MD Whistleblower

Last week, I related a vignette where a routine medication refill was denied by a patient's new insurance company.  The patient had developed symptoms 2 weeks after he ran out of the medication. I surmise that 100% of gastroenterologists surveyed would have agreed that refilling the medication was the next step. So, even though the best medical option was to refill the medicine that we know has worked, the new insurance company won’t cover it and the patient cannot afford to pay retail for the drug.  (As a separate point, I challenge anyone including those with PhD's in economics to explain retail drug pricing.)   The patient did his best to navigate the insurance company’s website and found a colitis medicine that is covered, but it is medically inferior.   Should we just cave and prescribe it to save money and a hassle?  Is this an issue that we want on our sick patients' agendas?  How would you like to face surgery and be told that the newer cla...

A patient came to see me recently with a suspicion that his colitis was recurring.     In general terms, colitis describes a condition when the large intestine is inflamed or irritated.   Typical symptoms are diarrhea, abdominal cramping and rectal bleeding.   This patient was concerned as his last 3 bowel movements were diarrhea.   He had been on a medicine called mesalamine, a safe and effective treatment for colitis, but he ran out of it 2 weeks ago.   While he was taking the medicine, he felt perfectly well.   So, his bowel change developed 2 weeks after he ran out of his medicine.   For readers who like to play doctor, choose among the following options: Schedule an urgent colonoscopy to verify that nothing has changed since his colonoscopy 6 months ago. Observe the patient without any treatment to give him time to heal himself. Recommend probiotics to restore his digestive health. Refill the mesalamine at his usual dosage. Reque...

First there was Bitcoin, a cryptocurrency that utilizes blockchain, a decentralized system of data collection and transactions that we are told will defy hacking.   (Wasn’t the Titanic said to be unsinkable?)    We read that cryptocurrency and other blockchain functions will be a societal gamechanger, much like the internet was when Al Gore invented it some years ago. My own state of Ohio will now accept Bitcoin as payment for commercial taxes.   And, of course, there are many other cryptocurrencies mushrooming around us.   In my life, many innovations seem to be solutions in search of problems.   I don’t find my current methods of transacting business – cash and credit cards – to be so onerous that I am screaming for a new way to conduct commerce.   But, I will admit that I have security concerns about my credit card number and other highly personal data being ‘safely stored’ all over the internet.   Some years ago, I enjoyed the thril...

Many organizations solicit private donations from benefactors and philanthropists.   Is there a stadium in the country that does not bear the name of a prominent donor?   There are also anonymous donors who are not cursed with egos that require their names to be emblazoned in giant font on a building’s façade.   But, most donors want recognition which is often used as an incentive when soliciting the donation. Donors understandably receive perks and privileges that ordinary folks will never be offered.   If you give a ton of money to a theater, you might receive prime season tickets as a gift.   If you make a sizable donation to a symphony orchestra, you may be invited to a private event to meet the conductor and leading musicians.   If you make a robust financial contribution to your city’s art museum, you won’t have to worry about competing for limited tickets to view the visiting Picasso exhibit.   You may very well have your own private tour....