Skip to main content


Showing posts from June, 2019

Why I Left Private Practice

After 20 years, I have left private practice and joined with the Cleveland Clinic.   To those who know me and this blog, this development may seem surprising, if not shocking.   On many levels, I’m shocked at this unexpected denouement of my career.     Let me explain. First, these past two decades in private practice have been fabulous.   Our amazing staff and my partner worked hard every day to provide concierge level care to our patients.   We survived only because we provided a level of service that the surrounding competitors simply could not rival.   We provided customized and personal attention.   Our patients were happy and satisfied.   And, so were we.   So, why did we make a change? Over the past few years, my partner and I had become uneasy about our practice’s ongoing viability.   The economics of a 2-person private practice are increasingly challenging.   Consider the math.   There is ongoing downward pressure on reimbursement with inexorable upward movement on e

Is My Doctor Any Good?

When I meet patients in the office, our conversations do not focus exclusively on the medical issue at hand.  Of course, if you come to see me with a stomach ache, at some point I will direct the dialogue toward your abdomen.  Often, our conversations are far removed from livers and pancreases, and deal with more personal vignettes and anecdotes.   Why does this happen?  First, I enjoy it; and secondly, it helps me to understand the patient better as a human being.  I won’t give this up, despite the many forces – Electronic Medical Records in particular – that conspire to dehumanize the medical experience.  I am a trained typist and had several secretarial jobs in my younger days.   The tool of the trade then was a contraption unknown to the generation whom are now soldered to their smart phones.  It was called a typewriter.  For those curious, you might actually be able to palpate one of these dust covered devices in your grandmother’s attic.  My favorite was the IBM Selectric, w

Medical Risks and Benefits - Shades of Gray

Readers know how strongly I feel that my profession is suffering from the twin chronic diseases of Overdiagnosis and Overtreatment.  Here's a primer on how physicians make medical recommendations to our patients. Take a look at this grid I prepared, which is worth a full year of medical school.                                     Low Benefit                    High Benefit Low Risk                                                            Medical Sweet Spot!                                  ________________________________________                         High Risk                  DANGER ZONE! When we physicians are contemplating a treatment, or are weighing one treatment against another, we are aiming for the Medical   Sweet Spot highlighted in blue above.   We want low risk and high reward for our patients.    Would we ever consider a treatment within the DANGER ZONE ?   We would if the patient’s medical circumstance were dire and there were n

Medicare for All - Bad Medicine for the Country

Last week, I presented my discerning readers with arguments supporting Medicare for All.  Here in Part II, I will offer a few rejoinders and caveats to those proposals.   Senator Bernie Sanders deserves credit for advancing this issue into our national conversations.  And, many of his 22 rivals who are angling for the Democratic nomination for president in 2020, have embraced the position in their collective leftward migration.  Indeed, if this leftward drift persists, we may soon be regarding Comrade Bernie as a moderate! First of all, the Medicare for All being proposed now should be renamed as it goes far beyond our current Medicare system.  The New & Improved Medicare for All promises the following additional benefits which are not included in conventional Medicare. Vision coverage Dental coverage Hearing Aids Long Term Care Medical Care for Illegal Aliens Minimal cost sharing, meaning no copays or deductibles I’m surprised that the generous proposed

Medicare for All - A Moral Imperative

Brace yourselves.   Over the coming months and longer, you will be hearing presidential candidates and their acolytes proclaiming the moral imperative of a Medicare for All program.   Is this just an electioneering slogan or is this really the Holy Grail of health care reform?   Nearly all Whistleblower posts are stand alone essays.   This  Medicare for All entry, will be a rare departure from this tradition and will be a two-parter.   If you like Part I today, then you will have strong incentive to visit this site next week.   And, if you find today’s post to be disappointing, then I invite you back next week with the hope that you will find the conclusion to be more captivating and riveting than this post.   How's my salesmanship? Let’s try to agree on one thing before we disagree over everything else.   Conceptually, we all support any health care system that provides high quality medical care, with reasonable access into the health care arena and is cost effective.