Sunday, December 27, 2015

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 the two winners.

Donald Trump.   He is becoming the most famous man in the world.
Hillary Clinton.   For HRC, he’s the gift that keeps on giving.  She prays daily that he will become the GOP nominee.

Is it possible that his campaign was secretly designed and executed to help Hillary gain the White House?  Did Trump and Hillary make a corrupt bargain?  Is this really implausible when you take an aerial view of events?  Is this hypothesis more far-fetched than your own explanation of Trump’s strategy and tactics?

Leave a comment and help ‘make the Whistleblower blog great again’.

Saturday, December 19, 2015

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!

Sunday, December 13, 2015

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 suffering from Alzheimer’s disease.  Is she really ready for home life?

Hospitals these days are more careful than ever about premature discharge, not so much from newfound compassion, but because they will suffer a financial penalty if a patient is readmitted within 30 days under certain circumstances.  For example, if a patient with congestive heart failure is sent home, but then returns 2 weeks later with worsening heart failure, then the hospital will lose money.  This has created a robust outpatient follow-up industry with visiting nurses, physicians and social workers to try to keep folks from coming back to the hospital, at least within 30 days.  (Joke alert: The terminal phrase of the last sentence was in jest.)  I applaud this system which serves everyone’s interests. 

In the hospital, care coordinators cruise through the corridors leafing through charts to initiate discharge planning.  These are nurses who have left the wards for a cleaner administrative function.   Although I did disparage the hospital discharge check list mentality above, and rightly so, I have found these care coordinators to be compassionate and understanding with regard to individual patient circumstances.  They know when to bend some rules, perhaps because they were once hands on nurses themselves. 

Sometimes, a patient needs to be readmitted to the hospital and it’s simply no one’s fault.  It is a difficult concept for many Americans to grasp that an adverse event could occur without an individual or an institution to blame.  Remember, we live in a society where folks sued Burger King alleging the company was responsible for their kids’ obesity.   I counsel families that when we are sending their relative home, particularly when they suffer from chronic diseases or other incurable conditions, that we do so based on what I and the others on the team know at the time.  We are not clairvoyant.   If we had this power and knew that the patient would become more ill 3 days hence, we wouldn’t sent him home.  It’s may not be quite fair, but would be quite understandable, to wonder if a patient who is readmitted should never have been discharged home in the first place.   There are some patients who are so fragile, that they can tilt backwards anytime and for very small reasons. 

What we know for sure is that life and illness are unpredictable. 

Sunday, December 6, 2015

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 screening colonoscopy.  Should he be denied this as it will violate the guideline even though this guy has a decent chance of living another decade

(2) A 60 year old comes to my office from his dialysis session dragging his oxygen tank behind him.  He’s never had a colonoscopy.  Does a screening study really make sense here?

Guidelines and all their ilk are a one-size-fits-all approach to a profession that needs to individualize its advice to living, breathing human beings.  There’s more absurdity to come.  Insurance companies and the government are increasingly tracking physicians to assure that they are following all appropriate guidelines.  Those who deviate face the prospects of decreased reimbursements and being highlighted publicly on websites  and elsewhere as being deficient.

How easy do you think it would be to argue your case to an insurance company that a particular guideline didn’t apply to a particular patient?   Having had the thrill and pleasure of  dealing with medical insurance companies and the government, I can answer this in a quiz format, one of my preferred educational tools. Please arrange the following 4 actions in increasing order of difficulty.

(1) Stumbling into a bee hive while walking in the woods.

(2) Swallowing glass shards.

(3) Watching C-SPAN for 24 hours without interruption.

(4) Reversing a claim of Medical Guideline Violation

Sunday, November 29, 2015

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 express thanks for what we have, for what we have been given. I know that many of us have been given what seems to be an unfair measure of misfortune and pain.  Life is not fair.

A Depiction of the First Thanksgiving

I have seen so many people over my career who have faced challenges and obstacles that dwarf my own, and yet demonstrate grace and thankfulness for what they have in their lives.  How do these ordinary people find extraordinary strength?   It’s effortless to be appreciative when you are coasting downhill.  Anyone can do this.  What really matters, however, is when we can do so when our downhill glide has taken a tortuous path.  This is a lesson that I contemplate often, but I haven’t mastered.   I am thankful for the people in my life who inspire me to try to be better than I am.

Sunday, November 22, 2015

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 emergency room yesterday and they told me to call you for pain medicine.
  • My diverticulitis is acting up and I need an antibiotic.
  • My breathing is worse.  I think it’s a side-effect of the new heart medicine I started last week.
  • What can I take for constipation?
  • My cousin had the same symptoms and it ended of being her gallbladder.  Can you give me the name of a surgeon?
  • I’m dizzy and my hemorrhoids have been bleeding for a week.  What can I take?
  • I have hepatitis C.  Is is okay if my grandchildren visit?
  • I had some chest pain yesterday when I was shoveling snow.  Should I double my Nexium?

The practice of  medicine is not fully wireless, at least not yet.  Sure, e-mail is convenient for everyone, but if used too casually it can become quicksand.  Often, the patient feels an e-mail is sufficient, but the physician may not be comfortable, depending upon the medical facts and how well the doctor knows this patient.  When you are face to face with your doctor, the medical history will be more detailed, there may be a physical examination, and there will be a dialogue and review of treatment options.  It’s a lot easier for us to assess your pain, for example, when you are in front of us.  Moreover, when you return to see us for a follow-up visit, we have a baseline to use as a comparison.

What are your thoughts on all this?   Feel free to e-mail me, but I’d prefer if you came to see me
face to face.

Sunday, November 15, 2015

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.

Wheat Attacks General Mills

I take care of patients with true celiac disease who need to avoid gluten.  Most of my gluten-avoiding customers are not celiacs, but feel better on their self-prescribed diet.  When these folks see me and relate their clinical improvement, I support their decision.  Why do I do so after I just mocked the gluten-free zealots?
  • Just because there is no medical evidence, doesn’t mean it’s not true.
  • There is scientific basis of true ‘gluten intolerance’ in folks who do not have celiac disease.
  • Never talk a patient out of anything that seems to be helping him. 
Recently, General Mills recalled nearly 2 million boxes of gluten-free Cheerios and Honey Nut Cheerios, because these boxes were contaminated with wheat, which contains gluten.  The company voluntarily and properly undertook this recall.  If a product is represented to be ‘gluten-free’, then it should be.   Folks who have life threatening allergies to peanuts, for example, depend upon true labeling for their very lives.  However, not every manufacturing goof will result in such a dire risk for consumers. Yet, the Cheerios recall is labeled a Class 1 recall which means that there is a reasonable probability that it will cause serious health consequences or death.  Give me a break.  The phrasing states will cause, not even may cause.  Gluten is not botulism.   If a celiac patients ingests some gluten by error – which every one of them does throughout their lives – they live to see another day.  This FDA’s Class 1 designation is over-the-top hyperbole of the first order, if you will forgive my redundancy.  We would expect a Class 1 recall to be invoked for a faulty pacemaker, for example. 

Who makes up these definitions?  Obviously, the FDA wasn’t thinking clearly when they did so.   They were probably on a sugar high after wolfing down too many bowls of Fruit Loops.  

Sunday, November 8, 2015

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 will state it here in boldface italic type.
Lower admission standards!
Dozens of law schools are deliberately lowering admission standards to increase their class sizes, as reported by The New York Times.  Of course, these students will face a high bar of passing the bar, assuming that they make it to graduation.  Apparently, generating highly qualified legal professionals is not the objective. The true objective appears below.

The Objective
My blog's readers are among the sharpest in the blogosphere.  Let me post some queries, which I hope will stimulate some insightful responses.
  • You don’t think law schools are accepting unqualified applicants just for the money, do you?
  • Will the exorbitant debt they will incur benefit them and society?
  • When these struggling students fail the bar exam, have they still enjoyed a valuable life experience?
  • Should we support lowering the admission standards to conform to the emerging norm that excellence is overrated and every competitor should go home with a trophy?
  • Should we encourage this process as society desperately needs more lawyers, particularly underqualified professionals?
What's next?  Lowering the passing rate for the bar exam?

Maybe there's a lesson here for the medical profession.  We all hear that many areas of the country are medically underserved.  Surely, there is some way we can recruit more doctors?

Any ideas?

Sunday, November 1, 2015

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 readily recognize.  Getting smashed in the head hundreds of times per season over many years is not good for the human brain. One must wonder about engaging in an activity that requires a helmet and body armor for protection.

Legalized violence

There are rules to govern this mayhem, and sometimes a player is kicked out.

Are errant physicians kicked out of the medical profession?  Yes, it does happen, but these are rare events.  Some have argued that there is a ‘white coat wall of silence’ that protects physicians who need to be sanctioned or sidelined.  A few times a year, I receive a list of Ohio physicians who have been disciplined by the State Medical Board of Ohio.  Most of these offenses involve personal substance abuse.  ‘Pill mill’ doctors are also targeted.  Physicians who engaged in improper and inappropriate behavior with patients are on the list, as they should be.

Losing a medical license is the most serious professional sanction that a physician can receive.  Such a penalty should be implemented only for a egregious act, or a pattern of wrongdoing, provided that the physician has been afforded due process. 

When do readers think that a doctor should be tanked?  I’ll offer a few hypothetical scenarios below.  Let me know if the physician is salvageable or should be cut loose.
  • A gastroenterologist misses a diagnosis of colon cancer three years in a row.
  • A surgeon refuses to repair a patient’s hernia because the patient has no insurance and cannot afford the operation.
  • A physician is a recovering alcoholic and is now found guilty of a DUI.
  • A review of a psychiatrist’s medical records confirm that 10 patients committed suicide in the past 36 months.
  • An internist is found guilty of domestic violence.  No drugs or alcohol are involved.
  • An investigative reporter discovers that an orthopedist was paid $250,000 last year to promote a medical device to colleagues across the country, and never disclosed this relationship.
  • A physician is discovered to be double billing Medicare over the past year.
  • A physician persists in asking one of his patients to date him.
Do these offenses merit surrendering a license?  Would this be unnecessary roughness?  

Sunday, October 25, 2015

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.  Operators are ready to speak with you in 9 languages.   

After the announcer states his message, scary music plays and we see black and white footage of suffering zombies.

Probiotics, unlike conventional prescription drugs, are not subjected to Food and Drug Administration (FDA) approval.  Hence, the germ guru who brought deep fried food to our office is free to discuss all possible uses of the agent despite the absence of any scientific basis underlying his claims.  Drug reps detailing prescription medicines do not enjoy a similar level of free speech.  In fact, they are securely gagged and are prohibited from discussing off label use of their products, even if we ask them about it.  If these guys and gals stray off message, not only will they be summarily terminated, but their companies may be heavily fined, as many have learned.

Drug Reps Cuffed by the FDA

Does this make sense?  Prescription drug reps, whose products have been rigorously tested and are used off label routinely, can't even whisper or use hand signals to communicate important but unofficial information to doctors.  In contrast, a purveyor of probiotics, whose products are unregulated and unproven, can sing like a canary extolling the benefits of billions of germs that we're told can fight all kinds of illness, foreign and domestic.

I've always felt that the FDA is too strict in restricting the content of conversations between drug reps and doctors.  This is an overreaction from pharmaceutical industry abuses with aggressive marketing of off label use to physicians.  As a result of this hyper response, physicians are deprived of an important information resource from reps whom have a very deep knowledge of a narrow subject.  Who wins here?

Who needs prescription drugs anyway, now that I know that probiotics are the panaceas that can cure all.   

Sunday, October 18, 2015

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.”
  • “The Sunday New York Times is now priced at $82.  Middle East turmoil has caused the price of newsprint to skyrocket!”
  • “Your overnight Fed Ex envelope will cost $325.  We haven’t had a price increase in 4 months and will use this revenue to serve you better.”
  • “Yes, I can reschedule your airline ticket with a keystroke for only $150.”
  • “Call this number and I will send you absolutely free my fool proof system to make millions in real estate without any money or experience!”
  • “One fat-burning pill a day will melt the pounds away without changing your diet or exercising!”

 No explanation, even when delivered by an authoritative  PR pro can make the bad smell go away.

Recently, Turing Pharmaceuticals acquired the drug Daraprim, which is used to combat toxoplasmosis, a potent parasite.   The new company decided that a slight price adjustment was necessary.  So, the price per pill was increased from $13.50 to $750.  No typo here.  Feel free to use your preferred search engine to seek out the company’s explanation for their mega-gouging.  While I always try to remain open to opposing views, can any explanation exist that would justify this increase?

This is an example of corporate excess that will boomerang right back to strike the perpetrator.  Wanton greed and arrogance will surely provoke anger and bring a hammer of reform crashing down.  Ask your doctor.  Physicians understand what happens when a profession refuses to heal itself. 

Sunday, October 11, 2015

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 use this information in the event that some of them wanted to buy a gun? Tell me how you would do this because I haven't a clue here.

Consider these facts.
  •  The vast majority of mentally ill Americans will never commit violence.
  • Medical ethics and privacy regulations do not permit identifying mentally ill people. 
  • New or existing laws would not have prevented most or all of these mass killings.
  • We have no reliable method to predict a person’s violent potential.
Even if we could eliminate these horrible paroxysms of violence – a worthy and necessary societal objective – we should realize that most of the hundreds of thousands of yearly deaths by gun are not mass murders.

Is this the enemy?

An overall reduction of violence will not be solved by incarceration or gathering up guns.  The solution that continues to evade us will be as much from economic social, and educational policies as from our legal response.  I am not ‘blaming society’ for the actions of criminals.  But, I do believe that the solution will be of societal origin. 

I know many gun owners.  I understand their passion in protecting their constitutional right to own a firearm.  They recoil when gun control advocates pose questions such as, ‘why does one person need so many guns?’  They believe that unfettered gun ownership is their right and it is not for others to limit it.  Many of us use the same argument with regard to free speech.  Ugly speech and provocative art are protected.  Haven't we heard protests against offensive art by those who argue 'why should a museum display this filth'?   

Like everyone, I am angry, vexed and ashamed.  As physicians understand, making the diagnosis is often the easy part.

Sunday, October 4, 2015

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 returned?   Do you think that various corporations donate to specific candidates only because these candidates support‘good government’?  They do so because they want something in return.  Many companies take no chances and donate to both Democrats and Republicans.

The New York Times recently reported on a published study that describes the practice of soliciting rich patients for cash to donate to support the physician’s research or the medical institution.  Readers are invited to review the article to become better informed.  Donating to a medical institution is a praiseworthy and ethical act that merits commendation.  If a philanthropist donates to support an institution’s Alzheimer research program or cancer vaccine research, then we should all be grateful.  If a wealthy family decides to make a generous gift because a family member’s life was saved, then everyone wins.

These examples are ethically distinct from a physician directly asking their patients for cash. Some programs try to carve the doctor out of the process while others don’t.  Shockingly, some doctors were offered a cash reward if his rich patient gave the institution a cash reward.

One not be a graduate student in bioethics to recognize how improper this scheme is.  Here are a few crimson flags.  Feel free to add your own.
  • Should physicians should look upon their patients as revenue reservoirs?
  • What preferential medical treatment would a donor expect and receive?
  • Would a patient who declines to donate fear or receive lower quality care?
  • Would physicians recruit rich patients with the hope of soliciting funds?
  • Would a wealthy patient who is seeking care from a select physician be contacted by the development office for a ‘conversation’?
Who is going to make the medical profession great again?

Sunday, September 27, 2015

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 serve.   This is where I can spread out a few newspapers and sip a carbonated beverage that has zero nutritive value.  I love the older music that is piped in there from the 50s and 60s.  (Don’t tell me you haven’t heard of the Marvelettes,  the Platters or Wayne Fontana and the Mindbenders?)  Denny serves me up when I arrive with courtesy and a smile.  He’s entered the senior phase of life, similar to many other workers at fast food establishments.  Although the food may be fast, Denny isn’t.  He has one speed which is between neutral and first gear.  He’s the kind of guy who just can’t be rushed, despite whatever pressure might be exerted upon him.   We all know folks like this.  Sometimes, I felt myself becoming impatient with this avuncular man who moved at the pace of a loris.  Patience is a lost virtue in a world that demands instantaneous data retrieval and communication.  In my parent’s day, I don’t think they would suffer apoplexy if the person in front of them in the supermarket check-out line was counting out some change.  It took months before I discovered that Denny was an intelligence officer who flew on combat missions during the Vietnam war.  What was I doing then?   Trying out for Little League or participating in some equally perilous activity.  Denny has earned the right to move a little slower than the instagram generation demands.  We can learn a lot from Denny.

Teachers are cool.  I recall a patient who was a science teacher.  I have enormous respect for educators and their profession.   I am partial to science teachers, not only because of my own love of the subject, but also because this country needs to cultivate science and math excellence for our self-preservation.   While I admired him for his career choice, I was in awe of his prior profession.  He was the commander on a nuclear submarine.  While he was circumnavigating the planet, I was writing college application essays. 
I am regularly amazed an awed to learn of the heroic and extraordinary acts of seemingly ordinary individuals.   I am also so impressed with their modesty and understatement.  Over the years, I have learned about their accomplishments because I have asked, not because they have volunteered their heroics, which they often shrug off.

Who’s serving you French fries and a burger?  If you’re not in too much of a rush, you might learn that the man who is giving you change, might have changed the world.  

Sunday, September 20, 2015

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 surgeon had a bone to pick with his bosses, but their edict was as rigid as a steely plaster cast.  There would be no exceptions.

Usually, when stuff like this becomes public, we are greeted by nauseating and sanitized statements from the PR office that generally seek to distract and deflect.  That’s when the PR Prism is so useful.  Consider some examples.

Facts: A sneaker company is discovered to be using child laborers in Southeast Asia for 10 years.
PR Prism: Our company never knowingly hires underage works and always strives to adhere to the highest corporate ethical standards.  We have started a full investigation and promise transparency and accountability.
Translation:  We got caught.

Facts: A presidential candidate deletes tens of thousands of e-mails that were housed on a personal server that was kept in her basement.
PR Prism: I never violated my well known stratospheric standards for probity and integrity.  To the best of my recollection, I never knowingly sent or received any e-mails that any reasonable Secretary of State would have regarded as Confidential, Top Secret or even Semi-Secret in accordance with written Policies and Procedures.  I wish I could share these P & P manuals with you, but of course, they are classified. 
Translation:  Ha! Ha! Ha!

In what I suspect was PR lapse, the statements from The Cleveland Clinic contained some glimmers of actual truth.  I would have expected some doublespeak about how the Clinic is ‘always striving to provide World Class Care…”, but here’s what the Chief of Staff said after acknowledging that their corporate and coercive decisions can give individual practitioners vexing choices

“It doesn’t make everyone happy.  There is a tremendous amount of change going on in health care as we work to drive quality, but do it in a more affordable way.”

I congratulate the Clinic on at least admitting that they trying to save money, and not disguising the cost-cutting under the veil of medical quality.   I support practicing cost-effective medicine, as I have expressed repeatedly in this blog.   However, I suspect there is an important part of this story that was not reported in 9/10/15 Plain Dealer article.

How did these 2 orthopedic device companies get the Cleveland Clinic gig?  Was it based on cost?  Did the Clinic or any of their physicians have financial ties to the companies?  While the Clinic claims that physicians had input into the choices of these two vendors, was the process in truth a preordained corporate decision?  Did artificial joint competitors have a fair shot to bid for the business?  If a competitor sold artificial joints to a Clinic competitor, would this company be shut out? 

This issue goes well beyond artificial joints.  Every hospital in the nation makes deals for artificial joints, heart valves, intravenous catheters, medications, surgical instruments and radiology equipment.  Increasingly, these are as much business decisions as they are medical decisions.  If a product or service can be delivered more cheaply with no loss of quality, than we all support it.  Who do patients trust to make these judgments?  Your doctor or the hospital’s accounting department?

I’m not suggesting that the Clinic, or the hospitals where I practice are crooked.  But, the medical industrial complex has many tense conflicts of interests that are sequestered far beyond the view of the public.  I’m sure there are troves of hospital e-mails that would be fascinating to review, unless the servers have been wiped clean.

Sunday, September 13, 2015

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 do so, the audience reliably responds with loud applause.

Of course, this is pure political pandering.  Here’s why.  Special interests are not a dark and ominous cloud hovering over us ready to thrust a bolt of lightning impaling us.  We all are ‘special interests’. Every one of us either belongs to or supports one of them.  
  • My beloved first grade teacher Mrs. White belonged to a teacher’s union.  Is she a ‘special interest’?
  • Is the letter carrier who delivers mail to my house a ‘special interest’?
  • My accountant prepares my taxes.  I pay him for this service.   Does he have a ‘special interest’ to resist tax reform?
  • Are NRA members and gun control advocates ‘special interests’ who are trying to further their agendas?
  • Is Emily’s List a ‘special interest’?
  • Is the Sierra Club a ‘special interest’?
  • Are trial attorneys who donate millions of dollars to politicians to pursue good government or are they a ‘special interest’?
  • Aren’t corporations allowed to advocate for their ‘special interests’ like the rest of us?
If you carve out all of the 'special interests', who's left?

When politicians speak of 'special interests', they never identify them specifically.  If they were to name them, they would alienate many voters who support them.  Politicians want voters to believe that the special interests being targeted are other voters’ interests, not theirs.

Is the medical profession a special interest?  You’d better believe it.  We are gluttons feeding at the ‘special interest’ trough.  Physicians, pharmacists, pharmaceutical companies, hospital administrators, medical device companies, nursing home owners, home care companies and medical insurance companies all have their own interests which may collide against the public interest.  For example, there may be many reasons why a particular artificial hip is used in a hospital.  Why are only certain heartburn medicines available on hospital formularies?  Similar questions can be asked of every medical specialty or hospital.  Get my point?

Who’s looking out for the patients?  What ‘special interest’ is advocating for them?

Sunday, September 6, 2015

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 entitled to a day off?

Entrepreneurs risk capital to create new or improved products and services.  While they don’t use hammers or wire cutters, it sounds like work to me.  Are they allowed to picnic tomorrow?

How about pregnant women who are about to deliver their offspring?  If they go into labor tomorrow, I say that Labor Day is for them.  Care to argue with me?

All work is honorable and deserving of honor.  Whatever you do for a living, fire up the grill tomorrow.  Make it a labor of love.

Sunday, August 30, 2015

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 of this pronouncement.  To know the date of your upcoming demise, a fate that is only known to those on death row, is cruel torture.   In this case, the doctors were wrong on two counts.  This man wasn’t going to die.  And, he didn’t have cancer.

What a horrible error that didn’t need to happen. While I didn’t have the medical details, here’s what I think happened.   He had a CAT scan of the chest because he was having respiratory symptoms.  A mass was found.  The physicians then followed up with a PET scan, which is a special radiographic test used to determine if a mass is cancerous.   While this result isn’t as definitive as a biopsy, a positive result usually portends unfavorable news.   Oncologists use PET scans routinely.  My guess is that this patient’s PET scan result was on fire and the patient was told that his days were numbered.   Surgery was scheduled.   When the final pathology of the resected lung specimen was issued, not a cancer cell was in site.  This patient had a fungal infection and completely recovered.

This was a colossal error, even though the outcome was a blessing.   If a patient is wrongly told that his condition is benign, and he has cancer, then the same error assumes a very tragic proportion.  My patient lived to relate his saga to the world.

An Error of Colossal Magnitude

Could he have successfully sued his treating physicians?  I think he had a reasonable case for pain and suffering damages, including perhaps, unnecessary surgery.   No case was ever filed.    I would hope that an unexpected gift of life would render a lawsuit to be a trivial pursuit, even if the case had legal merit.  He feels perfectly well now.  The damages diminished and faded while his life endured.  

I recognize that others may have a different view of what transpired here.  They may focus on what was taken from him and that he deserves to be made whole.  They may not feel that he has been given life, as his life was never truly in jeopardy. 

I’ve done about 25,000 colonoscopies and I’ve confronted scores of colon cancer.  I know it when I see it.   When I see a lesion that concerns me, I share this concern with the patient and his family after the procedure.   But, I still wait for my biopsy specimen results before issuing an authoritative declaration.  Shouldn’t I wait until I have 100% of the data before speaking with 100% certainty?

Sunday, August 23, 2015

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?
Spinner:   I have always said that this nation must have border security to protect our nation.

Reporter: Do you accept the Supreme Court’s decision legalizing gay marriage as settled law?
Spinner:   I am a champion for liberty and  I have always said that I believe that this issue should be addressed by the states.

Reporter: Will you say now on national television that you recommend American boots on the ground in Iraq?
Spinner: What I will say, is that if it weren’t for Obama’s leading from behind, we’d never be in this position.

The political spinmeisters are weaving a tapestry that is stretching across the country.

While the medical profession cannot rival the political class in spinning competence, we’ve been known to massage a phrase or two.  Have a look.

Medical Truth:  Regular exercise has a modest effect on weight loss.
Patient Spin:  Once I resume my exercise routine, the pounds will melt off.

Patient Truth:  Hey, where’s my doctor hiding?
Administration Spin:  If you like your doctor, you can keep your doctor.

Medical Truth: Proof of efficacy of probiotics for gastrointestinal diseases is lacking.
Health Food Store Spin:  After you swallow zillions of good and great bacteria, they become your personal warriors against digestive evil. 

PhysicianTruth:  The placebo effect is a real phenomenon.
Physician Spin: I think this pill has a good chance to deliver some relief to you.

What's your profession?  What yarns have you spun lately?

Sunday, August 16, 2015

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.  Of course, if a politician were to begin his response with, ‘Yes, but…’, he will be tossed aside as a spineless waffler.  

I hear the slogan ‘equal pay for equal work’ bandied about.  If a reporter shoved a microphone in your face and demanded to know if you support this slogan, would you scream ‘Yes!’ while you pumped your fist in the air for emphasis?   After all, who could oppose equal pay for equal work?  Shouldn't a man or woman receive the same wages for the same job?

Try this example.  A new teacher who has just completed his training becomes a 3rd grade teacher.  He is qualified and brings youthful enthusiasm into the classroom.  His colleague across the hall, has been teaching 3rd grade for 15 years.  This teacher is a seasoned professional whose students benefit from a career of experience during which she has honed her craft to higher level of performance.  Both are 3rd grade teachers.  Should each be paid the same salary?   I don't think so.  Does this mean that I do not  support equal pay for equal work?

Slogans are rife in the medical world.  How often do we read or hear about ‘quality health care’?  Not a day passes that I don't confront this slogan.  It’s an empty phrase that masquerades as something real.  It’s a phantom, a cloud, a ghost.  It falls apart if you try to hold it.  

I think every American deserves quality health care from quality physicians who prescribe quality medications dispensed by quality pharmacists purchased by quality patients.

My point?  Try to define quality medicine.  It’s not as easy as it seems.  Could you do it as a quality reporter with a mic and a camera demands a quality definition in 5 seconds?

Context anyone?

Sunday, August 9, 2015

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 would violate his privacy.

We looked over his shop and he then invited us into his home to show us how his stuff might look in an actual home.  When he learned what I did, he then told me that he had seen several gastroenterologists on a medical odyssey that started 3 years ago.

The man’s profession is not important.

The medical facts that resulted in a delay in his diagnosis of cancer are incidental.

His Christian faith, evidenced by numerous crucifixes adorning his property, would likely be deemed to be paramount by the man himself.

The doctors told this man that he had 3 months to live.  That was 3 years ago.  As a trained medical professional, it is my considered judgment after decades of medical training and experience, that he is quite alive.  Not just alive, but alive and well.  Not just well, but downright inspirational. 

When he was given this dire news, his response was that ‘it’ll have to kill me’, as he intended to fight back.  He did.  He has one final surgery remaining this fall.

The doctors were wrong, dreadfully wrong.  Perhaps, they were relying upon textbooks, which my new friend didn’t read.  He had his own playbook, which helped him to find a pathway back to life. 

Of course, doctors, as members of the human species, make mistakes.   We give wrong advice.  Sometimes, we give the correct advice, but something unexpected happens, as I suspect happened in this case.   Arrogance is the enemy of good medicine.

Sir William Osler, one of medicine’s preeminent physicians of all time, implored physicians to have ‘the grace of humility’’  No second opinion needed here.

Sunday, August 2, 2015

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 could be ‘adjusted’ so that fetal organs would not be damaged so they could be harvested.  The faux venders were told by Planned Parenthood that they prefer that the surrendered organs would be considered for ‘research purposes’, rather than as a typical business transaction as this would give the organization some ethical and legal insulation. 

One’s ultimate view on the legality and propriety of Planned Parenthood’s behavior should be independent of one’s view on the abortion question.  I am always agitated when an individual or organization’s views on an issue are tainted to conform to an ideology.  For example, if you are a Democrat who believes that Hillary Clinton’s email practices are entirely proper, then you should have the same view if Dick Cheney were substituted in her place.

If Dick Cheney says the earth is round, some folks will say he's wrong.

Regrettably, this is not the standard that operates in the public square.  Pro Life believers are clamoring to defund Planned Parenthood, an organization many of them loathe.  Pro Choice adherents, sidestep the videos’ content and focus instead on the deceptive techniques used to obtain them.  Both sides are missing the point on purpose.

If Planned Parenthood broke the law, then this fact should not be mitigated or expanded depending upon one’s abortion views.

This story has various medical ethical dimensions.
  • Must an abortion provider obtain consent from the patient for giving away fetal parts?
  • Is it ethical for an abortion provider to modify the procedure in order to preserve specific organs?
  • Is informed consent necessary for an abortion provider to use a different technique for a purpose unrelated to the medical task at hand?
  • Could the patient charge the vendor for fetal parts?

 I have not given my own view on the abortion question here.  It shouldn’t matter.  This issue should be judged separately from one’s view on the abortion question.   Call it straight. Support your adversaries and rebuke your own team when the facts demand this.  Telling the truth is good publicity.  

Sunday, July 26, 2015

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.  Kale is king. 

If we want to generate some heat in the green crowd, just mention the word ‘radiation’.  Ingesting irradiated food, for example, is believed to be tantamount to swallowing strychnine.  No persuasive evidence necessary.  Faith will suffice.   Nuclear reactors are regarded as atomic bombs in waiting, as if burning coal or hydraulic fracturing (fracking) are as clean and pure as the first snowfall.  The sun’s radiation, which assaults us daily is somehow not demonized, nor are cosmic rays, high energy radiation which bombards our atmosphere and can reach down to earth itself.

Cell Phone-Free Zone!

The City of Berkeley, the epicenter of New Age Goofiness, has just passed an ordinance that requires retailers to warn customers about the medical risks of devices that emit radiation, such as cell phones.
Here’s an excerpt from the caveat.

If you carry or use your phone in a pants or shirt pocket or tucked into a bra when the phone is on and connected to a wireless network, you may exceed the federal guidelines for exposure to radio frequency radiation.  This potential risk is greater for children...

Luckily, I'm mostly in the clear.  I am not a child and do not don female underwear.  I secrete the phone into the left inside pocket of the sport jackets I wear each day to work.  The phone, therefore, rests above my heart.  Perhaps, the gentle radiation from my beloved iPhone is conferring a cardiac benefit on me?  While it's just conjecture, perhaps, if my heart gets tempted to beat out of step, that my iPhone's rays keep my rhythm sure and steady.  

If I were the cell phone companies, here's how I would fight back.  Forget about litigation or trashing the fiends who fear all radiation, foreign and domestic.  I would sell my theory of cardiac protection to the American Heart Association. For a proper donation, they might consider cell phones to be 'Heart Healthy'.  

If your adversary argues without facts, then shouldn't you?

Sunday, July 19, 2015

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.  I’m sure that the patter-downers were following the rules and regs, but this doesn’t seem to be a well targeted effort. 

A Non-controversial Profile

I’m familiar with the argument against law enforcement using profiling to reduce crime and protect public safety.  I understand that this can lead to abusive practices by overzealous police officers.  But I wonder if, as El Al believes, this can be a legitimate tool in law enforcement’s armementarium.  I’m open to the debate here.

I’m a physician and I certainly profile my patients.  I don’t have a single template for treating abdominal pain in all  patients.   For example, if I see a recent immigrant from China with stomach issues, a part of the world where gastric cancer is relatively common, this may affect the speed and intensity of my evaluation.   If an American born patient comes to my office with the same complaint, my response might differ.   If breast cancer is more common in Ashkenazi Jewish women, shouldn’t we factor this in when we are advising them on risk reduction?  Certain populations have different health risks.  Physicians are always trying to separate out patients who might warrant special attention. 

If you are trying to reduce a certain disease that is largely restricted to one segment of the population, doesn’t it make sense to target this segment rather than everyone?

I realize that health and law enforcement may not be analogous.  I also realize that profiling in law enforcement is a very sensitive issues, particularly for minorities who have been victimized by this technique.   But, if we abandon the procedure entirely, are we forfeiting a tool that could keep us all safer? 

El Al has a different view.  Here, in America, TSA is trying to detect evil stuff. El Al is trying to detect evil people.  Which makes more sense?