MD Whistleblower

As readers know, the unifying theme of this blog is medical quality.  Indeed, the role of a whistleblower should be to raise the performance level of a profession or organization.  One need only scan this blog's category list for evidence of the blog's purpose.  Feel free to sample a post or two. The medical procedure that is fundamental to the practice of gastroenterology is colonoscopy.  I have performed north of 50,000 of these procedures on some very lucky inhabitants of northeast Ohio.  This will be my professional legacy, not quite a true gift to humanity such as music, art or literature.  I’ve been in practice long enough that there are patients whom I’ve performed more than 10 colonoscopies on.  Patients prefer to remain with a doctor whom they are comfortable with.  Long term relationships with patients is one of the joys of medicine. I also routinely perform colonoscopies on patients whom I have not met previously.  They are ref...

Over the years, I have treated various medical professionals from physicians to nurses to veterinarians to optometrists and to occasional medical residents in training. Are these folks different from other patients?  Are there specific challenges treating folks who have a deep knowledge of the medical profession?   Are their unique risks to be wary of when the patient is a medical professional? First, it’s still a running joke in the profession that if a medical student develops an ordinary symptom, then he worries that he has a horrible disease.  This is because the student’s experience in the hospital and the required reading are predominantly devoted to serious illnesses.  So, if the student develops some constipation, for example, he may fear that he has a bowel blockage, similar to one of his patients on the ward.. More experienced medical professionals may also bring above average anxiety to the office visit.  Physicians, after all, are members of...

Last week, I presented the U.S Services Task Force’s (USPSTF)recent revision on its mammography guideline.  I agreed with the assertion that lives will be saved.  There is a little more to the story.  When a task force or an organization is devising a preventive medicine guideline, lives are not the only consideration.   First, mammography is a screening test – an exam performed on an individual without symptoms to prevent illness.   For clarification, a mammogram, unlike screening colonoscopies, is not designed to prevent cancer.   The objective is to detect breast cancer at an early phase which should result in a more favorable prognosis. Whenever a screening test’s target population is widened, as just occurred with USPSTF’s mammography revision, more lives will be saved.  For example, if we started performing screening colonoscopies at age 30, of course we would save lives since colon cancer can arise in folks in their 30’s.  However, what...

Recently, the U.S. Preventive Services Task Force (USPSTF) issued a groundbreaking draft revision of its screening mammography guideline for women at average risk of developing breast cancer.  The new guideline advises women to undergo screening mammography every other year starting at age 40, ten years earlier than it previously recommended – a major modification.  This will be a two-part blog post. If you find this post of interest, I encourage you to return next week when I will share some ‘inside baseball’ on   mammography and medical guidelines. The USPSTF issues an array of preventive health advisories which it revises periodically.   I have always admired the task force’s measured and conservative recommendations, which reside within the boundaries of medical data and evidence.   The task force is comprised of experts who strive for objectivity, even though none of us are entirely immune to external influences.   They are a sober voice of reason ...