MD Whistleblower

We watched the president’s State of the Union address recently with the kids, to try and inculcate them with civic interest and responsibility. He is an inspiring and skilled speaker whose words seem to transcend partisanship and divisiveness. Nothing like an electoral ‘shellacking’ to push a politician into a Kumbaya mode. I thought the speech was long on ideals but sidestepped the pain and sacrifice it would take to reach the objectives the president outlined. I was waiting to hear the president’s plans regarding Medicare and Social Security, and I’m still waiting. The president took such a high road, that it was in the stratosphere, beyond real life. Here’s what he said:  ...by the end of the decade, America will once again have the highest proportion of college graduates in the world. Here’s what he didn’t say: ...to save Social Security we are cutting benefits and raising the age when seniors can collect. I’m not a journalist or a speechwriter, but my understan...

Medical ethics has properly gained a foothold in the public square. There is a national conversation about euthanasia, stem cell research, fertilization and embryo implantation techniques, end-of-life care, prenatal diagnosis of serious diseases, defining death to facilitate organ donation, cloning and financial conflicts of interest. Nearly every day, we read (or click) on a headline highlighting one of these or similar ethical controversies. These great issues hover over us. We physicians face ethical dilemmas every day in the mundane world of our medical practices. They won’t appear in your newspapers or pop up on your smart phones, but they are real and they are important. Here is a sampling from the everyday ethical smorgasbord that your doctor faces. How would you act under the following scenarios? A physician has one appointment slot remaining on his schedule. Two patients have called requesting this same day appointment. The first patient who called has no insurance and...

Whistleblower readers know of my criticisms of the electronic medical record (EMR) juggernaut that is oozing over the medical landscape. Ultimately, this technology will make medical care better and easier to practice. All systems will be integrated, so that a physician will have instant access to his patients’ medical data from other physicians’ offices, emergency rooms and hospitals. In addition, data input in the physician’s office will use reliable voice activated technology, so that some antiquated physician behaviors, such as eye contact, can still occur. Clearly, EMR is in transition. I place it on the 40 yard line, a long way from a touch down or field goal position. A colleague related a distressing meeting he had at the community hospital he works at. This hospital, like nearly every hospital in Cleveland, is owned by one of the two towering medical behemoths. I’m not a businessman, but I have learned that when something owns you, it’s generally better for the owner th...

I’m blogging again while aboard an airplane. Continental demonstrated an effective strategy for bestowing a small measure of comfort onto its beleaguered passengers. The flight was on a one hour delay. Of course, time is an elastic concept to the airline industry. One hour can morph and expand into several hours. The most frustrating aspect for passengers is that we cannot rely upon the latest update to be a firm commitment. It is a modern day recreation of the Sisyphus myth, recalling the king who spends eternity pushing a boulder up a mountain, but never reaching the summit. Are the death panels back? You remember this distortion from the political right who claimed that coverage for discussions of end-of-life care would soon lead to pulling the plug on granny? This provision was excised from the president’s health care plan, but has been resurrected by executive regulation at the end of 2010. The president has demonstrated that if you can’t get it by legislation, then grab it by r...

The medical profession’s ability to diagnose far exceeds its ability to effectively treat the conditions discovered. Consider arthritis, Parkinson’s disease, irritable bowel syndrome, strokes, emphysema and many cancers. When a physician orders a diagnostic test, ideally it should be to answer a specific question, rather than a buckshot approach. A chest x-ray is not ordered because a patient has a cough. It should be done because the test has a reasonable chance of yielding information that would change the physician’s advice. If the doctor was going to prescribe an antibiotic anyway, then why order the chest x-ray? Physicians and patients should ask before a test is performed if the information is likely to change the medical management. In other words, is a test being ordered because physicians want to know or because we really need to know the results? Does every patient with a heart murmur, for example, need an echocardiogram, even though this test would be easy to justify to ...