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Why Trump is Running

What is politics without a conspiracy?  Here are two facts. Donald Trump is a very intelligent man. (Just ask Vladimir Putin.) Donald Trump says idiotic stuff. How does one reconcile these two facts? When a really smart person says really dumb stuff, then something is up. Why does he regularly issue forth insulting invective and false statements? Does he truly believe that John McCain is not a war hero?  Does he feel that schoolyard insults against fellow candidates gives him presidential luster?  Is his plan to slam the door on all Muslims a surefire way to make friends and make us safer?  Is mocking a disabled journalist politically savvy? Is describing Hillary Clinton’s urological delay at the recent debate as 'disgusting', a demonstration of his measured temperament?  Star Quality? It’s very tough to ascribe such views to an intelligent man, which he is, and often says so.  Who benefits from his volcanic eruptions of rhetorical venom?  Here are

Whistleblower Holiday Cheer 2015!

Jingle bells, jingle bells, Cruz is ridin’ high, Jeb is lagging way behind, But tells us he’s our guy.  Trump is here, Trump is there, Trump is everywhere, Promising we’ll be as great, As his golden hair.  Walker’s gone, Perry’s out, And Jindal, “Not my time”. Lindsey Graham is begging us, “Please send me a dime.” Carly has a pretty face, Christie’s slimming down. Pataki sports a comb over, Santorum wears a frown. Huckabee, with a smile Gives fire and brimstone ash, Carson says, “I stabbed a guy!” Kasich trolls for cash. Who among these flapping jaws, Will be the next to fall? Who can make the case for ‘Prez’? Pataki or Rand Paul? Hillary’s in the catbird seat. Bernie just can’t hit. The GOP in unison ‘Oh where, oh where is Mitt!’ Wishing you Joy and Peace!

Was Granny Sent Home from the Hospital Too Soon?

Over the years, I have heard families bemoan that their relative who was just readmitted to the hospital was sent home too early just a few days ago.   Are they right? Was Gramps Kicked Out Too Soon? First, let me say that in some instances they may be correct.  It is certainly possible that the hospital, under increased pressure to kick folks out, may have pulled the discharge trigger too soon.  The hospital is not always right even if their ‘discharge check list’ seemed to be in order.  Of course, patients are not adequately represented by a check list any more than physicians’ quality can be fairly measured in the check off, cook book method that the government and insurance companies are now championing. The hospital discharge check list may indicate that a patient with pneumonia can be safely discharged home as she has no fever or need for supplemental oxygen.  However, this patient may be 89 years old, riddled with arthritis and needs to attend to a spouse sufferin

Am I Too Old for a Colonoscopy?

Most of us are familiar with the concept of medical guidelines.  These are sets of criteria that are supposed to ‘guide’ physicians facing certain medical circumstances. As physicians know, and often lament, guidelines over time morph to become mandates.  Even though by definition, a guideline is voluntary, many hospital oversight committees and insurance companies require physicians who deviate from guidelines to explain their actions. The U.S Preventive Services Task Force guideline states that folks 75 and older should not receive screening colonoscopies.  The  reason is that medical studies have demonstrated that the benefits of colon cancer screening in this age group is not justified by the risk and expense of the effort.  Of course, there is an age when colonoscopy does not make sense, but I’m just not sure what this magic number is. Too Old for a Colonoscopy? Consider these two hypothetical patients. (1)   A 78 year old man in excellent health has never had a scre

Why Do I Have to Work on Thanksgiving Day?

I began this past Thanksgiving Day seeing patients at two local hospitals.  Yes, I was working on Thanksgiving, as I have done on many holidays over the past 25 years.  Many folks have the luxury of jobs that offer every weekend and holiday off automatically.  Many don’t.   For example, on Thanksgiving, the hospitals were staffed by nurses, secretaries, security personnel, housekeepers and cafeteria workers.  And, of course, every patient was seen by his attending physician and various specialists.  If any of us contemplated complaining that we had to work, a quick glance at any of the patients confined to their hospital beds would have quickly set us right. It’s not only medical care that must be available every day of the year.  Law enforcement, firefighters, utility companies, and national security institutions simply can’t clock out on Friday afternoons.  If you call 911 on a Sunday, you will not be greeted by a recorded message.  The day is a national opportunity to expre

Is E-mailing with Patients a Good Idea?

Physicians speak with patients every day on the phone for a variety of reasons.   Our practice now uses a portal system, giving patients access to some of their medical data and to us.  Although I was resistant to having e-mail communications with patients, I have come to appreciate the advantages. It relieves our ever congested phone lines It relieves patients from a state of suspended animation as they hope and pray that a living breathing human being will return to the line after being placed on hold It saves our staff time who no longer have to triage calls as the patient directly reaches the doctor While this streamlined cyber communication system is useful, it does have limitations.  It can’t solve every problem.  Indeed, some issues are not appropriate for either a phone call or an e-mail. Calling his doctor? Consider the following scenarios.  Which can be appropriately handled on the phone and which merit a face to face encounter with a physician? I was in the

Gadzooks! There's Gluten in my Cheerios!

Gluten is in the news again.  Gluten and probiotics are among the two dietary issues that most consume my patients.  I am asked for my opinion on them several times each week.  Although my opinion is solicited, these patients have largely already made up their own minds as they are often avoiding gluten and swallowing zillions of ‘good bacteria’ with zeal and enthusiasm. Why do they do this in the absence of corroborating medical evidence?  Why do millions of voters support Donald Trump’s mantra that he will ‘make America great again’?  Both of these groups do so on faith.  When our need to believe something is overpowering, our demand for proof recedes.  Many of us need to believe that gluten is the agent responsible for our vague medical complaints that have stymied our doctors.  Similarly, our frustration with so many aspects of our society and conventional candidates makes us believe that Trump will turn the nation into yellow brick roads leading to Emerald Cities everywhere.

How to Increase Medical School Enrollment

Lawyers and physicians have so much in common, despite some benign grievances that occasionally reach the level of homicidal rage.  Just kidding.  Calm down, juris doctors.  Consider the similarities.  Both professions serve a public who needs help.  Both wield professional advice and judgment that must be tailored to an individual’s unique circumstances.  Neither professional is ever 100% certain of anything, and an outcome cannot be guaranteed.  Both are charged to put their clients' and patients' interests above their own.  (Snickering permitted here.) Let's see what our legal brethren are up to.  Law schools in America are having a serious problem that they are struggling to remedy.   They need more students.  Of course, they could fill their classrooms by recruiting qualified candidates to apply to their institutions.  This strategy apparently couldn't fill the seats, assuming that it was even considered.  So, here is their plan, brilliant in its simplicity.  I

When Should a Doctor Lose His License?

This afternoon, as I write this, a professional football player was ejected from a game for committing the transgression of unnecessary roughness.  This infraction should be taken seriously in a game where violence is not only legal, but desirable.  I’ll leave it to the reader to imagine how unnecessary the roughness was if it resulted in an ejection.  It is self-evident to any thinking person that the human body is not designed to withstand the punishment of this game.  Keep in mind that most of us are only seeing the actual games, and not the hundreds of hours of brutal practicing.  I take care of an octogenarian who played for the Cleveland Browns decades ago.  While this profession lifted him out of a Pennsylvania steel town, it is challenging for him to identify a part of his body that is working properly.   The National Football League (NFL), which showed us all last year how they fumbled their domestic violence issues, has belated admitted what most first graders would readi

Hear Ye, Hear Ye, Probiotics Cure All!

A probiotic rep came to our office bearing lunch and billions of bacteria.  Who on their staff, I queried, counts the bacteria verifying that each packet has 3 billion disease-busting germs?  I suspect that these quantities are only estimates and that consumers may be unwittingly subjected to either an inadequate dosage or a toxic amount.   Caveat emptor! I surmise that plaintiff law firms are hiring germ counting experts hoping to establish with clear and convincing evidence that the product's label is false and misleading.  Soon, we can expect to see TV commercials when we will hear an authoritative announcer asks, "If you or someone you love took probiotics and developed fatigue, joint pains, weight loss, weight gain, nightmares, daydreaming, lack of energy, excess energy, loss of a sense of humor, extreme frivolity, lackluster performance reviews at work, basement flooding or any other adverse life outcome, then you may be entitled to compensation.  Call 1=800 GETCASH

The Daraprim Debacle - The Smell Test Sniffs Out Price Gouging.

You don’t need to be an ear, nose & throat doctor to be conversant with the ‘smell test’.   We use this technique in everyday life.  This diagnostic test is used to determine if a situation is an egregious deviation from established norms.  The beauty of the smell test is that one need not be encumbered by facts and data.  It relies upon emotion and instinct, which greatly simplifies its use.  Let me illstrate. Situation When Smell Test Does Not Apply Grading the SAT Examination.  Sniffing and smelling just won’t work here. Situation When Smell Test Applies A city mayor hires his brother in a no-bid contract as a consultant.  Are you catching on here? The Mother of All Smell Testers I surmise that my erudite and insightful readers would sniff deeply through flared nostrils if they confronted the following situations. “A double dip ice cream cone, which yesterday cost $4.25 is now $57.85.  A severe shortage of sugar cones developed last night.”

Is More Gun Control the Right Prescription?

Guns are in the news again.  Here are some incontrovertible facts. Mass murders committed by young males have become a new phenomenon in American life. Individuals who should not be permitted to own a firearm can legally purchase one. Many other advanced nations have much lower incidences of mass killings. There is no political solution to this issue in sight. I remain skeptical  that restricting guns will make us safer.  I doubt that further legal restrictions against buying guns would apply to criminals who by definition are law breakers.  I concede that we should consider additional barriers to keeping guns away from those who are mentally unstable.  I challenge any reader here to offer a template on how we might accomplish this.  There are tens of millions of Americans with mental illness or a history of mental disease.  What about creepy people or folks who seem angrier than they should be?  Loners? Assuming we could identify these millions of citizens, how would we us

Make America and the Medical Profession Great Again

Even those who have but a passing interest in the American political know that Donald Trump is: Very Rich. Leading in every poll. Going to build a wall that Mexico will pay for. One of these 3 statements will remain true even if Trump’s campaign tanks.  He will still be rich.  I’ve heard some of his flailing critics who are claiming that he isn’t worth $10 billion, but only $5 billion.  Wow, that’s a really potent attack strategy.  I think that if his net worth is a mere $5 billion that he will manage to squeak by. The Hollywood Walk of Fame Because he is rich, he is self-funding his campaign.  He points out repeatedly that his adversaries are taking millions from lobbyists and other special interests who will expect something in return.  Of course, these candidates deny this, but we all know the truth here.  Remember, access is power.  If you donate a seven figure sum to support a candidate or a president, do you think it would be difficult to get your phone calls

Heroes Behind the Counter & In Other Places

The Marvelettes in 1963 Patients are cool.   I did a colonoscopy on a hospitalized man who was saddled with the ravages of obesity, diabetes, sleep apnea and respiratory disease.  My partner had performed the initial consultation, and it was my task to bring light into a dark place by performing a colonoscopy.  I engaged in some conversation prior to the procedure, not simply to acquire relevant medical facts, but also to establish some rapport with a man I hadn’t met before, who I was poised to violate.  I learned that he was a navy SEAL decades ago during the Vietnam war, and enjoyed some leisure time in Cambodia then.  He mentioned that he was waterboarded during his training repeatedly and described it as a routine exercise.  Yikes.  When I was his age, I was dissecting a cadaver in medical school.  The most risk I faced was crossing a New York City street. Fast food workers are cool.  I stop often in the morning at a McDonalds near one of the community hospitals we s

Is Your Hospital Crooked?

I read an interesting piece this morning about a medical renegade who turned his back on one of the most powerful health care systems in the world.  It’s not easy to push back against a leviathan.  If I give you an oar, I doubt that you could change the direction of a cruise ship.  But sometimes, a single person can make a wall fall down.  Remember, the brave Chinese man who faced down an approaching tank in Tiananmen Square, which was captured on an iconic video?  On a lesser scale, an orthopedist, formerly employed by The Cleveland Clinic Foundation, decided that his Clinic bosses were preventing him from offering his patient’s the best medical care possible.  He fired them. "Let's blow this joint!" The Clinic, in a cost cutting move, restricted orthopedists to using artificial joints from only two device companies.  The surgeon had been using artificial joints from another company for nearly 3 decades, and he reported excellent results.  This orthopedic surg

Is the Medical Profession a 'Special Interest'?

Don’t expect this humble blogger to explain Donald Trump’s broad and sustained GOP support, if our most seasoned political pundits are flummoxed.   Why is this man with no prior political or governmental experience trumping all of his competitors? Is he ahead because he is right on, or is he leading because the competitors are way off? Like most folks, the conventional politicians are by and large an uninspiring lot who offer scripted screeds that are canned and calculated.  Indeed, most political junkees like me can almost orate their stump speeches, since they vary little from speech to speech. Trump Appears to have no 'Special Interests' The conventional candidates often rail against ‘special interests’, a pejorative term that conjures up an evil group that is possessed by greed that tramples over the public good to serve themselves.  I challenge you to identify a candidate who has not spewed vitriol against these nefarious ‘special interests’.   When they

Labor Day Honors All

It’s Labor Day tomorrow when we pause to honor those whose labor has laid down the scaffolding of this nation.  Are we all in agreement who the honoree is on this federal holiday?  Labor Day - A Sad Day for Cows Originally, the holiday was to honor the labor unions, organizations that emerged over a century ago as a response to unfair and unsafe labor practices.  I certainly honor the working man for their contributions. There are carpenters and electricians who work for themselves, not for  labor unions.  Is the holiday for them also? What about the rest of us?  I’m a physician.  I work hard and hope that I am making some contribution toward the public good.  Is this holiday for me also? Business owners and management work long hours, often beyond traditional shifts, to maintain the success of their companies.  Is this holiday for them? Artists labor long hours coloring canvases or sculpting provocative creations.  Should they work tomorrow or are they ent

Patient Survives Death Sentence - Medical Negligence?

Doctors do not know everything.    We make mistakes and mistakes in judgment.  Sometimes we make the mistake of speaking when we should keep silent.  At times, patients ask us questions that we can’t or shouldn’t answer; and yet we do.  It shouldn’t be our objective to force certainty into an issue which is amorphous and murky.  Here’s a response that I recommend in situations where certainty is elusive. “I don’t know.” I saw a patient for the first time when he was sent to me for a colonoscopy.  Prior to the procedure, we interviewed him to be acquainted with his medical history.  We are always particularly interested in the cardiac and pulmonary history, as these conditions impact on the risk of the procedures and the anesthesia.   This patient had a lung resection.   He related the details which left my staff and me aghast. “The doctors told me that I had cancer and would be dead in 3 months.” Of course, it is not possible for a spectator to imagine the horror o

Is Your Doctor a Spin Doctor?

We are in the Age of Spin as the presidential campaigns percolate along.  So much fun to watch!  It’s a performance in doublespeak, deflection and distraction that is so obvious, that even a person who knows no English can spot it.  I used to get exasperated when I would watch a politician dodge the question posed, but now I view it as pure entertainment.   I’m glad I made this transition, particularly since I live in Ohio where we will see more spinning than anywhere else. Spinning is an old profession. To those who are unschooled in spinning recognition, keep your ear out for these phrases which are classic spin initiators. ‘…what I will say…’ ‘The question we should be asking…’ ‘I have always said…’ Let me illustrate. Reporter:  Do you support the president’s Iran deal? Spinner:     The question we should be asking is why are we caving to the Ayatollahs? Reporter:  Do you support a path to citizenship for the 12 million undocumented immigrants?

Who Deserves Quality Medical Care?

We all should know the difference between a slogan and real substance.   One of these has size and shape while the other is just a shadow.   Why then, is the slogan so powerful? A slogan is one of the weapons wielded by the Guardians of Political Correctness.  They will point toward the slogan du jour, and then, with cameras rolling, demand to know if you support it.  Even a moment’s hesitancy will be taken as weakness.   Expect to see your waffling go viral for all to see, edited down and sans context.  Politicians Advised to Avoid Waffles. During a presidential election, this practice is omnipresent.  Mr. Bush, do you support fair trade ? Mrs. Clinton, is your immigration policy to give amnesty to all illegal aliens? Mr. Cruz, do you believe in the rule of law ? These questions cannot be adequately answered with a reflexive yes or no.   The slogans contained within these 'gotcha' questions point to complex and nuanced issues that need layered responses. 

When Does Life End? Ask a Humble Doctor.

About a week before I write this, I met a man for the first time.  Though it is unlikely that I will see him again, it is unlikely that I will forget him. This was a side trip for us, as we meandered for a weekend through the beauty and nostalgia of Ohio.  Once you find yourself about an hour south of Cleveland, you are in a Land of Barns, where cornfields and cattle punctuate the countryside.  There are miles and miles of open roads unblemished by Starbucks, CVS or Big Box Retail.  Is the air truly fresher or does it just seem that way? On the Open Road in Ohio We drove out to meet this man to examine his wares.  The GPS faithfully led us to the desired location, but we assumed that we were misled as there was no business sign to alert customers like us.  Not quite the marketing strategy we know from city life where advertisements will soon appear on toilet paper.   He has an unusual profession, which I will not identify, as this might be enough to identify him which wo

Planned Parenthood Videos Threaten Truth

While we have all heard the adage, any publicity is good publicity, I don’t agree.   See if you agree that the subjects of the following hypothetical headlines would have preferred anonymity. Local Surgeon Loses Scalpel – in Patient’s Abdomen Teacher Pursues New Career as Porn Star Restaurant Owner Claims Rats are Really Pets Planned Parenthood is in the news.  Several videos, surreptitiously taken, have been released showing discussions between Planned Parenthood personnel and folks who were pretending to be interested in procuring fetal parts.  It is illegal under federal law for Planned Parenthood to make a profit selling fetal parts.  More fact gathering will be necessary to determine if a legal line has been violated.  Legalities aside, the videos have generated revulsion across the ideological spectrum by how unseemly and casual the Planned Parenthood folks discussed a subject with huge ethical and legal ramifications.  The public heard how the abortion technique cou

Warning! Cell Phones Can Kill You!

In medicine and beyond, folks just want stuff to be true.  Sometimes, we believe stuff that is unproven, but might be true.  We doctors recommend such treatments to patients every day.  On other occasions, a benefit of a drug or food item is extrapolated way beyond the data.  For example, if Nexium is known to be effective against stomach ulcers, then why not use it for patients with stomach aches who are ulcer-free?  There’s not a gastroenterologist on the planet that hasn’t engaged in this therapeutic mission creep.  More interestingly, folks often persist in beliefs that have been disproven.  The notion, for example, that certain vaccinations can cause autism has been thoroughly debunked by rigorous scientific study, yet there remain diehards who defy the science.  Curiously, many unproven or disproven practices have gained a fair measure of street cred in the Court of Political Correctness.  Keeping a gluten-free diet today is downright chic.  Colonic cleansing is the bomb.  K

Should Physicians Profile Our Patients?

Profiling in this country is highly discouraged and is illegal in many circumstances.  Anti-profilers decry this technique which, they argue, unfairly targets innocent individuals violating their rights.  Our beloved Transportation Security Administration, or TSA, is charged not to use profiling as a screening tool.  Personally, I object to this prohibtion.  While an individual’s rights are important, it must be weighed against the rights of the community.  Our cherished rights to free speech and assembly are not absolute. I have flown on El Al airlines, whose personnel actively profile in an effort to keep its passengers safe.  Anyone who has been a passenger on this airline will likely agree with me that he has never felt safer on an airplane.  I have a right not be blown up, and if profiling further minimizes this risk, then call me a fan. Last year, my mother, who appears as threatening as a school librarian, was patted down twice when she traveled to visit me in Cleveland.