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Should HIPAA Compliance Guard All Protected Medical Information?

Everyone is familiar with the acronym HIPAA, which is the 1996 edict called the Health Insurance Portability and Accountability Act.  Isn’t that a smooth and melodious name? These are rules & regs that are designed to protect your confidential protected medical information.  I support the mission.  I don’t think that your medical records should be deliberately or inadvertently shared with those who are not lawfully permitted to view them.  Medical charts (remember when there were medical charts?) should not be left open on the counter. A physician should not yell to front desk personnel within earshot of others to give the patient a psychiatric referral. Elevators are not proper venues to have medical discussions about specific patients. Medical information should not be disclosed to inquiring friends and family without permission. I maintain that HIPAA has been OperationOVERKILL for many physicians and staff.  Keep in mind that doctors, at least in my generation,

Whistleblower Holiday Cheer 2013!

Jingle bells, Jingle bells, Sebelius in her role, Oh what fun it is to see Her bringing us some coal. Obamacare, If you dare, The website has a glitch Fox News ratings - out of sight! While Dems are in the ditch. Here a tweak, there a tweak, Mad Obama fans, When he said a hundred times “You can keep your plan.” Here’s a clue, From me to you Just a little trick, To help survive Obamacare You’d better not get sick! Wishing you Joy and Peace

Physician Fee Schedule 2014 Uses Frequent Flier Model

Whistleblower readers know that I have spewed some vitriol toward the airline industry, where customer service goes to die.  Indeed, in a prior post I contrasted their routine harassment of frequent fliers with the individualized stroking that Apple customers routinely receive.   For sarcastic scriveners like me, the airlines are the gift that keeps on giving.  The target is so large that one can hit it from miles away with a blindfold on at night. Fun, fun, fun... Some, but now all, sources of customer angst include: The convenience and rationality of the TSA process (“Out with those dentures, Granny!”) The sumptuous meals served aboard. (“Exact change for the pretzels is appreciated.”) The plush and spacious seats which easily accommodate those with BMIs < 18 On-time performance (Do we really know what time is?) Truthfulness with regard to the occasional flight delay  (Pinocchio would nasally impale customers if he worked as a gate agent.) The simplicity and p

Disaster Obamacare Rollout Rolling Over A Cliff

I can’t add much meaningful commentary to the Obamacare roll out disaster.  There has been a deserved tsunami of criticism and derision across the political spectrum.  Democrats are sprinting for the exits.  Many of them in their last campaign repeated the sound bite of 2013, “If you want to keep your doctor…”.  Of course, without the miracle of video tape, these obfuscators would simply deny their own words.  The disaster rollout is a travesty on so many levels.   We should not forgive any institution that produces an abject failure after 3 years of preparation and nearly $600 million when they have been crowing for months about the October 1 st start date.  It did start something, but not what the government wanted.   More incredible is that the government was told by experts prior to the launch that the website was not even half baked, and yet they rolled it out anyway.  Is there any reader who can explain this decision to me?   If we knew that a plane had mechanical defects,

Thanksgiving, Pausing to Say Thanks...

To everything, there is a season, and a time to every purpose under heaven. Ecclesiastes It’s time to pause and offer gratitude for the blessings that have been bestowed upon us. Roman Goddess with Cornucopia We are thankful that our insurance coverage has not yet been cancelled. We are appreciative for websites that work as promised. We are grateful when our personal approval rating is above 50%. We acclaim the president for his interim deal with the Iranians, a government that supports Bashar Al Assad, funds Hezbollah and refers to Israel as a rabid dog. We offer Hosannas to Democrats Dianne Feinstein, Harry Reid, Barbara Boxer, Joe Biden and Barack Obama who were all vehemently against dismantling the Senate’s filibuster rule until they were for it. Diverging from sardonicism, I hope that all enjoyed a Thanksgiving holiday filled with mirth and laughter in the presence of loved ones.  To those who find themselves in one of life’s valleys, I hope that brigh

Should Doctors Apologize to Patients?

I had thought that apologizing was a straightforward act, but I now realize that it is a nuanced art form.  We’ve all heard the ‘mistakes were made’ version, usually issued by politicians who attempt to insert a layer of passive voice insulation between themselves and their screw ups.  There is also the ever present conditional apology which by definition falls short of complete responsibility acceptance.  The template here is: “I’m sorry for my oversight which wouldn’t have happened if….” The Gettysburg Address - Silly Remarks? There have been several apologies in the news recently.  First President Obama offered a faux mea culpa with regard to his indisputable and repeated ‘misrepresentations’ on his broken promise that we could all keep our own doctors and health insurance plans.  Here’s what he said on November 7 th . “I am sorry that they are finding themselves in this situation based on assurance they got from me.” Finding themselves ?  Really?  I grade this as

Medical Overtreatment: Why Doctors Like to Slay Dragons

Saint George slaying the dragon. Bernat Mortorell, 15th century I’m sending a patient downtown to see a pancreatic expert.   He’s a young man who didn’t fully appreciate the health risks of a former alcohol addiction.  He’s been sober for well over a year, but alcohol toxicity can be unforgiving and permanent.   We don’t fully understand why some alcoholics develop cirrhosis and other complications while others seem to skate by without a scratch.  While I want folks who have the strength to conquer addictions to regain lost health and opportunities, many life choices lead to irreversible consequences.   Life is often an unfair mystery.  We witness this in medicine often.  Some smokers live well into their 80s, while others become tethered to oxygen tanks or contract cancer.   Trim athletes who eat seaweed salads seasoned with probiotics keel over while obese Whopper-swallowers wallow their way into old age.  My guy has chronic pancreatitis, a known consequence of alcohol ab

Why Won't President Obama Tell us the Truth about Keeping our Doctors?

Morality, truthfulness and personal integrity do not command the currency that they should or used to.  Truman’s phrase, ‘the buck stops here’ is of historical interest only.  Consider authors and journalists who admit to plagiarizing and then go on to resume their careers.  Resourceful students use modern technology to cheat on standardized tests.  Our government refuses to classify a military replacement of a government in Egypt as a coup d’etat.  Teachers strike for more money claiming that their only interest is their precious students.  Politicians deny that campaign contributions will confer any special influence by the donors. A parade of overachieving athletes over the years denies they have ingested any banned substances.  Our intelligence services are not spying on Americans.  Physicians order diagnostic tests claiming they are only for medical reasons. Sometimes, the dishonesty is stealth while on other occasions it is transparent.  I suggest that the phrase ‘it h

Has Your Health Insurance Policy Been Cancelled? Who Knew?

I feel bad for Jay Carney, the president’s spokesman.  Each day, he faces the Washington Press Corps -piranhas on the hunt – and he must dodge and obfuscate.  I am surprised that the velocity of his spinning hasn't resulted in him drilling himself a mile below the earth’s crust.  He is a human spinning tornado. Presumably, this role must be challenging for Carney, who formerly practiced as an actual journalist who was charged with ferreting out the truth.  Now, he is under orders to avoid the truth.  While I do not suggest that he openly prevaricates, withholding the truth qualifies as dishonesty, as I see it. Tornado or Jay Carney? Carney and all politicians leapfrog over the specific questions being asked.  Their non-responsive responses are exasperating to the questioner and to the public.  There are many rhetorical techniques that these professional double talkers use to change the subject.  Let me illustrate with a hypothetical interview. Interviewer:  “If the v

Should Michael Jackson's Doctor Practice Medicine Again?

Before Michael Jackson, most folks didn’t know what propofol was.  Now, patients are asking me for it by name.  It’s an awesome drug.  It provides a beautiful sedation, is extremely safe and rapidly clears after the procedure.  Under its effects, colonoscopy has become a sublime experience.  We administer it in a different manner than Conrad Murray did.  For those who may have just awakened from a 5 year coma, Conrad Murray was Michael Jackson’s personal physician who administered propofol to Jackson in his home to promote sleep.  Murray succeeded and received the modest salary of $150,000 per month for his medical services. Sleep Aid? Administering propofol in a patient’s home without necessary monitoring and training is an egregious breach of standard medical practice.  Those of us who use the drug properly were shocked to learn of this doctor’s reckless and indefensible care.   Here are a few hypothetical examples of similarly negligent care. A surgeon removing yo

Obamacare Health Insurance Exchanges Crash and Burn. Tweaks and Glitches

A few days ago, lawmakers sealed a deal to reopen the government and to relax the debt limit.  This was no O’Henry story with a surprise ending.  This was the outcome that all of us knew was forthcoming.  The GOP not only had no cards to play, but their empty hand was known to all.  It’s very hard to bluff when your cards are face up and you don’t even have a pair of deuces.   Obamacare was the GOP target that quickly became a phantom.  It disappeared.  Afterwards, there was nothing for them to shoot at except each other. GOP vs Dems A perusal of my posts nestled in the Health Care Reform Quality category will demonstrate my skepticism and hostility against Obamacare, which is an interim step toward something even worse.   But, the law was legally enacted, approved by voters in the last general election and was upheld by the U.S. Supreme Court.  That such a monumental program was passed in a unipartisan manner is wrong, but is not illegal.  The roll out of the exchanges ha

Ted Cruz Filibuster Misses the Mark

Even the most casual Whistleblower reader is aware of my hostility toward Obamacare, which appears destined for incremental implementation.  Ted Cruz’s paper mache weapons were no match for the Democrats' artillery brigade.   When the Chamber of Commerce, corporate America and organized labor are all on the same side of this issue, it suggests that healing this forerunner of socialized medicine will take more than a tweak or two to smooth it out.  Cruz Takes Aim There’s nothing unexpected or unfair here.  Romney campaigned hard against Obamacare.  The country had an opportunity to elect him, and declined to do so.   Did we expect that Obama would dismantle his signature legislative first term achievement in his second term?   When Romney lost, Obamacare won. The Affordable Care Act was legally enacted, albeit without a single Republican vote.  The Supreme Court determined that the law was constitutional.  Elections matter.  So, a flawed program, whose ultimate consequenc

Gun Control and Gun Violence - Is the Right to Bear Arms Absolute?

I’m writing now in the wake of another tragic shooting here in the United States.  For most of us, we have never experienced the current pandemic of senseless violence that we read about and visualize every day.  I challenge you to find a newspaper tomorrow morning, or listen to a news broadcast, that will not report on dark and pernicious inclinations and accomplishments of evil practitioners.  If that challenge is not sufficient, then find an American over the age of 70 to attest that the world is better today than it was during his youth.   I listened to the every word that President Obama said at the ceremony honoring the fallen Navy Shipyard personnel.  He spoke well, and his reference to congressional inaction with regard to gun violence didn’t trouble me at all.   It was beyond shameful when craven congressman couldn’t pass any piece of legislation in the wake of the Newtown catastrophe.   This was a bipartisan failure that broke congress’s already abysmal performance l

Force-feeding Guantanamo Prisoners Tortures Medical Profession

Nearly every physician regards himself as an ethical practitioner.   Nearly none of us are, at least not fully.   There is no bright line that separates ethical from improper behavior.  Indeed, it is because the boundary is fuzzy that ethicists and the rest of us wrestle with contentious controversies.  It is, therefore, expected that ethicists are divided on many issues, much as the U.S. Supreme Court is often split in its decisions.  If the Court’s cases were easily decided, then most of its decisions would be unanimous. Finding the balance. While there are some bedrock ethical principles that should remain immutable, the field needs some breathing space to accommodate to societal changes and new research findings.  Analogously, the Constitution prohibits cruel and unusual punishment, but the definition of this evolves, so that today’s court may decide a punishment issue differently from its predecessors.  Similarly, it is possible that an issue deemed ethical today,

Syria Chemical Weapons Agreement: President Obama Declares Victory

Outcomes matter.  One will forget a tortuous path if it leads to a sanguine outcome.  This is true in medicine and in life.  Look at the recent path of American foreign policy and where it has led us. Can You Choose the Right Path? The president announces that Assad has to go. The president lays down a red line for Syria with regard to chemical weapon use. The Syrians detonate a few chemical weapons, testers which we ignore. 100,000 Syrians are killed.  We ignore this as this is not a ‘ red line ’ violation. A death by sarin gas is more objectionable than a death by a grenade. There is a chemical weapon massacre in Syria which shocks the world. The president and the administration give daily public briefings on our intended limited military response. The administration assures that this "will not be a pinprick".  The Syrian regime watches CNN and FOX News so they can be apprised of the date and hour of our response. The Secretary of State makes a persuasive c

CME Medical Course Draws Hundreds of Physicians

Some time ago, about 200 physicians met one evening for a conference. This is not newsworthy. Medical education is deeply engrained in our professional culture. Indeed, physicians are committed to lifelong learning and self-improvement. To stay current, we read several medical journals and professional communications, we attend lectures at our hospitals, we engage in on-line educational pursuits, we learn from colleagues and we travel to medical conferences. Conscientious physicians devote many hours to educational activities each week On this night, however, we were not learning about new treatments for heart disease or diabetes. We were not learning about emerging strategies to diagnose cancer at a curable stage. There was no talk about new techniques to reduce hospital infections or other preventable complications. We were not even learning about ‘soft’ subjects, such as medical ethics or doctor-patient communication issues. We were together at the strong urging of our medic

Medical Errors Earn Hospitals Money - Who Knew?

Though I have been accused by various commenters as protecting my own specialty when I point out excesses, flaws and conflicts of interest in the medical profession, this accusation would be handily dismantled after a fair reading of prior posts.  Indeed, my own specialty of gastroenterology and my own medical practice has felt the effects of the honed Whistleblower scalpel.   If an individual or an institution will not willingly engage in self-criticism, then it creates a credibility gap that may be impossible to bridge.  If you want a seat at the table, then arrive exposed and humble. My Preferred Instruments A study was published in the prestigious medical journal JAMA, the Journal of the American Medical Association in April 2013 publishing what we have known for decades: hospitals make more money when medical errors are committed.   As an aside, I have much more respect for JAMA than I do for the AMA , but I’ll resist the strong temptation to digress. Here’s how it

Unnecessary Colonoscopies: Confessions of a Gastroenterologist

We gastroenterologists are regularly summoned to bring light into dark places.   We are the enlightened ones who illuminate anatomical shadows.   Sure, we have ‘tunnel vision’, but we like to believe that we can think broadly and creatively as well.  We are the scope doctors. Am I Just a Tool? We are commonly consulted by primary care physicians and hospitalists to perform colonoscopies, upper endoscopies (EGDs) of the esophagus and stomach and other gastrointestinal delights.  We deliver a probing element to patient care.  We are called to serve as technicians – plumbers, if you will - although we actually have cognitive knowledge of our specialty.  Yes, we can think.  Often, we have tension over what we are asked to do and what we think we should do. Do I think that every procedure I am asked to do is medically necessary.  Of course, not.  Before you target me for investigation and professional censure, realize that every physician in America and beyond would

Don't Call Me a Health Care Provider - I'm a Doctor

One thing doctors like to do is to use fancy language.  Patients, however, want physicians to use simple terms.   Perhaps, using highfalutin language makes physicians feel more scholarly and important.  Of course, this bombast only confuses patients who may be too timid to respond that they don’t have a clue what we're saying.  If your doctor is speaking in tongues, then ask for a translator. He'll get the message. Icon of Pentecost when Apostles spoke in tongues Many professions have their own technical languages which is necessary for internal communications or scholarly work.  Beyond this, there is also a pomposity that drives this lexical elitism.  In the medical profession, medical terms seem to offer no advantage over colloquial alternatives.  Yet, physicians want to ‘speak like doctors’, whatever that means. Cool Medical Term            Lame Alternative Thrombus                                    Clot Stenosis                                  

Does Your Doctor Know Advanced Cardiac Life Support (ACLS)?

Folks must think than all doctors know all things medical.  I know this is true by the questions that I have been asked over the years.  While my expertise spans hemorrhoids to heartburn, I am routinely queried on medical issues well beyond the specialty of gastroenterology.  When I can’t answer questions about a new medicine for hypertension or if an MRI of the shoulder makes sense, folks look at me quizzically as if I must not be a real doctor. Today, more than ever, physicians are highly specialized with a very narrow medical niche.  There are ophthalmologists, for example, who only treat retinal disease.   Perhaps, there are even retinal specialists for the left eye only.   It wouldn’t surprise me.  My partners and I perform routine gastroenterology procedures in an ambulatory surgery center.   Patient safety is our priority and our staff and us are dedicated to this mission.  All of us are required to be certified in Advanced Cardiac Life Support in the unlikely event th