MD Whistleblower

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. Some time ago, I performed an upper endoscopy, or EGD, on a patient who had a family history of Barrett’s esophagus (BE).  In this condition, the esophagus has developed a new internal lining which is readily apparent when examined with a scope.  These patients are followed periodically because of an increased risk of developing cancer, which fortunately is a rare event in this condition.  I discovered reflux esophagitis at the lower portion of her esophagus. Curiously, she had no heartburn or other symptoms of reflux.   I did not identify BE and the biopsy results were benign.    One of the mysteries of gastroenterology is that at times we discover fairly i...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. Where have all the ulcers gone?   Peptic ulcers are very common lesions in the stomach and the first portion of the small intestine called the duodenum.  Why, then, do I – a gastroenterologist - rarely discover them in my patients?  The answer is twofold.  First, my gastroenterology practice is now limited to outpatients exclusively.   It’s been years since I’ve done hospital rounds.   Back in those days, one the most common reasons I was called in to consult on a hospitalized patient was to evaluate internal bleeding.   I saw hundreds of these patients and many of them had ulcers responsible for the bleeding.   As an aside, most folks commonl...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. Gastroenterologists see patients with digestive symptoms.  We also see patients who are suffering from all manners of stress and anxiety.  It can be vexing to determine if there is a causative relationship between both sets of symptoms. It’s a chicken and egg phenomenon.   Do the stomach aches cause the stress or is it the other way around? Even seasoned practitioners may find it difficult to unravel this conundrum.   And so do our patients.   Why does my stomach hurt? First, it’s true that physical complaints may have no connection to psychological distress.   I think that medical professionals at times impute a psychological basis for physical complain...