folks who are accused of being right wing tools. Too much politics and too little policy. There is another genre of medical politics that is not covered by the press, but should be of interest to every one of us who seeks health care. This is the politics that exists in every doctor’s office and directly affects your medical care. I was never taught about any of this during my medical training. I learned about it on the job, and much of it isn’t pretty. As a younger doctor, I assumed that physicians chose consultants for their patients based on their med...

The concept of medical excess is very difficult for ordinary patients to grasp. The medical community has worked hard for decades teaching them that more medicine meant better medical care. The public has learned these lessons well. Physicians who sent their patients for various diagnostic tests or specialty consultations were regarded as conscientious and thorough. Patients approved of doctors who prescribed antibiotics regularly for colds and other viruses believing that something beneficial was being done for them. We can’t expect a patient to know if a CAT scan a physician orders is medically necessary. From a patient’s perspective, a test is medically necessary if the doctor orders it. However, physicians, with professional training and experience, know whether medical testing is urgent or optional. Isn’t that our jobs? Of course, the practice of medicine often resides in the murky gray area where there is no single correct answer. In these instances, there can be several rational...