MD Whistleblower

There are two ways to sedate patients for colonoscopy.  There is conscious sedation is when the gastroenterologist administers a ‘twilight sedation’, or moderate sedation when sedation is administered by an anesthesia professional, usually with propofol, a drug now known to most of us as  a contributor to the death of pop superstar Michael Jackson. Most Patients Prefer Propofol over the Twilight Zone Leaving issues of cost aside, most individuals involved in the colonoscopy experience prefers the propofol option.  Here’s why. The drug is extremely safe when administered by trained personnel, who in most cases are Certified Registered Nurse Anesthetists (CRNAs). Unlike with twilight anesthesia, the procedure is entirely painless.  Patients can expect to experience the same level of discomfort as they do with a haircut. Knowing that they face complete comfort during the procedure, patients are relieved of anxiety that often precedes the proce...

My great pal Lewis, with whom I have shared a friendship for over half a century, have much in common professionally.   Is he also a gastroenterologist?    A physician?   A nurse?   Actually, he is a tax attorney.   So, where’s the commonality?   Could it be that my patients and his adversaries both feel that they are being ‘instrumented’?    While I suspect that this may be true, it is a different aspect of our respective professions that binds us. Lewis’s clients and my patients need to grapple with and accept uncertainty.   I find the parallels here to be striking and I’ll do my best to illustrate. Legal Uncertainty The client brings an issue to his attorney seeking a legal remedy or an opinion.    Let us assume a corporation wants to know if a particular expense can be legally considered a tax deduction.   The experienced tax attorney responds, after careful thought and deliberation (yes, the time...

There are two ways to raise the quality level.  The old-fashioned way to work and study and practice and seek assistance and practice again and fail and regroup and ultimately objectively increase performance. Here are a few examples of this technique. A basketball player works with a coach and increases his foul shot success rate by 15%. A new medicine increases the cure rate of a disease by 40%. An engineering team invents a cell phone battery that has 5x the storage of current batteries. There is another way to increase quality ratings that has become quite common.  Lower the standards or game the system.  Here are some examples to illustrate. Lower academic standards in order to increase a high school's can graduation rate. Lower the income threshold of poverty so we can boast that there are fewer impoverished people in our communities. A surgeon's outcome stats rise markedly when he declines to accept very ill patients. So, if you are trying to improv...

Why are millions of Americans actively seeking out complementary medicine?   The lack of robust supportive evidence for many of these treatments has not diminished their appeal.   Indeed, demand for them is higher than ever and I anticipate continued growth.   Here in Ohio, the legislature has sanctioned medical marijuana for nearly 2 dozen maladies in the absence of persuasive and sound scientific evidence of efficacy.   For my rant on this, I will refer you to a prior post and I would welcome your response. Why then do intelligent and informed patients seek out alternative medical treatments that are unproven and are unlikely to be covered by their insurance companies?    In most cases, they do so because conventional medicine has failed and frustrated them.   Every medical specialist and general physician sees patients with recalcitrant medical issues that defy diagnosis and successful treatment.   Is it any wonder why such patients would ...