MD Whistleblower

Ask most of us if we are honest and we will likely respond in the affirmative.   Who among us wants to admit publicly that we are a cheat or a liar? It would be more accurate to describe ourselves as mostly honest, since there are occasions when we do some fact massaging and truth shading.   And, sometimes, applying a little spin may be the better choice. Consider this hypothetical. Your mom has been working all afternoon to prepare meatloaf as a birthday treat for you.   While it appears appetizing with its golden-brown appearance, it is simply not palatable.   Your mom asks you directly how it is.    Choose among the following potential responses. Mom, did you mix in some dog food in by mistake? Hey, are you trying to poison me? I like the ground glass.  It give the meat a great crunch. Mom, this is great!  I hope there will be leftovers for tomorrow, if I can wait that long! 'Mom, the meatloaf was....indescribable!' While I do believe in the e

Is gluten really Public Enemy #1?   Many seem to regard it as a toxin. .   Restaurants and supermarkets offer a wide variety of gluten-free foods.   Years ago, physicians advised a gluten-free diet only for individuals who had celiac disease (CD), which is an autoimmune disease that largely affects the small intestine.    If a celiac patient wades back into Glutenland, his or her intestine will start an internal uprising.   I care for a few of these folks, but they are but a slim fraction of my patients who are shunning gluten.    Gluten are proteins contained in wheat and other grains.     Many adherents of a gluten-free diet believe that this is a more healthful dietary choice.   For most of them, there is no supportive evidence for this contention.    Why should it matter if an individual chooses to avoid gluten?   After all, there’s no risk here?   In fact, avoiding gluten can lead to vitamin deficiencies and increased exposure to arsenic and mercury.   I’m not suggesting that

You might think that gastroenterologists like me are conversant with food allergies.   You would be wrong.   Here is a second misunderstanding you likely harbor.   Most individuals who believe or suspect that they are suffering from a food allergy have no allergic condition at all.   A true allergic reaction involves the firing off of one’s immune system in response to an external stimulant resulting in a rash, wheezing and other characteristic allergic responses.   Poison ivy, for example, is an allergic reaction.   Nausea resulting from an antibiotic is not an allergic reaction.   Physicians, of course, appreciate this distinction.   This is why when you tell us you are ‘allergic’ to a medication, we will ask you specifically what the reaction was.   In my experience, most of these ‘allergic reactions’ are routine non-allergic side effects.   Often enough, a patient will claim to have a penicillin allergy, for example, but has no clue what the reaction might have been.  

There are many forces driving utilization in health care.  Patients come to doctors for explanations and relief. They relate symptoms that will likely lead to diagnostic testing.  For example, if you tell your physician that you have a burning sensation when you urinate, it is likely that you will be asked to surrender an aliquot of your urine for analysis.  If you enter your doctor’s office with some difficulty breathing, fever and a cough, I’ll wager that there’s a chest x-ray just around the corner.  These diagnostic tests are appropriate. When does utilization morph into overutilization?   I don’t know where the threshold between them lies.   Moreover, doctors disagree amongst ourselves on what constitutes an unnecessary medical test. Doctors agree that there is too much testing and prescribing going on, but they tend to point their fingers toward their colleagues rather than toward themselves.   Think of politicians here.   It’s common for a congressman to criticize another cong