MD Whistleblower

Medical ethical issues confront physicians daily.  Most of us contemplate ponderous ethical dilemmas, such as end-of-life care care, allocation of the limited supply of organs for transplant or our unequal access to health care.  Many ethical decision points are rather quotidian, not situations that would serve as content for bioethical conferences. Here are some examples of everyday ethical issues that physicians deal with. A patient asks his doctor to support a claim for disability that is not warranted. A patient asks his gastroenterologist to change his constipation diagnosis after the fact so that his colonoscopy is covered more fully by the insurance company.  An employee in a doctor’s office, whose own doctor is booked solid, requests an antibiotic prescription for a urinary tract infection from her physician boss. A physician falsely claims to an insurance company that he has tried certain medicines on a patient in order to gain approval of a desired m...

The value of anything becomes apparent when it is taken away from you.  Nothing profound here about one of life’s central truths.  It is an ongoing challenge not to take life’s gifts for granted.  I have never known hunger or lived without shelter. I have never been unemployed or suffered a serious illness. I pay my bills.  I have 5 children who enjoy excellent health and are forging pathways toward their dreams.  I love the people I work with.  I have found new love in the 6 th decade of life.  And, I have ice cream every day of my life. It would be shameful to have been bestowed so much and then to complain about some of life’s trivialities.  But, I am human. The Mother of All Gifts Consider the following list of events.  Has any of them ever dampened your mood, made you angry or resulted in an outburst of coarse language?  You find yourself in a traffic jam which delays your arrival to a meeting by 20 minutes. You...

“There are three kinds of lies: lies, damned lies and statistics.”   There is much truth in this quotation of uncertain provenance.  We see this phenomenon regularly in the medical profession.  We see it in medical journals when statistics are presented in a manner that exaggerates the benefit of a treatment or a diagnostic test.  Massaging numbers is raised to an art form by the pharmaceutical companies who will engage in numerical gymnastics to shine a favorable light on their product.   It’s massaging, not outright mendacity.   The promotional material that pharmaceutical representatives present to doctors is riddled with soft deception. A favorite from their bag of tricks is to rely upon relative value rather than absolute value.  Here’s how this works in this hypothetical example. A drug named Profitsoar is tested to determine if it can reduce the risk of a heart attack.  Two thousand patients are participating in the ...

Like nearly every gastroenterologist, we have an open access endoscopy system.  This means that patients can be referred, or refer themselves, directly to our office for a a procedure without an office visit in advance. Why do we do this?  We offer it as a convenience so patients do not need to make two visits to see us when it is clear that a procedure is necessary.  For example, a referring physician doesn't need our consultative advice for his 50-year-old patient with rectal bleeding.  He just needs us to do a colonoscopy.  We have a strict screening process in place to verify that these patients are appropriate for our one-stop colonoscopy program.  If we have concerns about medical issues or potential informed consent capability, then we arrange for these patients to see us in advance. However, no screening process is perfect.  On occasion, someone shows up whom we might have preferred to see in our office first. How should we handle the...