MD Whistleblower

Not long ago, Telemedicine was something that I read about.   Now, it’s something I do.   Over the past weeks I have been evaluating patients over the phone from home.   It has been an adjustment, but it has been smoother than expected.   First, I have always thought that the physical examination is overrated.   Yes, I recognize that such a declaration constitutes medical blasphemy, but I stand by it.   Don’t extrapolate beyond my actual meaning.   I am not suggesting that the physical exam is superfluous.   Indeed, there are many circumstances when the exam is absolutely critical.   However, for a good bulk of the routine gastroenterology patients I see, particularly for those who are returning to my office for a follow up visit, the exam contributes little value. Here is a sampling of patient visits where the history alone is largely sufficient. A patient with years of chronic constipation returns to see me for a 6 month follow up...

Tomorrow will be a Memorial Day worth remembering.   Of course, its core meaning – to remember and honor those we have lost in the service of this nation – remains paramount.   I have thought over the years that the day’s essence has become blurred as the day has become one of family picnics and barbecues.   I confess that I have not sufficiently paused and meditated on the day's meaning in year's past as I think I should have.  I placed a small American flag on our front lawn today, the smallest of gestures to honor a very solemn remembrance.     But this Memorial Day is different.  To those of us like me who have never served, this may feel as close to a war atmosphere that we will hopefully ever know.  Lockdown.  Shelter in place.  Commerce shuttered.  Empty streets and concert halls.  Fear.  Desperation. Hope.  Propaganda.  Supply chain disruption. Heroes.  Victims.  Agony an...

A few months ago, most of us had never heard of an N95 respirator or mask.   I had never heard of it. It is an essential element of Personal Protective Equipment, or PPE, which we have all heard so much about. The N refers to ‘non-oil’, meaning that the mask should not be used in the presence of oil-based substances.   The 95 means that 95% of airborne particles are screened out if the mask is worn properly.   Keep in mind that 95% is less than perfect.   It means that the mask will fail 5% of the time.   And, if the mask is not worn with a tight seal, the efficiency percentage will drop further.   And, the mask wearer is instructed not to adjust the mask during use which will break the seal.   So, the 95% standard is likely under idealized circumstances.   As of this writing, I have only worn the N95 mask on two occasions.   My initial experience donning the mask was for a fit testing by an occupational health specialist to ve...

Prior to the pandemic, patients who entered my office building were greeted by 2 staff professionals who would assist patients in checking in and performing the usual logistical tasks that occur prior to a medical appointment.   Shortly after the pandemic commenced, I would arrive to work to witness these 2 ladies in rather different garb.   They were now fully gowned, masked, gloved and goggled.   Each carried a bottle of hand sanitizer.   If not for their voices, I would not have recognized either of them.   Patients and medical personnel passing by would extend one an open palm to receive a squirt of the precious cleansing elixir.   While I acknowledge the necessity for staff interfacing with the public to don protection, it was an eerie site for me to witness, even as a medical professional. It is simply a scene that is foreign to most Americans. I recall when I traveled to Israel for the first time, I was struck at the site of uniformed and armed s...

In a recent post , I presented why I believe that the fragmentary and anecdotal medical evidence supporting the use of chloroquine and hydroxychloroquine for COVID-19 does not justify its use. Certainly, if I become infected with the coronavirus, I would be reluctant to accept a recommendation to take either of these 2 medications, based on what is currently known. Ordinary people, especially when they or loved ones are afflicted with a disease, will readily accept unproven remedies, especially when conventional medicine has no effective treatment.   We all understand this.   But the lack of a treatment, in my view, does not justify abandoning our usual standards that physicians rely upon when we make treatment recommendations.   Shouldn't Physicians Weigh the Risks and Benefits? Here are some reasons why I object to coronavirus patients taking chloroquine and hydroxychloroquine for COVID-19.    The principles outlined below certainly extend b...