MD Whistleblower

The world is asunder.  As I write this, Iraq is sinking into a sectarian abyss.  ISIS, a terrorist group, now controls a larger territory than many actual countries.  Russia has swallowed Crimea and has her paw prints all over eastern Ukraine.  China is claiming airspace and territories in Southeast Asia increasing tensions with Japan, Vietnam and the Philippines.  The Israeli-Palestinian peace process is in another deep freeze.  Terrorists in Sudan and Nigeria are kidnapping and murdering innocents with impunity.  The Syrian regime has resulted in 160,000 deaths and has displaced over 6 million people.   The Taliban continue to destabilize and terrorize in Afghanistan and Pakistan.  Disease and hunger claim millions of lives in the developing world while other world regions have a surplus of food and medicine.  We have an immigration crisis in this country that gets worse by the day.  Several million Americans are still out o...

A few weeks back, I posted a piece entitled, Are Emergency Rooms Admitting Too Many Patients?   The essay was cross posted on KevinMD’s site a week or so after it appeared on my blog.  I received buckshot style criticism from various corners of cyberspace on my post.  What provoked particular ire, was my implication that Emergency Department physicians faced financial conflicts of interest with regard to admitting patients into the hospital.   I’m open to criticism and debate in the blogosphere and in my own life.  My father was an attorney and my brother is a sitting judge.  I’ve raised my kids to question, argue and to seek out the other sides of issues despite that they may already feel that they grasp them sufficiently.  Now, that they are adults, I am often the target of these skills that I worked so hard to cultivate in them.  Numerous physicians were offended by my reimbursement implication.  In reading their respons...

One of the frustrating aspects of medical practice is trying to divine if the medication I am prescribing is covered by the patient’s insurance company.  Even with the advent of electronic medical records, which should be able to determine this, we are often left to hope and pray. Here’s how it works.  Individual insurance companies have formularies – lists of approved drugs – that they encourage patients and their physicians to use.  Of course, this is all about the money.  There’s nothing evil about an insurance company making a deal with a particular drug company that gives them a price break.  The drug company will be delighted to offer the insurance company a discount in return for an anticipated high volume of prescriptions.   You can easily picture an insurance company negotiating with several different GERD medication representatives watching them each lowering their bid trying to get the contract.   Nexium Guy:   W...

Despite our professed values, everything has a price. We value life, but our society is unwilling to lower the highway speed limit to 40 mph, which would surely save lives.  The price of our collective inconvenience and economic impact is too high. Lower Speed Limit and Save Lives? We leave no soldier on the battlefield, but this military value cannot be viewed in isolation.  We are told this week by our commander-in-chief and his acolytes that rescuing a captured soldier is worthy regardless of the price.  We are told that negotiating with terrorists, breaking the law by not notifying congress and the release of 5 hardened Taliban detainees is a reasonable price for the return of a captured sergeant.    I feel that the price exacted was too high, although admittedly my view would be different if the sergeant were in my family.  For those who argue that no price is too high to rescue one of our own, should we have surrendered to the Nazi...

If you read this blog, then you likely know about the scam known as Pay for Performance (P4P).  This program not only fails to deliver on its stated mission to improve medical quality, but it actually diminishes it.  For a fuller explanation on why this is true, simply insert ‘Pay for Performance’ into this blog’s search box, and grab some Rolaids.  In short, P4P pays physicians (or hospitals) more if certain benchmarks are met.  More accurately, those who do not achieve these benchmarks are penalized financially.   I do not object to this concept.  Folks who perform at a higher level should be rewarded accordingly.   My objection is that the benchmarks that have been selected are arbitrary and too far removed from true medical quality measurements.  Benchmarks have been chosen that are easy to measure even if these measurements don’t count for much.  In other words, what really counts in medicine, isn’t easy to count or measur...