MD Whistleblower

I review several dozen medication lists each week.  I do so in my office visits as well as prior to performing procedures.  This routine task is not always as easy it seems.  One would think that this would be a breeze in the era of the electronic medical record (EMR). But it’s not.  On a regular basis there are inaccuracies.  There may be medicines listed that the patient is no longer taking.  More challenging, there may be medicines being taken that do not appear on the list.  Many patients are on more than 10 medicines.  Medication dosages often change and I often have to hope that the recorded dosages are accurate.  And, as every physician knows, patients are often unaware of the purpose or doses of some of their medicines. I regularly query patients if they are taking a particular medicine on the list and often they simply do not know. The medical profession has made progress is closing these gaps.   For example, when patients a...

It can be daunting to keep track of new drugs, particularly if the doctor is not prescribing them regularly. During my medical training, I generally was familiar with all of the medicines that patients were taking.  Not so anymore.  Now, it is more likely than not that when I review medication lists, that some of the drugs are unknown to me.  I do my best to remain current in my own specialty – itself a challenge.  I am no longer well versed in the medicines used to treat diabetes, heart conditions and various autoimmune diseases, among others conditions. Medical illnesses that formerly were managed with just a medicine or two now have many more options.   And the medication lists keep growing.   I wonder at times if some of these new pharmaceutical additions truly add a material advantage over existing options.   For instance, there is an array of effective heartburn medicines that I believe are largely equivalent to each other with respect to safet...

After a few decades of medical practice, I am increasingly humbled by how much I do not know.  In some ways, I felt more confident just after completing my training in internal medicine and gastroenterology (GI) than I do now.  While some aspects of the profession have remained unchanged, such as the value of taking an accurate medical history from patients, other aspects of medicine have morphed into a more expansive and complex landscape.  Compared to yesteryear, the array of diagnostic tests and medications has truly exploded.  It has been a great challenge to remain current in my own specialty of GI, particularly since I am a GI generalist who has seen a very broad range of digestive conditions.   Nowadays, there are more and more drugs to become familiar with and more complex disease monitoring and treatment strategies to know.   It is incumbent on those who advocate a new treatment to demonstrate that actual human patients will benefit.   While...