MD Whistleblower

Behold the denizen who has bravely entered our property so close to Thanksgiving! Wishing all of you a great holiday.

At least a few times a year I am asked to prescribe antibiotics to people who are not my patients.  From my point of view, there is only one answer that makes sense here – no.   I have the same reaction when patients call me for a refill or advice when I have not seen them in a year or two.  The patient may feel that I will refill their heartburn medicine indefinitely without an office visit, but I won’t.  Once I hit the refill button, I am now totally responsible as the doctor.  Patient Gets Medication Refill in 14th Century The Patient’s Perspective I’ve been on the same medicine for 10 years and all I need is a refill.  I feel fine. I do not want to take time off work for an unnecessary appointment. Why should pay a copay when all I need is a refill?  Sounds like a rip off. The Physician’s Perspective No refill until I verify that there are no concerning symptoms. A routine ‘heartburn patient’ may have developed some sw...

Doctors dispense medical advice.  That’s what we do.  Folks come to our office with various medical issues.  We talk to them.  We poke around some of their body parts.  Then, we exercise our medical judgement.  We might order a CAT scan.  We might prescribe stuff.  We might simply reassure them and send them on their way. This is a typical ‘day in the life’ of a health care provider, formerly known as a doctor.  From time to time, folks solicit my advice under different circumstances.  Despite my efforts to keep my medical specialty stealth, sometimes the secret seeps out when I am in a social setting. “Oh, you’re a gastro guy?  Would you mind if I asked you quick question about my husband?  He has a gas problem…” I get questions like this all the time, and I do my best to respond in way that sounds authoritative, yet dispenses no legitimate medical advice.  Here are some examples of how I might respond to the...

I’ve delved into the issue of medical judgment more than once on this blog.  I have argued that sound judgment is more important than medical knowledge.  If one has a knowledge deficit, assuming he is aware of this, it is easily remedied.  A judgment deficiency, per contra, is more difficult to fix.  Who doesn’t think he has good judgment? For example, if a physician cannot recall if generalized itchiness can be a sign of serious liver disease, he can look this up.  If, however, a doctor is deciding if surgery for a patient is necessary, and when the operation should occur, this is not as easily determined.  Medical judgment is a murky issue and often creates controversies in patient care.  Competent physicians who are presented with the same set of medical facts may offer divergent recommendations because they judge the situation differently.  Each of their recommendations may be rationale and defensible, which can be bewildering for patient...