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Showing posts from June, 2022

The Difference Between a Screening and Diagnostic Colonoscopy.

Many patients are confused by the difference between a screening and a diagnostic colonoscopy.  While the actual procedure is the same, the distinction between the two depends on why the colonoscopy is being done.  While you might think that I am wading into a sea of nonsense and absurdity, I am offering you a glimpse of the rational and reasonable world of medical insurance!  Try to follow along. Here’s a primer. A screening exam means that you have no symptoms or relevant laboratory or x-ray abnormalities that justify a colonoscopy.   Consider this to be a simple check-up for your colon.   You are being screened to determine if you have a hidden abnormality or lesion.   Get it?   A diagnostic exam means that the doctor is investigating an existing or suspected abnormality. A medical condition is under consideration and a colonoscopy is advised to investigate.     For example, if you have bowel symptoms, weight loss, blood in the stool, a personal history of colon polyps

Practicing Medicine in the Gray Zone

Many issues have clear and obvious solutions.  Consider some illustrative examples.  If a light bulb has burned out, then most of us would agree that popping in a new bulb should be the enlightened response.  If a flower bed is dry, then we reach for a hose.  If our car’s fuel gauge is nearing empty…   I think you get the point here. Here's a slightly more complex scenario.    Let’s say that your car has a rattle.   The mechanic may not know the cause or the solution, at least initially, but we can all agree that there is a specific malfunction that can be remediated with a targeted intervention.   As with the dead light bulb example above, there is a specific, reparable defect present.  Unlike in the automotive world, other disciplines operate with a loose, flexible and proprietary framework.   Consider the financial industry.   One need only read a newspaper’s business section for a week to appreciate the divergence of opinions on financial and investment matters.   Experts c

Is My Stomach Pain in my Head?

Stomach Pain and Mind-Body Relationship This is a delicate issue and must be approached by medical professionals with care.  Of course, it is an established fact that psychic distress can be responsible for physical ailments.  Did you ever get a headache after having an argument?  Were you one of those students who experienced diarrhea before final exams? This past week, I saw 3 new patients in my practice with abdominal distress all of whom volunteered that they felt that emotional stress and anxiety were the culprit, or at least a major contributor to their gastro issues.   Obviously, when the patient has this level of insight and expresses it to the physician, it paves the way for a fruitful conversation. But, this is not always the case. When I see new patients with long histories of unexplained abdominal complaints, I do not initially raise the possibility of a psychic connection.   I think this is arrogant and has the potential to communicate the wrong message to the patient,

Medical Ethics -vs- Medical Behavior

When a judge hears a case, neither party is 100% correct.  Each litigant may have a meritorious claim, but one of them will be found to have the better argument. If the dispute could be easily and amicably resolved, or one party was clearly wrong, then the matter would be unlikely to have reached a courtroom.  One litigant may be found to be 'more right' than the other Which litigant's right will prevail? Medical ethics has a similar construct.  Rarely, is an issue clearly and easily decided.  For example, with limited financial resources, tough decisions must be made on how to ethically allocate these funds.  Those who will not receive any funds may still have an ethical right to receive them, yet other groups may have a stronger right.  If our society decides that it will not pay for dialysis in moribund individuals, it does not mean that these individuals have no right to this treatment. These complex decisions create winners and losers.  Those who are ru