tag:blogger.com,1999:blog-73236921225142814552024-03-19T04:47:52.193-04:00MD WhistleblowerMD Whistleblower presents vignettes and commentaries on the medical profession. We peek 'behind the medical curtain' and deliver candor and controversy in every post.Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.comBlogger799125tag:blogger.com,1999:blog-7323692122514281455.post-31452428369351799452024-03-17T06:00:00.013-04:002024-03-18T11:08:54.221-04:00Artificial Intelligence in Medicine - Caveat Doctor!<p>Artificial intelligence (AI) has arrived and will permeate
every aspect of our society. It will
touch all of us in our work, in the arts, in entertainment, in our government, and in our culture. As with all
technology, it will deliver us both blessings and curses. We have been sharply warned of its potential
destructive capability even by advocates of this technology. Will governments, industry, and the public
agree on proper guardrails and restraint or will the tiger simply be let out of
the cage? I worry that the strategy will be
<i>Ready! Fire! Aim!</i>, instead of adopting thoughtful and prudent measures to keep
us safe. Indeed, I’ve offered some sober
thoughts on this issue to my readers in a <a href="https://mdwhistleblower.blogspot.com/2024/01/the-risks-of-artificial-intelligence.html" target="_blank">prior post</a>.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">My medical journals are now riddled with studies on various medical
uses of AI portending an unimaginable future in the medical profession.<o:p></o:p></p>
<p class="MsoNormal">A few paragraphs further down in this post, I will ask my readers a philosophical question regarding AI and
I invite a dialogue.<span style="mso-spacerun: yes;"> </span>Until
recently, we have valued work and accomplishments by our own hands.<span style="mso-spacerun: yes;"> </span>The expressions ‘self-made man’ or ‘rags to
riches’ typifies the value of achievement through one’s own work without the
advantages of wealth or connections.<span style="mso-spacerun: yes;"> </span>Indeed,
when one achieves because of external or unearned advantages, many of us view the accomplishment differently.<span style="mso-spacerun: yes;">
</span>Such an advantaged individual was in effect ‘born on 3<sup>rd</sup> base.’<o:p></o:p></p>
<p class="MsoNormal">Sooner than we think, AI will be able to write books,
compose music, create culinary masterpieces, diagnose illnesses, design
clothing, and operate motor vehicles – better than we
humans can.<span style="mso-spacerun: yes;"> </span>Who knows?<span style="mso-spacerun: yes;"> </span>Perhaps, AI will also be raising our
children, administering counseling and therapy, and entertaining us with faux
human comedians and actors!<span style="mso-spacerun: yes;"> </span>Fasten your
seatbelts.<span style="mso-spacerun: yes;"> </span>Turbulence is ahead.<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiM8JTcrkzgrQtyVxfCGuUHeeaGkR5XXXqazM0Njrj4hmuPgBnMdaSDKuVQhyphenhyphenngmUW_x8S73ZRGVmYARfsmXlmZ7WC-tyVoXIXtjCRDQgXYfaUfqxGdbIi3g7edlfbJZwtxvVF93Yhudr0YlvTyY1qJr0Eq1bBBPdbzhBSKjp0ivm6YAdAC-6uuKrgEfQGm/s674/Moritz_von_Schwind_Schubertiade.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="406" data-original-width="674" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiM8JTcrkzgrQtyVxfCGuUHeeaGkR5XXXqazM0Njrj4hmuPgBnMdaSDKuVQhyphenhyphenngmUW_x8S73ZRGVmYARfsmXlmZ7WC-tyVoXIXtjCRDQgXYfaUfqxGdbIi3g7edlfbJZwtxvVF93Yhudr0YlvTyY1qJr0Eq1bBBPdbzhBSKjp0ivm6YAdAC-6uuKrgEfQGm/s320/Moritz_von_Schwind_Schubertiade.jpg" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><i>Franz Schubert at the keyboard.</i></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><i>What if AI can make better music than we can?</i></div>
<p class="MsoNormal">So, here’s the question for my readers to ponder.<span style="mso-spacerun: yes;"> </span>If AI can write an
essay, for example, much better than a person can, why should any of us struggle
to craft one?<span style="mso-spacerun: yes;"> </span>If we can’t rival the
literary outcome of AI, why should we struggle to create an inferior
product?<span style="mso-spacerun: yes;"> </span>Keep in mind that this query is
from a blogger who has personally crafted every post on this blog which comprises
over 800 essays.<span style="mso-spacerun: yes;"> </span>Would my readers be
better served if AI created more interesting and engaging posts? You could craft similar examples of AI vs Humans concerning art, painting, acting, architecture, design, the culinary arts, and hundreds more. What is our response and purpose if machines can do everything better than we can?<o:p></o:p></p>
<p class="MsoNormal">What do you think?<span style="mso-spacerun: yes;"> </span>I
look forward to your responses which I trust will be your own work.<o:p></o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com1tag:blogger.com,1999:blog-7323692122514281455.post-76036349657051430122024-03-10T06:00:00.002-04:002024-03-18T11:15:26.612-04:00Do I Have a Rare Disease?<p> There’s an adage known to every medical student, intern,
resident, and practicing physician.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal" style="text-align: center;"><span style="background: white; color: #444444; font-family: Montserrat;"><i><b>When you hear hoofbeats behind you, don't expect to see a
zebra.</b></i></span></p>
<p class="MsoNormal"><span style="background: white; color: #444444; font-family: Montserrat;">This quote has been paraphrased into several iterations, but
the quote is credited to Dr. Thomas Woodward in 1940.<span style="mso-spacerun: yes;"> </span>Dr. Woodward, a wise medical professor and
Nobel Prize nominee, offered his advice to medical interns.<span style="mso-spacerun: yes;"> </span>The aphorism has timeless value.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="background: white; color: #444444; font-family: Montserrat;">The point is for physicians to exhaust common explanations
when confronting medical clues before broadening the exercise to contemplate
rare potential diagnoses.<span style="mso-spacerun: yes;"> </span>It is more
likely that hoofbeats are made by a common horse than a more exotic hoofed
beast.<span style="mso-spacerun: yes;"> </span>Get it?<o:p></o:p></span></p>
<p class="MsoNormal"><span style="background: white; color: #444444; font-family: Montserrat;">Let me offer a brilliant quote.<span style="mso-spacerun: yes;"> </span>Common things occur commonly.<span style="mso-spacerun: yes;"> </span>If a patient sees his physician to evaluate a
fever, it’s unlikely that the doctor will entertain malaria as a diagnostic
consideration, even though fever is a hallmark of malaria.<span style="mso-spacerun: yes;"> </span>Seasoned clinicians will widen their
diagnostic view when persistent symptoms defy explanation.<span style="mso-spacerun: yes;"> </span>While any diagnosis is possible, rare things
occur rarely.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></p><p class="MsoNormal"><span style="background: white; color: #444444; font-family: Montserrat;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixPkTFscWmMcqlnav1iysS5n7HhRZwxGWRn4Y4ThLpnqomrRSl9Kf1DRutJR3dTw1cFsEZ3lvgpt1ru8236aJmGtv6KJeo4o9aVttvUfU-kTqzqq7qvOMzVPjOpWIvVWwq2ro08l2_TQCLbrI4Jx0UVzPPQDW5aCYKsrfmSa1BWRoV4l0goGdrkmCh9HHF/s640/IMG_3353.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="480" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixPkTFscWmMcqlnav1iysS5n7HhRZwxGWRn4Y4ThLpnqomrRSl9Kf1DRutJR3dTw1cFsEZ3lvgpt1ru8236aJmGtv6KJeo4o9aVttvUfU-kTqzqq7qvOMzVPjOpWIvVWwq2ro08l2_TQCLbrI4Jx0UVzPPQDW5aCYKsrfmSa1BWRoV4l0goGdrkmCh9HHF/s320/IMG_3353.jpg" width="240" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><i>Hoofbeats? Must be those zebras again!</i></div><span style="mso-spacerun: yes;"><br /></span><p></p>
<p class="MsoNormal"><span style="background: white; color: #444444; font-family: Montserrat;">There are two circumstances when zebras are given undue consideration.<span style="mso-spacerun: yes;"> </span>It is often
invoked by young physicians, particularly during their training years.<span style="mso-spacerun: yes;"> </span>These professionals haven’t accumulated
sufficient experience to have a deep data bank of common medical
maladies.<span style="mso-spacerun: yes;"> </span>And since they are in teaching
or academic programs, the patients they see may be skewed since many patients
with unexplained symptoms are referred there to crack the puzzling cases.<span style="mso-spacerun: yes;"> </span>So, a ‘rare’ diagnosis may occur more commonly
in a medical training program.<span style="mso-spacerun: yes;"> </span>Let’s
assume an intern in the hospital is caring for 2 patients with joint pains
attributed to lupus. If this intern evaluates a patient with knee pain, she
might wonder if this patient also has lupus instead of common arthritis, based on her experience.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="background: white; color: #444444; font-family: Montserrat;">The other scenario where zebras are considered is by patients themselves offering their physicians diagnostic advice. Every doctor has had multiple instances of
patients suggesting very rare diagnoses responsible for their unexplained illnesses. Try googling for illnesses responsible for fatigue, abdominal pain, nausea, dizziness, sleep disturbances and various rashes and prepare yourself for an
avalanche of diagnostic possibilities.
Naturally, a patient with unsolved symptoms might feel that he
has found a novel path to pursue. <i>Doctor, how do you know I don't have a parasite?</i> This has been a recurrent inquiry from my patients over the years.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="background: white; color: #444444; font-family: Montserrat;">I don’t have a rigid template guiding me when to let the
zebras in.<span style="mso-spacerun: yes;"> </span>This process needs to be
customized to the individual patient.<span style="mso-spacerun: yes;">
</span>Medicine is an art. Physicians, like everyone, are flawed members of
the human species.<span style="mso-spacerun: yes;"> </span>When a patient
harbors a rare condition, it may take several physicians sometime before their
diagnostic arrows hit the target. In the meantime, let common sense reign. If you hear a horn blaring outside, is it more likely to be a car or a musician playing the trumpet?<o:p></o:p></span></p>
<p class="MsoNormal"><span style="background: white; color: #444444; font-family: Montserrat;"><o:p> </o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com0tag:blogger.com,1999:blog-7323692122514281455.post-21727364793093030642024-03-03T06:00:00.017-05:002024-03-18T11:16:31.491-04:00Are Probiotics Safe and Effective?<p><span face="Calibri, sans-serif" style="background-color: white; color: #212529; font-size: 10pt;">Recently, I stated that probiotics are marketed and sold free from the strict scrutiny of Food and Drug </span><span face="Calibri, sans-serif" style="background-color: white; color: #212529; font-size: 13.3333px;">Administration</span><span face="Calibri, sans-serif" style="background-color: white; color: #212529; font-size: 10pt;"> (FDA) oversight that our prescription drugs routinely undergo. And this is just how these companies want it. Trust me, if probiotics had to endure the same vetting process that actual drugs go through, most of them would be snuffed out along the way.</span></p><p><span face="Calibri, sans-serif" style="background-color: white; color: #212529; font-size: 10pt;">Here’s a simplified glimpse of how the system works.</span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiXbk3v7G0XIj9hTsgtip-THU6C9-OVTb99rNHX9dBjJ4xywUtyOicNI1-0WBb-Jw7wrM75AzL4M2CXifdKstbQmvHAvVFG88A7J1BfL_lMhOCs4My4oKcTcMls4XG1hcqPyHVs8pKF9OEskb21NXG7zBMY9o0szaPQdgl0vX3HI3M7xb8MoFfwnaGxYg=s768" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="317" data-original-width="768" height="93" src="https://blogger.googleusercontent.com/img/a/AVvXsEiXbk3v7G0XIj9hTsgtip-THU6C9-OVTb99rNHX9dBjJ4xywUtyOicNI1-0WBb-Jw7wrM75AzL4M2CXifdKstbQmvHAvVFG88A7J1BfL_lMhOCs4My4oKcTcMls4XG1hcqPyHVs8pKF9OEskb21NXG7zBMY9o0szaPQdgl0vX3HI3M7xb8MoFfwnaGxYg=w225-h93" width="225" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><b><i>Yo ho, hey hey, keep away from the FDA!</i></b></div><span face="Calibri, sans-serif" style="background-color: white; color: #212529; font-size: 10pt;"><br /></span><p></p>
<p style="background: white; margin-top: 0in;"><span face=""Calibri",sans-serif" style="color: #212529; font-size: 10pt;">Many probiotics are classified
by the FDA as dietary supplements, rather than drugs.<span style="mso-spacerun: yes;"> Indeed, it is this classification that allows the industry to thrive. </span>The FDA regulates supplements
much more leniently than they do conventional prescription drugs that must
endure years of intensive vetting and successive clinical trials.<span style="mso-spacerun: yes;"> The drug approval process is so rigorous that most drug candidates will not reach the finish line. The FDA maintains high standards for safety and efficacy. However, b</span>ecause probiotics are not drugs, they do not
need to establish that they are effective.<span style="mso-spacerun: yes;">
</span>This is why when you see or hear them advertised, there is always the
disclaimer that the supplement <i>is not intended to diagnose, treat, cure or prevent
any disease</i>.<span style="mso-spacerun: yes;"> </span>Yet, the ads use coded
language that strongly suggests that these supplements do in fact treat diseases.<span style="mso-spacerun: yes;"> </span>Phrases such as ‘good for bone health’ or is
‘good for digestion’ or 'improves memory and recall', sound to most of us like they are actual treatments for these diseases. <o:p></o:p></span></p>
<p style="background: white; margin-top: 0in;"><span face=""Calibri",sans-serif" style="color: #212529; font-size: 10pt;">And this regulatory system for
supplements is their Holy Grail.<span style="mso-spacerun: yes;"> </span>They
are making billions of dollars selling zillions of bacteria without ever having
to prove that they actually work.<span style="mso-spacerun: yes;"> Not a bad business model, eh?</span><o:p></o:p></span></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com0tag:blogger.com,1999:blog-7323692122514281455.post-44893619094403174092024-02-25T06:00:00.005-05:002024-03-18T11:19:06.270-04:00Should Insurance Companies Pay for Off-Label Drugs?<p>Usually, we doctors give you advice. In this case, I’d like readers to offer an
opinion on an issue that patients and I face regularly.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">First, let’s acknowledge the huge reservoir of frustration
and anger directed against insurance companies concerning their coverage
decisions.<span style="mso-spacerun: yes;"> </span>I have willingly entered this
arena to wage battles for patients.<span style="mso-spacerun: yes;"> </span>Despite
my vigorous prosecutions of these contests, the outcomes have been
variable.<span style="mso-spacerun: yes;"> </span>Indeed, these competitions are
not for the causal physician participant.<span style="mso-spacerun: yes;">
</span>The doctor must have the mettle, determination, skill and endurance of a
Navy SEAL if there is to be any prospect of success. <o:p></o:p></p>
<p class="MsoNormal">Some of my prior duels against Big Pharma and Big Insurance
are chronicled in the Pharmaceutical Quality category on this blog.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Considering many insurance company coverage actions and decisions,
it is understandable that patients do not believe that these companies
prioritize the health of their members.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Although it is understandable to demonize this industry,
insurance companies are businesses, not charitable organizations.<span style="mso-spacerun: yes;"> </span>While they deserve opprobrium for many of
their practices, they are not always in the wrong.<span style="mso-spacerun: yes;"> </span>We cannot expect them to pay for every
medical treatment that we doctors recommend.<span style="mso-spacerun: yes;">
</span><o:p></o:p></p>
<p class="MsoNormal">For example, should insurance companies be required to cover
medicines that are prescribed off-label?<span style="mso-spacerun: yes;">
</span>Every prescription drug has been approved by the <a href="https://www.fda.gov/">Food and Drug Administration</a> (FDA) only for certain specific conditions.<span style="mso-spacerun: yes;"> </span>For example, gastroenterologists see many
patients with nausea.<span style="mso-spacerun: yes;"> </span>We commonly
prescribe Zofran (ondansetron), an effective anti-nausea medicine.<span style="mso-spacerun: yes;"> </span>The FDA has approved this medicine for nausea
resulting from chemotherapy, surgery, and radiation treatment.<span style="mso-spacerun: yes;"> </span>Most of the patients for whom I prescribe
ondansetron fall outside of this FDA list of indications.<span style="mso-spacerun: yes;"> </span>I am prescribing the medicine off-label,
albeit for the same symptom of nausea.<span style="mso-spacerun: yes;">
</span>In this instance, insurance companies have generally covered the drug.<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwsgP1zX5H7amKV-Zx9V7ZqdTO0t4wBJKMNym0JIP2DNCo7xqaYrAIJkwCfcwtf_GTpdi8VIWmPSgyPfN86nSrhUphFiQdhoPMrayteTbvET8ejmxN-IXRN_D7k4IuzYAB71geP8PBYpUSCI3qmBt-O2TlHlHJ3XJeMQjgiKN-3_yrkhjg5tvm0XxzhQ/s185/images.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="123" data-original-width="185" height="123" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwsgP1zX5H7amKV-Zx9V7ZqdTO0t4wBJKMNym0JIP2DNCo7xqaYrAIJkwCfcwtf_GTpdi8VIWmPSgyPfN86nSrhUphFiQdhoPMrayteTbvET8ejmxN-IXRN_D7k4IuzYAB71geP8PBYpUSCI3qmBt-O2TlHlHJ3XJeMQjgiKN-3_yrkhjg5tvm0XxzhQ/s1600/images.png" width="185" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><i>Should off-label prescriptions be covered?</i></div><div class="separator" style="clear: both; text-align: center;"><i><br /></i></div>
<p class="MsoNormal">There are other instances where the off-label use is for an
entirely different purpose.<span style="mso-spacerun: yes;"> </span>For
instance, gastroenterologists commonly prescribe a drug that is FDA-approved
to lower cholesterol to patients with certain types of diarrhea.<span style="mso-spacerun: yes;"> </span>Often, insurance companies will not cover
this off-label use for a medical complaint entirely distinct from the drug’s
approved role, even though this off-label use is considered to be routine use.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">These can be difficult issues that may have a medical-ethical dimension. We have all heard of agonizing situations when an insurance
company declines to pay for an experimental medicine for a patient who is
desperate to receive it.<span style="mso-spacerun: yes;"> </span>And to make it
more complex, there may be a dispute within the medical community if the
treatment is experimental or is actually an established treatment.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Should a drug that is effective for a medical condition but
is not FDA-approved for it be covered by insurance companies?<span style="mso-spacerun: yes;"> </span>If so, would we all be willing to pay much
higher premiums to accommodate this greatly expanded list of off-label
treatments?<o:p></o:p></p>
<p class="MsoNormal">What do readers think about all of this?<span style="mso-spacerun: yes;"> </span>Should any drug prescribed by your doctor be
covered?<span style="mso-spacerun: yes;"> </span>If not, when are insurance
companies justified to refuse?<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com2tag:blogger.com,1999:blog-7323692122514281455.post-68406893250067820202024-02-18T06:00:00.006-05:002024-03-18T11:20:23.737-04:00How to Choose the Right Surgeon<div class="MsoNormal">
Let me test my readers to gauge how skillful you have become in choosing wisely in the Byzantine medical universe. You develop abdominal pain and, although you
are not a trained medical professional, you fear that you have appendicitis. There are two surgeons available and you want
to engage in due diligence to ascertain which physician should be granted
access to your abdomen. A quick
internet search uncovers the following data.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Surgeon A: Twenty
patients had proven appendicitis. This
surgeon operated on all of the patients. No
case of appendicitis was missed. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Surgeon B: Twenty patients had proven appendicitis. This surgeon chose to operate on 18
patients. Two cases of appendicitis were
missed. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Before reading on, think to yourself which surgeon would you
choose?<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
While this is not a trick question, I wonder how many
readers were entrapped to select Surgeon A.
Who wouldn’t choose a surgeon with a 100% track record? I wouldn’t.
I’d place my belly under the care of Surgeon B. I’ll explain why.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://4.bp.blogspot.com/-jhPKsm2GDMI/WCDBSbwmvSI/AAAAAAAACNg/NDJWyNH9a5MNnzvflgJcZ5fN3pTY_13swCLcB/s1600/800px-Various_scalpels.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://4.bp.blogspot.com/-jhPKsm2GDMI/WCDBSbwmvSI/AAAAAAAACNg/NDJWyNH9a5MNnzvflgJcZ5fN3pTY_13swCLcB/s320/800px-Various_scalpels.png" width="164" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: x-small;">The question is not how to use these instruments, but when.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
While I have been truthful here, I haven’t divulged the
whole truth, and many readers may not have thought to ask for critical
additional information. If a surgeon has
what sounds like a perfect record of never missing a case of appendicitis, then
something is wrong, because no surgeon can achieve this result. Physicians, as members of the human species,
are just not that good. In addition,
some cases of appendicitis are not typical and won’t be recognized as
appendicitis even by seasoned doctors. It
is understandable that in such a case, a surgeon may elect to keep his or her scalpel
securely holstered. </div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The question that patients need to ask is how often the
surgeon operated for suspected appendicitis, but no appendicitis was found. Follow along with me here. Assume that Surgeon A sees 100 patients with
abdominal pain, but only 20 of them have appendicitis. The other 80 have simple stomach aches and do
not need surgery. Surgeon A takes all
100 patients to the operating room and removes every appendix. He can truthfully state that he didn’t miss a
single case of appendicitis, but he has operated on far too many patients who
did not need surgery. His ‘perfect
record’ is the result of over-operating. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Surgeon B who sees the same 100 patients might decide to operate on 21
patients, 18 of whom had true appendicitis and 3 of whom did not have the
condition. He doesn’t have a ‘perfect
record’ since he missed two cases of appendicitis, but clearly, he is the
superior surgeon. The vast majority of
Surgeon A’s patients who went under his knife didn’t need to be there. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A surgeon who operates on every patient will never miss a
case. While his surgical technique might
be exemplary, his medical judgment is in critical condition.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Avoid being seduced by medical statistics that promise perfection. This caveat is especially true now that
physicians and hospitals are rated on the internet. The stats you read might be true, but they may not be the whole story. <o:p></o:p></div>
<br />
<div class="MsoNormal">
<br /></div>
Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com0tag:blogger.com,1999:blog-7323692122514281455.post-35372599595331318072024-02-11T06:00:00.003-05:002024-03-18T11:22:20.863-04:00Will Private Equity Buy Your Hospital?<p>Advertisers are masters at knowing how certain words and
phrases will affect us. Consider some of
the seemingly innocent words and phrases below and how they have an emotional impact.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><i>IRS<o:p></o:p></i></p>
<p class="MsoNormal"><i>Big Tech<o:p></o:p></i></p>
<p class="MsoNormal"><i>Police officers<o:p></o:p></i></p>
<p class="MsoNormal"><i>Corporate profits<o:p></o:p></i></p>
<p class="MsoNormal"><i>Millennials<o:p></o:p></i></p>
<p class="MsoNormal"><i>Congress<o:p></o:p></i></p>
<p class="MsoNormal"><i>The Nursing Profession.</i><o:p></o:p></p>
<p class="MsoNormal">Over time we have been conditioned to experience emotional
responses to various phrases and labels.<span style="mso-spacerun: yes;">
</span>For instance, there is nothing intrinsically evil in businesses earning
money since this is an expected and desirable outcome.<span style="mso-spacerun: yes;"> </span>Yet, ask us to react to the term
<i>corporate profits</i> and I suspect that most of our reactions would trend
negatively.<span style="mso-spacerun: yes;"> </span>It’s unlikely that a
political candidate would proclaim in an ad or a speech that he or she wants
to be a <i>Champion of Corporate Profits!</i><o:p></o:p></p>
<p class="MsoNormal">Private Equity certainly merits inclusion in the above list.<span style="mso-spacerun: yes;"> </span>Most folks have an unfavorable opinion of PE
even if they don’t fully understand this business model.<span style="mso-spacerun: yes;"> </span>And some of the actions committed by PE justify suspicion and outrage, but I don’t support demonizing the industry writ
large.<span style="mso-spacerun: yes;"> Bad actors are not tantamount to a bad profession. </span>Similarly, I have argued on this blog that the
<a href="https://mdwhistleblower.blogspot.com/2024/01/demonizing-big-pharma-good-politics-but.html" target="_blank">pharmaceutical industry</a>, which is routinely demonized, is a critical source
of cures and treatments that we all so desperately need.<span style="mso-spacerun: yes;"> </span>Haven’t we seen in the past few years the
consequences of demonizing our opponents and adversaries?</p>
<p class="MsoNormal">Recently, the hospital Summa Health in Akron, Ohio announced that it
will be purchased by a private equity firm. While this was big news for
northeast Ohio, it is not a unique development.<span style="mso-spacerun: yes;">
</span>Nearly 400 hospitals in the U.S. are owned by PE.<span style="mso-spacerun: yes;"> Beyond health care, a few minutes on your search engine will reveal how may familiar businesses across the country have partnered with PE.</span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7_ugEABpMiEUVeYnXfEFj5yiXBY6I3nlQXPheVG0GzrJQ8I0UMO1Fc-40FUTk9DGitU8ARyiOsaj4LhvalcU8u-r5AQ7IFd33VcWLO2w5GxJQNgyHV7mjONAixthqTqrTunGeLzNBea1X7Ka9OQMwX1Zs9R6rJSCibMZTCuo4KRbr7SLiGKhlrvD1OBVg/s804/Summa_Logo.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="464" data-original-width="804" height="185" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7_ugEABpMiEUVeYnXfEFj5yiXBY6I3nlQXPheVG0GzrJQ8I0UMO1Fc-40FUTk9DGitU8ARyiOsaj4LhvalcU8u-r5AQ7IFd33VcWLO2w5GxJQNgyHV7mjONAixthqTqrTunGeLzNBea1X7Ka9OQMwX1Zs9R6rJSCibMZTCuo4KRbr7SLiGKhlrvD1OBVg/s320/Summa_Logo.jpg" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><i><b>Under new management!</b></i></div><span style="mso-spacerun: yes;"><br /></span><p></p><p class="MsoNormal">So, is the Summa Health purchase good news?<span style="mso-spacerun: yes;"> </span>We’ll have to watch closely.<span style="mso-spacerun: yes;"> </span>We know that PE's focus on generating
profit could collide with the medical profession’s mission to
provide health care to the community.<span style="mso-spacerun: yes;">
</span>But companies are sold to PE for a reason.<span style="mso-spacerun: yes;"> </span>In general, these are companies that are at
risk and need additional capital to survive or simply aim to grow.<span style="mso-spacerun: yes;"> </span>PE provides the funds and often the
managerial expertise to accomplish these goals.<span style="mso-spacerun: yes;">
</span>They can improve efficiencies throughout the organization, introduce
higher level technology and innovation, provide economy of scale, apply best
practices in management, and yes, increase profits.</p><p class="MsoNormal">Just because investors make money doesn't make the project evil.</p><p class="MsoNormal">
If PE is so shortsighted and pursues short-term profits at the expense of
caregivers and their patients, then the venture will fail.<span style="mso-spacerun: yes;"> </span>Every hospital is being strictly scrutinized
with quality metrics that are made public.<span style="mso-spacerun: yes;"> If corners are cut, the news will soon get out. </span>I
think that when PE and the hospital’s interests are aligned, as they should
be, that success is much more likely. If PE puts profits over patients and medical professionals, then medical quality and the hospital's reputation will decline and medical professionals will run for the
exits. The hospital’s value will tank. Such actions and outcomes would banish PE from the healthcare universe and could also invite governmental regulation and oversight, which would discourage investors. <o:p></o:p></p>
<p class="MsoNormal">Realize that PE will have to make changes and some of these
may be disruptive and painful.<span style="mso-spacerun: yes;"> </span>Some
jobs will likely be lost.<span style="mso-spacerun: yes;"> </span>But hospitals or businesses are not selling to PE to maintain the status quo.<span style="mso-spacerun: yes;"> </span>They do so because they need help and there is no available remedy
internally.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></p><p class="MsoNormal"><span style="mso-spacerun: yes;">Those who distrust PE and oppose their purchase of hospitals, nursing homes, physician practices and other healthcare facilities, need to propose how they would bring financial strength and vitality to players in healthcare who can't make it on their own. My guess is that there is no obvious alternative solution that created market space for PE to exploit. </span></p>
<p class="MsoNormal"><o:p> </o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com0tag:blogger.com,1999:blog-7323692122514281455.post-48092718145725084352024-02-04T06:00:00.008-05:002024-03-18T11:25:46.751-04:00When Should Your Doctor Refer for a Second Opinion?<p>As a gastroenterologist (GI), I am regarded by primary care
physicians and other medical professional as having special expertise in
digestive diseases. Indeed, I have
highly specialized training in digestive maladies and function. I regard myself as a GI generalist, that is a practitioner who treats the full array of digestive
conditions. Over the past decades, I have
treated patients with diseases of the small and large bowel, stomach, and
esophagus issues and pancreatic liver and gallbladder disorders. And I have had a full endoscopy practice –
the tools of the GI trade. One of the
appeals of being a GI Gen is that I see a wide and diverse span of medical
conditions. In a single
week, I may address heartburn and ulcers. Crohn’s disease, hepatitis, bowel
changes, internal bleeding, nausea and vomiting, abdominal pain, and hemorrhoids.
I enjoy the variety. </p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitXrQrBr24OJPEW6YnP71CrD91VHYuvlgI2H6joqNO8uDBRovpu77C9YbeLTP_ldznIN0cnQDF7suVAowqUF2H8cEgqpdbESiFQqQRgncMF9xA2m09Y9X9rQ1d8qRdvBWeKqdLm9nTsvLmhkWlGb_iAfY8O04Nbi4wbxOk1ge355Yuo7EF25aZKA0IOA/s1130/Digestive_system_diagram_en.svg.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1130" data-original-width="800" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitXrQrBr24OJPEW6YnP71CrD91VHYuvlgI2H6joqNO8uDBRovpu77C9YbeLTP_ldznIN0cnQDF7suVAowqUF2H8cEgqpdbESiFQqQRgncMF9xA2m09Y9X9rQ1d8qRdvBWeKqdLm9nTsvLmhkWlGb_iAfY8O04Nbi4wbxOk1ge355Yuo7EF25aZKA0IOA/s320/Digestive_system_diagram_en.svg.png" width="227" /></a></div><br /><p style="text-align: center;"><i>GI Generalists Cover a Lot of Ground!</i></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">During most of my career, I seldom referred patients to
other gastroenterologists for advice.<span style="mso-spacerun: yes;"> </span>But,
whenever I needed help, I asked for it. There were instances when I
was unsure of a diagnosis or my proposed treatment was not effective.<span style="mso-spacerun: yes;"> </span>If this occurred, and I harbored doubt or concern, <span style="mso-spacerun: yes;"> </span>I arranged for another opinion.<span style="mso-spacerun: yes;"> </span>Obviously, judgment and common sense must be
relied upon in this process. <span style="mso-spacerun: yes;"> </span>If I can’t explain a
patient’s symptom that is clearly a benign issue, I may not advise another GI opinion to assess it, unless the patient requests it.<span style="mso-spacerun: yes;"> </span>General gastroenterologists see thousands of
patients each year, yet only a small fraction of them are referred out for additional GI advice.<span style="mso-spacerun: yes;"> </span>Knowing when to solicit another medical
opinion is an important and necessary skill for every medical professional.<o:p></o:p></p>
<p class="MsoNormal">I now work for an internationally renowned medical
organization that is based in Cleveland.<span style="mso-spacerun: yes;">
</span>I’ll leave it to my reader-sleuths to divine its identity.<span style="mso-spacerun: yes;"> </span>There are well over a hundred
gastroenterologists on staff.<span style="mso-spacerun: yes;"> </span>There are
scores of GI generalists like me but also superspecialist GI’s who focus on very
narrow niches within the specialty.<span style="mso-spacerun: yes;"> </span>There are
physicians who specialize in the esophagus or the pancreas or the liver, for example.<span style="mso-spacerun: yes;"> </span>There are experts in celiac disease and
gluten disorders.<span style="mso-spacerun: yes;"> </span>There are doctors
whose practices are devoted to various forms of colitis.<span style="mso-spacerun: yes;"> </span>There are also physicians who spend most of their
times performing futuristic and complex endoscopic procedures.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">How has this impacted me?<span style="mso-spacerun: yes;">
</span>The availability of superspecialist GI talent means that with every
patient I see, there are doctors on staff who are more knowledgeable and experienced
than I am in addressing the medical issue. <span style="mso-spacerun: yes;"> </span>This is a humbling realization.<span style="mso-spacerun: yes;"> </span>Should I be referring every patient to the
downtown experts changing my role from physician to a triage functionary?<span style="mso-spacerun: yes;"> </span>Of course not.<span style="mso-spacerun: yes;"> </span>In any profession or occupation, one can
perform at a high level of excellence even if there are colleagues nearby who
have stronger credentials.<span style="mso-spacerun: yes;"> </span>Imagine if we
insisted upon seeing the absolute best physician, electrician, attorney, house
painter, accountant, pet groomer, hair stylist, teacher or photographer?<span style="mso-spacerun: yes;"> The system would collapse. </span>First of all, good luck agreeing on who is, in
fact, the very best.<span style="mso-spacerun: yes;"> </span>Secondly, when we
hire a professional or a tradesman, we are seeking competence, fairness, and integrity all of which may be below the apex of the reputational pyramid.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com1tag:blogger.com,1999:blog-7323692122514281455.post-25304039364957479962024-01-28T06:00:00.004-05:002024-01-28T06:00:00.128-05:00What do Medical Consultants Do?<p>I am a gastroenterologist.
Like most medical specialists, most of the patients I see are referred
to me by other medical professionals. In
this role, I am serving as a consultant.
Similarly, when a specialist is asked to see a hospitalized patient by
the attending physician, the requested doctor will be serving in a consultant
role.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">Consultants are recruited when the medical team or an individual practitioner feels that
additional knowledge and experience is necessary.<span style="mso-spacerun: yes;"> </span>Consider three hypothetical scenarios.</p>
<p class="MsoNormal"><i>A patient has not responded to a standard course of
antibiotics.<span style="mso-spacerun: yes;"> </span>The attending physician
asks an infectious disease physician to make recommendations.<o:p></o:p></i></p>
<p class="MsoNormal"><i>A primary care physician is uncertain if the abnormal
chest x-ray is heart failure or pneumonia.<span style="mso-spacerun: yes;">
</span>The doctor calls in a cardiologist to assist.<o:p></o:p></i></p>
<p class="MsoNormal"><i>A patient with colitis comes to an emergency room with worsening diarrhea after
starting a new medicine.<span style="mso-spacerun: yes;"> </span>The ER physician is uncertain if the patient’s diarrhea is a side-effect of
medication or is a worsening of the underlying illness.<span style="mso-spacerun: yes;"> </span>A
gastroenterologist is consulted to evaluate the situation.</i></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5X_H0ifPLp34QYZCkzURaDJAWjIXT31uO-QETc8oTAcfVPgGcIJbkxsuNqupr9xzG_oYnkWhyNhNiEBg7LhlK8WxLnpArlTpf9b-TTZbSDqDsUYdon2HHoqENP3wVitsFOiNHBJ7ykezU7BkSCWbb57HVWSYy-B_4KkWo96oVQqtKOAlcz5J_NCrozA/s1024/1024px-Severerash.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="768" data-original-width="1024" height="188" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5X_H0ifPLp34QYZCkzURaDJAWjIXT31uO-QETc8oTAcfVPgGcIJbkxsuNqupr9xzG_oYnkWhyNhNiEBg7LhlK8WxLnpArlTpf9b-TTZbSDqDsUYdon2HHoqENP3wVitsFOiNHBJ7ykezU7BkSCWbb57HVWSYy-B_4KkWo96oVQqtKOAlcz5J_NCrozA/w251-h188/1024px-Severerash.jpg" width="251" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><i>Not sure what this rash is. Let's have a dermatologist consult on the case.</i></div><i><br /></i><p></p>
<p class="MsoNormal">The consultant’s role is to offer
recommendations to the patient and to the referring physician - not to take over the case which often occurs.<span style="mso-spacerun: yes;"> The consultant's role is advisory. </span>For example, a surgical consultant may advise an operation, but the patient’s doctor of many years and the patient may have good reasons to prefer a conservative approach. Obviously, there should be robust communication among the consultant, the patient and relevant members of the care team.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> In theory, t</span>he doctor in charge, not the consultant,
synthesizes the advice from one or more consultants and then makes recommendations to the patient, who has<span style="mso-spacerun: yes;"> the ultimate authority. </span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">Consultants like me prefer when our opinion is sought on a
specific medical question.<span style="mso-spacerun: yes;"> </span>Not only does this
allow us to focus more narrowly, but it also indicates that the referring
physician has given thought to the medical situation.<span style="mso-spacerun: yes;"> </span>Consider these 2 hypothetical consultation
requests.<o:p></o:p></p>
<p class="MsoNormal"><i>Please see my patient who has had repeated attacks of upper
abdominal pain with vomiting.<span style="mso-spacerun: yes;"> </span>The
symptoms persisted despite taking medication for ulcers.<span style="mso-spacerun: yes;"> </span>Labs and a CAT scan from a recent ER visit
were normal.<span style="mso-spacerun: yes;"> </span>Even though a gallbladder
test was negative, I still wonder if the gallbladder is the culprit. </i></p><p class="MsoNormal">OR</p>
<p class="MsoNormal"><i>See patient with stomach pain.</i><o:p></o:p></p>
<p class="MsoNormal">There are instances when a patient referred to me doesn’t
know the reason why.<span style="mso-spacerun: yes;"> </span>And there have been
times when the chart does not enlighten me on why a consult is being
requested.<o:p></o:p></p><p class="MsoNormal">Throughout my career, nursing home residents have been brought to my office accompanied by aides who does not know them and bring paperwork that does not specify a reason for the visit. Not medicine's finest hour.</p>
<p class="MsoNormal">In a perfect world, which is not our world, all medical
consultation requests would be sufficiently detailed.<span style="mso-spacerun: yes;"> </span>I’m not faulting my referring colleagues
for how consultations are issued.<span style="mso-spacerun: yes;"> P</span>hysicians are incredibly overworked and overstretched.<span style="mso-spacerun: yes;"> </span>And their burdens are mounting.<span style="mso-spacerun: yes;"> </span>Typical days are filled with patient
visits, phone calls, portal messages, ‘paperwork’ on the computer, refills,
covering for vacationing colleagues, worry over sick patients, adding on
patients to the schedule, seemingly endless e-mails and running behind in the
office.<span style="mso-spacerun: yes;"> Is it any wonder why their consult request communications might be abbreviated? </span></p><p class="MsoNormal"><span style="mso-spacerun: yes;">Doctors need our own consultants</span> to decompress us and stave off burn out. Does such a professional exist? <o:p></o:p></p><p class="MsoNormal"><br /></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com0tag:blogger.com,1999:blog-7323692122514281455.post-24309690909689476082024-01-21T06:00:00.008-05:002024-01-21T06:00:00.161-05:00Medical Marijauna Avoids FDA Scrutiny<p>Many of my patients are using medical or recreational
marijuana to ease symptoms that do not respond well to conventional medical
treatments. I understand this. I have
already opined <a href="https://mdwhistleblower.blogspot.com/2022/01/is-medical-marijuana-safe-and-effective.html" target="_blank">on this blog</a> that I believe that the medical evidence supporting
the safety and efficacy of medical marijuana is rather thin, very different
from the strict standards that the Food and Drug Administration (FDA) relies
upon in assessing prescription drugs and medical devices. Moreover, here in Ohio and elsewhere, our
legislature is deeply involved in determining which medical conditions are
eligible for medical marijuana treatment, a role that I believe should be
handled exclusively by medical professionals and appropriate federal government
agencies, such as the FDA. Politicians
should leave this to the professionals. How can you argue otherwise?</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">I am employed by Cleveland’s largest health care
organization which has national and international reach.<span style="mso-spacerun: yes;"> </span>The organization will not permit any
caregiver to participate in the medical marijuana program with patients.<span style="mso-spacerun: yes;"> </span>One could argue that they are denying their
patients legitimate medical care that other Ohioans routinely receive.<span style="mso-spacerun: yes;">
</span>However, they, like me, are skeptical of the safety and efficacy data as
well as the lack of uniformity in the various forms of medical marijuana and product
differences among dispensaries – all valid points.<span style="mso-spacerun: yes;"> </span>Moreover, since employee marijuana use is
prohibited by my employer, it would be inconsistent and ludicrous if I were
permitted to recommend medical marijuana to my patients but was forbidden to use it personally.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLFnYlkSqVuIb-EnrkW0jyNe-TxhPMZqj3utmo8TmBybnHSLJXbTZNRdJNvNm7ZZvPIC2mWtEmSG-gIKDENKixNAg91oqig-1_Cz4PDR_aky1Rttqr-Yhj_T9bUSJUaIoCNsbsDO_AW84Vzt_fIXvTBOjpIg_fj03zEDBCJQ54Y83R6hKUc36c8X2McLGQ/s948/800px-Food_and_Drug_Administration_201x_logo.svg.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="948" data-original-width="800" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLFnYlkSqVuIb-EnrkW0jyNe-TxhPMZqj3utmo8TmBybnHSLJXbTZNRdJNvNm7ZZvPIC2mWtEmSG-gIKDENKixNAg91oqig-1_Cz4PDR_aky1Rttqr-Yhj_T9bUSJUaIoCNsbsDO_AW84Vzt_fIXvTBOjpIg_fj03zEDBCJQ54Y83R6hKUc36c8X2McLGQ/w193-h229/800px-Food_and_Drug_Administration_201x_logo.svg.png" width="193" /></a></div><div class="separator" style="clear: both; text-align: center;"><i><br /></i></div><div class="separator" style="clear: both; text-align: center;"><i>The FDA states there is no evidence that </i></div><div class="separator" style="clear: both; text-align: center;"><i>medical marijuana </i><i>is safe and effective for any condition.</i></div><p class="MsoNormal"><br /></p>We must also recognize that marijuana purchase and use
remain illegal on the federal level.<span style="mso-spacerun: yes;"> </span>The
feds currently classify it as a Schedule 1 substance, along with heroin and
LSD.<span style="mso-spacerun: yes;"> </span>While I’m not a pharmacologist, it
does seem to me that marijuana doesn’t belong on this list.<span style="mso-spacerun: yes;"> </span>I predict that in time the feds will
legalize medical marijuana as has occurred in various states.<span style="mso-spacerun: yes;"> </span>I also predict that the medical marijuana
industry, similar to the probiotic industry, will not want to be subjected to
the FDA’s testing requirements for obvious reasons.<span style="mso-spacerun: yes;"> </span>If you really believed in your product’s
performance, and wanted to reassure and protect the public, then wouldn’t you
demand FDA oversight?<span style="mso-spacerun: yes;"> </span>What conclusion
would you draw if a manufacturer of a medical treatment or any product angled
to avoid scientific testing?<span style="mso-spacerun: yes;"> </span><p></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">My own view is that the forces that have propelled medical (and
recreational) marijuana into the marketplace are more economic than
medical.<span style="mso-spacerun: yes;"> </span>There is a fortune to be made
in this growing industry that has an expanding national market base.<span style="mso-spacerun: yes;"> </span>And, every municipality or state is hungry
for additional tax dollars.<o:p></o:p></p>
<p class="MsoNormal">So here in Ohio, my state gives me the green light to
ingest medical marijuana, my employer says no for me or my patients and the feds are lurking in the background
maintaining that marijuana use is a crime!<span style="mso-spacerun: yes;"> </span>How’s
that for consistency and clarity?<o:p></o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com1tag:blogger.com,1999:blog-7323692122514281455.post-65085092778464395872024-01-14T06:00:00.009-05:002024-01-14T06:00:00.141-05:00Demonizing Big Pharma - Good Politics but Bad Policy<p>When I was training to become a gastroenterologist decades
ago, the heartburn drug Prilosec (omeprazole) was released in the United
States. I prescribed it then to patients
who had been suffering from heartburn for most of their lives. After just days of treatment, their heartburn
disappeared. These folks couldn’t even
remember what it felt like to live without heartburn. And suddenly, they were cured with one small
pill daily. </p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">Now I know that heartburn is not exactly cancer, but this
experience very early in my career showed me the potential for a pharmaceutical
agent to improve lives.<span style="mso-spacerun: yes;"> </span>I still relay
this vignette to patients. Pharma is not the enemy.<o:p></o:p></p>
<p class="MsoNormal">Think of all of the institutions and professions that we and
our politicians demonize -<span style="mso-spacerun: yes;"> </span>lawyers, oil companies,
congress, corporate America, Big Tech and the pharmaceutical industry.<span style="mso-spacerun: yes;"> </span>Recently, Ivy League universities have been
promoted to a top ten ranking on this coveted list.<span style="mso-spacerun: yes;"> </span>On a granular level, even individuals
routinely demonize others who might harbor a different political view or have
planted the ‘wrong’ yard sign during election season.<o:p></o:p></p>
<p class="MsoNormal">I don’t fully grasp how we Americans reached this point or how we find our way
out of this labyrinth.<span style="mso-spacerun: yes;"> </span>And as I look
across the political landscape with a presidential election looming, I don’t forecast
peace in the valley anytime soon.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">The irony is that we raise our fists and foam at the mouth
against a profession until the moment that we need this profession
ourselves.<span style="mso-spacerun: yes;"> </span>For instance, we deride
attorneys as soulless agents of avarice, but when we need an attorney…<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEih1LOZ1PPVxCuOqY2jcnroogbEgUs3n5-keVJ0gkSCrcMADvUzQnIO01QOAHYO1-FygLZrdBuNssKbw-1hmhMl-LbvodbH3yb8mYuwhMC-GPrMGzKQxJTfIVQMXoBK4OKBkSygTnXdJr5LjUZDlEu4e8fxKkckKSPawYTwNBr7j7bYlPrK1ywqvNKQqAYB/s688/Backer_Judgment_(detail).jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="595" data-original-width="688" height="277" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEih1LOZ1PPVxCuOqY2jcnroogbEgUs3n5-keVJ0gkSCrcMADvUzQnIO01QOAHYO1-FygLZrdBuNssKbw-1hmhMl-LbvodbH3yb8mYuwhMC-GPrMGzKQxJTfIVQMXoBK4OKBkSygTnXdJr5LjUZDlEu4e8fxKkckKSPawYTwNBr7j7bYlPrK1ywqvNKQqAYB/s320/Backer_Judgment_(detail).jpg" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><i>Is demonization the best way to achieve progress?</i></div>
<p class="MsoNormal">A few days before penning this post the White House bragged, <i>Oh no.<span style="mso-spacerun: yes;"> </span>We’ve upset Big Pharma
again.</i><span style="mso-spacerun: yes;"><i> </i> </span>This message to the public and
voters was to convey that the government is on their side by virtue of being
against the drug companies.<span style="mso-spacerun: yes;"> </span>This might
be good politics but it doesn’t strike me as good policy.<span style="mso-spacerun: yes;"> </span>It’s fair game to criticize the drug industry
for pricing, corporate policies, attention to profits or marketing
strategies.<span style="mso-spacerun: yes;"> </span>I oppose, for instance, drug
companies flooding the airwaves with drug commercials which often follow one
another in succession.<span style="mso-spacerun: yes;"> </span>Remember, the
purpose of an ad is to sell a product.<o:p></o:p></p>
<p class="MsoNormal">Criticizing an industry or a profession is very different
from demonizing it.<span style="mso-spacerun: yes;"> </span>Why would we
demonize an industry that we all need and depend on?<span style="mso-spacerun: yes;"> </span>Aren’t we all desperate for new treatments
for cancer, dementia, arthritis, depression and autoimmune diseases?<span style="mso-spacerun: yes;"> </span>Where do you think these treatments are going
to come from?<span style="mso-spacerun: yes;"> </span>Is it good strategy to
paint these folks as enemies?<span style="mso-spacerun: yes;"> </span>I expect
such an approach from our politicians but the rest of us should know better. <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com1tag:blogger.com,1999:blog-7323692122514281455.post-54485019663313576962024-01-07T06:00:00.006-05:002024-01-07T06:00:00.128-05:00The Risks of Artificial Intelligence<p>One thing we have all learned about technology is that it
cannot be restrained. With the release
of ChatGPT and various competitors, we are aware that an unfathomable
technology will disrupt our lives in ways beyond our imagination. In the coming years 2<sup>nd</sup> and 3<sup>rd</sup>
generation AI will replace its forerunners. My guess is that this technology
will dwarf the impact that the internet has had on all of us. </p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">It will be able to create and cure and innovate and
communicate and build and teach and protect and even drive your car.<span style="mso-spacerun: yes;"> </span>As mentioned, future AI functions and
capabilities are beyond the horizon and are out of view.<o:p></o:p></p>
<p class="MsoNormal">Exciting?<span style="mso-spacerun: yes;"> </span>What if
your job would be an AI casualty?<span style="mso-spacerun: yes;"> </span>It
you drive a vehicle for a living, how will you and your family adapt when human
drivers are no longer necessary?<span style="mso-spacerun: yes;"> </span>Even
jobs and occupations that we might believe are beyond AI’s grasp, may be in the
crosshairs.<span style="mso-spacerun: yes;"> </span>AI’s reach will be
boundless.<span style="mso-spacerun: yes;"> </span>It’s tentacles will reach through
blue collar America and will penetrate deeply into the white collar professional
world.<o:p></o:p></p>
<p class="MsoNormal">Physicians 10 years ago would have denied that telemedicine
could replace office visits.<span style="mso-spacerun: yes;"> </span>Ten years
from now, AI might be able to replace a physician.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyG3Fjc65ik54u_0UPyVWlnOcQY6BNkZSHQ3d2k4v9gybuOivdmbl55G4OzUP8sJuR5qh1Wf11-joKWCOPsBJOr0e1KeRfxZOiyycncO99bRrMhAr1JhF_n13wGooIS0YP6SNPvmPIcOnJKM-IxyfsUxvixyUGNYE3wr1WgnpuQd8GK8F3y2AVMUZY8OvM/s1280/20180927-RD-LSC-0048_(44259432605).jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="853" data-original-width="1280" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyG3Fjc65ik54u_0UPyVWlnOcQY6BNkZSHQ3d2k4v9gybuOivdmbl55G4OzUP8sJuR5qh1Wf11-joKWCOPsBJOr0e1KeRfxZOiyycncO99bRrMhAr1JhF_n13wGooIS0YP6SNPvmPIcOnJKM-IxyfsUxvixyUGNYE3wr1WgnpuQd8GK8F3y2AVMUZY8OvM/s320/20180927-RD-LSC-0048_(44259432605).jpg" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><i>Telemedicine is now commonplace. </i></div><span style="mso-spacerun: yes;"><br /></span><p></p>
<p class="MsoNormal">And like any technology, there will be nefarious consequence
from individuals, businesses, nations and non-state actors who have evil
intent.<span style="mso-spacerun: yes;"> </span>Will the AI industry and the
rest of us defer AI’s general use until safeguards and codes of conduct and a
robust security infrastructure are in place? <span style="mso-spacerun: yes;"> </span>I doubt it. The time to erect safeguards is
before a new and controversial technology is released.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Suppose a business wants to prevail in the marketplace.<span style="mso-spacerun: yes;"> </span>The old fashion way is to market a superior
product or have a lower price point.<span style="mso-spacerun: yes;"> </span>The
new way may be to produce credible but false evidence smearing a competitor’s
research practices, safety operations, financial dealings or even the personal
behavior of the company’s leadership.<span style="mso-spacerun: yes;">
</span>Individuals can wield the same technique against a neighbor or a
boss.<span style="mso-spacerun: yes;"> </span>How will innocent parties be able
to defend themselves?<span style="mso-spacerun: yes;"> </span>If a videotape
clearly shows me robbing a bank, for example, what fate might befall me?<span style="mso-spacerun: yes;"> </span>What if a nation receives falsified
intelligence that an adversary is launching missiles toward it? Scary
thoughts.<span style="mso-spacerun: yes;"> </span>The destructive potential of AI would make today’s
internet hackers and ransomware practitioners seem quaint.<o:p></o:p></p>
<p class="MsoNormal">Of course, this technology needs to be regulated.<span style="mso-spacerun: yes;"> </span>As always, the challenge will be on achieving
agreement on where to draw the line.<span style="mso-spacerun: yes;">
</span>Some will regard regulations to be guardrails while others will argue that
they are handcuffs.<span style="mso-spacerun: yes;"> </span>As an ordinary
person, I’d rather have more safety and less innovation.<o:p></o:p></p>
<p class="MsoNormal">If you think that our nation and the world is in turmoil now,
do you imagine that the emergence of AI would bring us all healing and harmony? <o:p></o:p></p><p class="MsoNormal">Despite all of my misgivings, I am an AI supporter but want industry and governments to do all they can to protect us. Of course, risk can't be eliminated but it can be reduced.. And we need a global system that will enforce the rules of the road with real world consequences. But even with such a robust system, there is no guarantee of compliance. Our strategy must not be Fire! Ready! Aim! </p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com1tag:blogger.com,1999:blog-7323692122514281455.post-24284186760051469492023-12-31T06:00:00.007-05:002023-12-31T06:00:00.140-05:00Electronic Medical Records vs Physicians: Not a Fair Fight!<p>Each work day, I enter the chamber of horrors also known as
the electronic medical record (EMR).
I’ve endured several versions of this torture over the years, monstrosities that were designed more to appeal to the needs of billers and coders than physicians. Make sense? I will admit that my current EMR, called
Epic, is more physician-friendly than prior competitors, but it remains a
formidable adversary. And it’s not a
fair fight. You might be a great chess
player, but odds are that you will not vanquish a computer adversary armed with
artificial intelligence.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">I have a competitive advantage over many other physician
contestants in the battle of Man vs Machine.<span style="mso-spacerun: yes;">
</span>I can type well and can do so while maintaining eye contact with the
patient.<span style="mso-spacerun: yes;"> </span>You must think I am a magician
or a savant.<span style="mso-spacerun: yes;"> </span>While this may be true, the
birth of my advanced digital skills started decades ago.<span style="mso-spacerun: yes;"> </span>(As an aside, <i>digital </i>competence is essential
for gastroenterologists.) During college, I worked as a secretary for various
temporary agencies.<span style="mso-spacerun: yes;"> </span>Each one required a
typing test for speed and accuracy.<span style="mso-spacerun: yes;"> </span>I
plugged in my earphones and transmitted dictation into a typewritten
product on an IBM Selectric typewriter, a precursor to today’s voice-to-text technology.<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7ULk0LxhKs93d9rfSaNl17eaEKkpdRiNILe4MK4wQENmPgMfEwi0vMWtgAi7ERQUIWBwyQUn2sCw5CNGPBDrgqu3HfCInwA_delCg0NnFShRT37ZUurb0cgROldngKE2FZJxsSfP60XFeBzYlDqO3ZzuofezymUDVYIvaWvkP6icRuL6YP43I29W1yw/s640/Underwoodfive.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7ULk0LxhKs93d9rfSaNl17eaEKkpdRiNILe4MK4wQENmPgMfEwi0vMWtgAi7ERQUIWBwyQUn2sCw5CNGPBDrgqu3HfCInwA_delCg0NnFShRT37ZUurb0cgROldngKE2FZJxsSfP60XFeBzYlDqO3ZzuofezymUDVYIvaWvkP6icRuL6YP43I29W1yw/s320/Underwoodfive.jpg" width="320" /></a></div><p class="MsoNormal" style="text-align: center;"><i>Which matters more? </i></p><p class="MsoNormal" style="text-align: center;"><i>Knowing how to use a stethoscope or knowing how to type?</i></p><p class="MsoNormal" style="text-align: center;"><i><br /></i></p>
<p class="MsoNormal">I did not contemplate then that my typing skills would
become an essential medical skill.<span style="mso-spacerun: yes;">
</span>Without this ability, I would be hunched over the keyboard pecking away
with my eyes fixed on my fingers and not on the patient.<span style="mso-spacerun: yes;"> </span>Seem like a good formula for
patient-physician bonding?<span style="mso-spacerun: yes;"> </span>It
isn’t.<span style="mso-spacerun: yes;"> </span>Some physicians can work around
this with use of a scribe or using voice-to-text technology, but most of the
doctors I know do not use them.<o:p></o:p></p>
<p class="MsoNormal">If the EMR system goes down, guess what?<span style="mso-spacerun: yes;"> </span>I can’t work.<span style="mso-spacerun: yes;">
</span>If a world class physician, a medical luminary, a doctor’s doctor, can’t
use a computer, could this doctor get a job?<span style="mso-spacerun: yes;">
</span><o:p></o:p></p>
<p class="MsoNormal">EMR is a wily opponent.<span style="mso-spacerun: yes;">
</span>Just when I might think that I am gaining ground on him, I am informed
that a software upgrade is about to be implemented.<span style="mso-spacerun: yes;"> </span>Think of this as a quarterback being sacked
30 yards behind the line of scrimmage on 4<sup>th</sup> down.<span style="mso-spacerun: yes;"> </span>All you can do is punt and surrender the ball
to the other side.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com6tag:blogger.com,1999:blog-7323692122514281455.post-69419439290069508292023-12-24T06:00:00.032-05:002023-12-24T09:46:22.559-05:00Whistleblower Holiday Cheer 2023!<p style="text-align: center;"><span style="color: #1f1f1f; font-size: 12pt;"><i><b><br /></b></i></span></p><p style="text-align: center;"><span style="color: #1f1f1f; font-size: 12pt;"><a href="https://1.bp.blogspot.com/-81U9H0np-2U/YZ-gpug-e3I/AAAAAAAAEhA/A498mjI23RcyzylWGG4mBnRkAaPl_i9qQCLcBGAsYHQ/s350/350px-Jingle-Bells-Sheet-Music-chorus-SS%255B1%255D.jpg" style="font-size: medium; margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="342" data-original-width="350" height="313" src="https://1.bp.blogspot.com/-81U9H0np-2U/YZ-gpug-e3I/AAAAAAAAEhA/A498mjI23RcyzylWGG4mBnRkAaPl_i9qQCLcBGAsYHQ/s320/350px-Jingle-Bells-Sheet-Music-chorus-SS%255B1%255D.jpg" width="320" /></a></span></p><p style="text-align: center;"><span style="color: #1f1f1f; font-size: 12pt;"><i><b><br /></b></i></span></p><p style="text-align: center;"><span style="color: #1f1f1f; font-size: medium;"><b><i>‘Twas the night before
Christmas</i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>And all through the
night,<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>Biden's pet puppies<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>Were ready to bite!<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><o:p><b><i> </i></b></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>The Dems will run Biden<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>GOP will have Trump<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>While most of the nation<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>Want both of them
dumped!<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><o:p><b><i> </i></b></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Biden's their man.<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>The race is but done,<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Yet most of his party<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Don’t want him to run.<o:p></o:p></i></b></span></p><p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i><br /></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Biden is fit!<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>His mind is so keen,<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Part of his charm?<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>His gaffe-making machine!<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><b><i><span style="font-size: medium;"><span style="line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p> </o:p></span><span> </span></span></i></b></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Trump is in charge.<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>His nomination can’t fail.<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>But will he be running<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>From a federal jail?<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><b><i><span style="font-size: medium;"><span style="color: #1f1f1f; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><o:p> </o:p></span><span style="color: #1f1f1f;"> </span></span></i></b></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>The country’s divided<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>Will this be our fate?<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>Who needs peace and love<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>When we’re nourished by hate?<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><o:p><b><i> </i></b></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>McCarthy was in.<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>McCarthy was out.<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>Santos was in.<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="color: #1f1f1f; font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-ligatures: none;"><b><i>Now Santos is out!<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><b><i> </i></b></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>With a few civil trials,<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>And 91 counts<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Trump's polling goes up<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>And his legal bills mount.<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><b><i> </i></b></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>The best news for Trump<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>That fits well with his style<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Was the political gift<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Of criminal trials!<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><b><i> </i></b></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>GOP in the House<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>In search of a speaker,<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Thumbs down on Jim Jordan<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>A microphone seeker.<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><b><i> </i></b></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>So now we have Johnson<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Running the House<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Who’s ever heard<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Of this mild mannered mouse?<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><b><i> </i></b></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Johnson's soft spoken <o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Who speaks often of God,<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>In the GOP’s version<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Of a Republican ‘squad’<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><b><i> </i></b></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>The Middle East is on fire,<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>And Ukraine is still fighting.<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>We should all be grateful<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>To President Biden.<o:p></o:p></i></b></span></p><p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i><br /></i></b></span></p><p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>The Colorado Supremes</i></b></span></p><p class="MsoNormal" style="text-align: center;"><b><i><span style="font-size: medium;">Bar Trump from Election</span></i></b></p><p class="MsoNormal" style="text-align: center;"><b><i><span style="font-size: medium;">He engaged and incited</span></i></b></p><p class="MsoNormal" style="text-align: center;"><b><i><span style="font-size: medium;">The insurrection.</span></i></b></p><p class="MsoNormal" style="text-align: center;"><b><i><span style="font-size: medium;"><br /></span></i></b></p><p class="MsoNormal" style="text-align: center;"><b><i><span style="font-size: medium;">Of course, Trump delays,</span></i></b></p><p class="MsoNormal" style="text-align: center;"><b><i><span style="font-size: medium;">He will always appeal</span></i></b></p><p class="MsoNormal" style="text-align: center;"><b><i><span style="font-size: medium;">Is this what he meant</span></i></b></p><p class="MsoNormal" style="text-align: center;"><b><i><span style="font-size: medium;">By The Art of the Deal.</span></i></b></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><b><i> </i></b></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>So let’s pray for peace<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>Not more of the same,<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i> Life need not be<o:p></o:p></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: medium; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b><i>A zero sum game.<o:p></o:p></i></b></span></p><p class="MsoNormal" style="text-align: center;"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><i><b><br /></b></i></span></p><p class="MsoNormal" style="text-align: center;"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b style="font-size: medium;"><i><span style="color: red;">Wishing Everyone Joy and Peace!</span></i></b></span></p><p class="MsoNormal" style="text-align: center;"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><b style="font-size: medium;"><i><span style="color: red;"><br /></span></i></b></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><i><b> </b></i></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><i><b> </b></i></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><i><b> </b></i></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><i><b> </b></i></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><i><b> </b></i></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><i><b> </b></i></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><i><b> </b></i></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><i><b> </b></i></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p><i><b> </b></i></o:p></span></p>
<p class="MsoNormal" style="text-align: right;"></p><div style="text-align: center;"><i><b><br /></b></i></div><span style="line-height: 107%;"><div style="text-align: center;"><br /></div>
<!--[if !supportLineBreakNewLine]-->
<!--[endif]--><span style="font-size: 12pt;"><o:p></o:p></span></span><p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com1tag:blogger.com,1999:blog-7323692122514281455.post-67177227082962047182023-12-17T06:00:00.002-05:002023-12-17T15:29:03.600-05:00Analyzing the Risks and Benefits of Medical Treatment<p>A fundamental skill that physicians rely on is calculating
risk/benefit analyses when we advise patients.
My use of the word ‘calculating’ is a misnomer as there is no reliable
scientific method to quantify risk and benefit.
Indeed, different physicians might ‘calculate’ such an analysis
differently. Similarly, different
patients in the same medical circumstances might gauge the potential medical benefit
differently. This is not hard science. </p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">Some folks might feel that a 5% risk of a major complication
is acceptable, while others would balk at this statistic.<span style="mso-spacerun: yes;"> </span>And on the benefit side, is it worth taking a
medication that has some risk with the hope that it might shave 1 day off of a
7 day illness?<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Despite that risk/benefit analyses are not easily quantified,
physicians and patients must enter into a dialogue on this issue when a
treatment or a test is being proposed.<span style="mso-spacerun: yes;"> </span>The
participants have to do their best to tease through the issues.<o:p></o:p></p>
<p class="MsoNormal">If a 25-year-old athlete develops acute appendicitis, a
risk/benefit analysis likely favors surgery.<o:p></o:p></p>
<p class="MsoNormal">If an 80-year-old individual develops acute appendicitis,
but also suffers from severe emphysema and heart disease, a risk/benefit
analysis might favor a conservative approach with antibiotics.<o:p></o:p></p>
<p class="MsoNormal">And, as every doctor knows, some patients analyze the
risk/benefit balance differently than do their doctors.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0lkVUyUxI_6-q5FqR14RdM0vV-4VbJDOIi6bHHImASB__DWO-HD8sUd3vO5buhWq9KTLeVjuK8zE8n5CdfaNJwZNQWoFKLqKrE_btRTfdw72HYQngXIiCemNa2yNFzX11-BQgsVJ9ea4YeqtSAmdjcvol2gHCQCCNLkMwfhg8hqa_iDI3TE2T5HSepw/s459/Oil_painting_palette%20(1).jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="459" data-original-width="358" height="235" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0lkVUyUxI_6-q5FqR14RdM0vV-4VbJDOIi6bHHImASB__DWO-HD8sUd3vO5buhWq9KTLeVjuK8zE8n5CdfaNJwZNQWoFKLqKrE_btRTfdw72HYQngXIiCemNa2yNFzX11-BQgsVJ9ea4YeqtSAmdjcvol2gHCQCCNLkMwfhg8hqa_iDI3TE2T5HSepw/w184-h235/Oil_painting_palette%20(1).jpg" width="184" /></a></div><p class="MsoNormal" style="text-align: center;"><i>Medicine is an art.</i></p><p class="MsoNormal" style="text-align: justify;"><span style="text-align: left;"><br /></span></p><p class="MsoNormal" style="text-align: justify;"><span style="text-align: left;">Can’t doctors simply look up the risks and benefits of
medical treatments in medical journals or other sources?</span><span style="mso-spacerun: yes; text-align: left;"> </span><span style="text-align: left;">It’s not as easy as it sounds.</span><span style="mso-spacerun: yes; text-align: left;"> </span><span style="text-align: left;">When physicians research a particular treatment
with regard to risk and efficacy, often the patients in a research study are
different from the patient sitting in the office.</span><span style="mso-spacerun: yes; text-align: left;"> </span><span style="text-align: left;">So, doctors must be cautious before
extrapolating published research conclusions to real world patients.</span><span style="mso-spacerun: yes; text-align: left;"> </span><span style="text-align: left;">Unlike my own patients, research participants
are tightly screened.</span><span style="mso-spacerun: yes; text-align: left;"> </span><span style="text-align: left;">Many candidates
for the research trial were disqualified from the study for a variety of
reasons.</span><span style="mso-spacerun: yes; text-align: left;"> </span><span style="text-align: left;">So, for example, if a high
quality published study concludes that a new medication decreases the risk of a
heart attack by 10%, this applies only to the type of patients that were
admitted into the study.</span><span style="mso-spacerun: yes; text-align: left;"> </span><span style="text-align: left;">It is
understandable, however, that lay person who reads about this study might
erroneously assume that he and everyone else should be on this medicine.</span><span style="mso-spacerun: yes; text-align: left;"> </span><span style="text-align: left;">Similarly, a study that points out adverse
reactions and side-effects of a treatment does not mean that a random patient
outside of the study would face this outcome.</span><span style="mso-spacerun: yes; text-align: left;">
</span><span style="text-align: left;">I encourage all who read about medical developments in the lay press to
view the material through a skeptical lens.</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">Do your best to understand the respective risks and benefits
of the reasonable diagnostic and treatment options for your condition.<span style="mso-spacerun: yes;"> </span>It is your doctor’s responsibility to help
you to navigate through this.<span style="mso-spacerun: yes;"> </span>But this
is not a mathematical calculation where every doctor would reach the same point.<span style="mso-spacerun: yes;"> </span>If you present the same medical patient to 10
different doctors, don’t expect consensus.<span style="mso-spacerun: yes;">
</span>Are you familiar with the adage, medicine is an art, not a science?<o:p></o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com2tag:blogger.com,1999:blog-7323692122514281455.post-73505454271402189322023-12-10T06:00:00.001-05:002023-12-11T07:43:55.464-05:00Why Do People Take Probiotics?<p><span face="Calibri, sans-serif" style="background-color: white; color: #212529; font-size: 10pt;">Several times each month
patients solicit my view on probiotics.</span><span face="Calibri, sans-serif" style="background-color: white; color: #212529; font-size: 10pt;">
</span><span face="Calibri, sans-serif" style="background-color: white; color: #212529; font-size: 10pt;">The tens of billions of dollars
spent annually by Americans on these agents provides us with overwhelming
evidence of an economic truth – marketing works.</span><span face="Calibri, sans-serif" style="background-color: white; color: #212529; font-size: 10pt;"> </span><span face="Calibri, sans-serif" style="background-color: white; color: #212529; font-size: 10pt;">Conversely, the evidence that probiotics
actually deliver on their health claims ranges between thin and absent.</span><span face="Calibri, sans-serif" style="background-color: white; color: #212529; font-size: 10pt;"> </span><span face="Calibri, sans-serif" style="background-color: white; color: #212529; font-size: 10pt;">Why, then, are they so popular?</span></p>
<p style="background: repeat white; margin-top: 0in;"><span face=""Calibri",sans-serif" style="color: #212529; font-size: 10pt;">While modern medicine has
delivered much for the public, there are so many mysterious and chronic
afflictions that remain out of reach.<span style="mso-spacerun: yes;">
</span>Patients and physicians struggle over addressing bowel disorders,
chronic arthritis, depression, fatigue, memory lapses, allergies, autoimmune
diseases, skin rashes, sleep disorders, obesity and many other stubborn conditions.<span style="mso-spacerun: yes;"> </span>When conventional medicine fails to deliver,
many other treatments of questionable quality emerge.<span style="mso-spacerun: yes;"> </span>This is undeniable.<span style="mso-spacerun: yes;"> </span>Claiming benefit, however, should not be sufficient.<span style="mso-spacerun: yes;"> </span>Any new treatment should be subjected to
the same rigorous vetting process that all drugs and medical devices undergo.<span style="mso-spacerun: yes;"> </span>I certainly understand why a suffering
patient is willing to consider treatments that promise relief in the absence of
proven benefit. Remember, how many folks during the pandemic were willing to
swallow hydroxychloroquine or even ivermectin?<o:p></o:p></span></p><p style="background: repeat white; margin-top: 0in;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgyYS8K_d02UNLAaHYIraG7cBr3_yRaLibFdW3LbKXcIO3uLBIK2vM5x_vW3Eu4St0SX4y7Zq74451-a9LA4gQlI8SCVx99Dfwpd3v4YzWFw3tVXSzxHzfbdxfiWUDkGUUsSkGkrUEo_ZFfUrjOd-8OQiBAiw87kNSLBHv8poGS_JTxOf0vstNoWNk_sA=s768" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="317" data-original-width="768" height="82" src="https://blogger.googleusercontent.com/img/a/AVvXsEgyYS8K_d02UNLAaHYIraG7cBr3_yRaLibFdW3LbKXcIO3uLBIK2vM5x_vW3Eu4St0SX4y7Zq74451-a9LA4gQlI8SCVx99Dfwpd3v4YzWFw3tVXSzxHzfbdxfiWUDkGUUsSkGkrUEo_ZFfUrjOd-8OQiBAiw87kNSLBHv8poGS_JTxOf0vstNoWNk_sA=w198-h82" width="198" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><b><i>Keep Away from the FDA!</i></b></div><span face=""Calibri",sans-serif" style="color: #212529; font-size: 10pt;"><br /></span><p></p>
<p style="background: repeat white; margin-top: 0in;"><span face=""Calibri",sans-serif" style="color: #212529; font-size: 10pt;">Probiotics are exempted from the
standard prescription </span><span face="Calibri, sans-serif" style="color: #212529; font-size: 13.3333px;">Food and Drug Administration’s (FDA)</span><span face="Calibri, sans-serif" style="color: #212529; font-size: 13.3333px;"> </span><span face="Calibri, sans-serif" style="color: #212529; font-size: 10pt;">drug approval process.</span><span face="Calibri, sans-serif" style="color: #212529; font-size: 10pt;">
</span><span face="Calibri, sans-serif" style="color: #212529;"><span style="font-size: 10pt;">And, you won’t find any probiotic manufacturers clamoring to fall under
the FDA's firm </span><span style="font-size: 13.3333px;">regulatory</span><span style="font-size: 10pt;"> hand. Why not?</span></span><span face="Calibri, sans-serif" style="color: #212529; font-size: 10pt;"> </span><span face="Calibri, sans-serif" style="color: #212529; font-size: 10pt;">If their products worked as well as they claimed,
wouldn’t you think they would want the FDA’s seal of approval?</span><span face="Calibri, sans-serif" style="color: #212529; font-size: 10pt;"> </span><span face="Calibri, sans-serif" style="color: #212529; font-size: 10pt;"> </span><span face="Calibri, sans-serif" style="color: #212529; font-size: 10pt;">On the
contrary, the biggest threat these companies could face is an aggressive FDA
testing probiotics for safety and efficacy.</span><span face="Calibri, sans-serif" style="color: #212529; font-size: 10pt;"> Instead, probiotics are permitted to use phrasing such as 'clinically tested' or similar vague language which is not the rigor the public deserves. Consumers should regard such claims of benefit to be advertising and not medical evidence. Advocate for yourself. Research the risks and benefits of probiotics - as you might any proposed treatment - from trusted medical sources and authorities. Then, make an informed decision. </span></p><p style="background: repeat white; margin-top: 0in;"><br /></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com0tag:blogger.com,1999:blog-7323692122514281455.post-71001073747936506072023-12-03T06:00:00.003-05:002023-12-04T21:51:20.394-05:00Should Doctors Wear White Coats?<p>Many professions can be easily identified by their uniforms
or state of dress. Consider how easy it is for us to identify a policeman, a
judge, a baseball player, a housekeeper, a chef, or a soldier. There must be a reason why so many professions
require a uniform. Presumably, it is to
create team spirit among colleagues and to communicate a message to the
clientele. It certainly doesn’t enhance
professional performance. For instance,
do we think if a judge ditches the robe and is wearing jeans and a T-shirt,
that he or she cannot issue sage rulings?
If members of a baseball team showed up dressed in comfortable street
clothes, would they commit more errors or achieve fewer hits? </p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">The medical profession for most of its existence has had its
own uniform.<span style="mso-spacerun: yes;"> </span>Male doctors donned a shirt
and tie and all doctors wore the iconic white coat.<span style="mso-spacerun: yes;"> </span>The stated reason was that this created an
aura of professionalism that inspired confidence in patients and their
families.<span style="mso-spacerun: yes;"> </span>Indeed, even today you will
often see physicians sporting this sartorial style.<span style="mso-spacerun: yes;"> </span>But I am not one of them.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">I haven’t worn a white coat or a tie at work in decades.<span style="mso-spacerun: yes;"> </span>I do have a box of starched and folded white
coats in the trunk of my car provided to me by my employer.<span style="mso-spacerun: yes;"> </span>I’ll be sure to return them in pristine
condition when I retire years from now.<span style="mso-spacerun: yes;">
</span>Imagine how much I am saving them on cleaning fees.<span style="mso-spacerun: yes;"> </span>Perhaps, I should request a laundry
reimbursement.<o:p></o:p></p><p class="MsoNormal"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEh-RfeHTY52gDDWokXJLf0gZmx3ZR6BtzJaYtQ2xvMYQBQuPqtsv_PnG-WRSlJ07sGVaHXGUxs9ajRQX8e2hSz8KJ3RjskZ5jdQ5RaeNXAsI7z8P_K67ZZeQJxbJCf9zdTMGsa94SXHmHJOCs-Xyn_Hbovw8GOt9tQ4SOov2yXvothlxCHsRyi-6Gon7Q=s320" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="320" data-original-width="240" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEh-RfeHTY52gDDWokXJLf0gZmx3ZR6BtzJaYtQ2xvMYQBQuPqtsv_PnG-WRSlJ07sGVaHXGUxs9ajRQX8e2hSz8KJ3RjskZ5jdQ5RaeNXAsI7z8P_K67ZZeQJxbJCf9zdTMGsa94SXHmHJOCs-Xyn_Hbovw8GOt9tQ4SOov2yXvothlxCHsRyi-6Gon7Q" width="240" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><b><i>Never been worn!</i></b></div>
<p class="MsoNormal">I haven’t found that my casual presentation has affected my
relationships with my patients.<span style="mso-spacerun: yes;"> </span>As far
as I can tell, patients are appreciative of my work and judge me by criteria
other than how I package myself.<span style="mso-spacerun: yes;"> </span>I think
this is how it should be.<span style="mso-spacerun: yes;"> </span>I certainly
come to work well-attired, but my style clearly departs from the classic image
of the white-cloaked physician in a traditional necktie.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">It seems that there has been an overall societal dressing
down in recent years.<span style="mso-spacerun: yes;"> </span>Come to the
theater or a decent restaurant and you will see patrons dressed very
differently than they would have been a few decades ago.<span style="mso-spacerun: yes;"> </span>There was a time when many men came to work
every day in a business suit.<span style="mso-spacerun: yes;"> </span>These days
are long gone.<span style="mso-spacerun: yes;"> </span>In fact, many folks are
now working at home wearing just about anything or perhaps nothing.<o:p></o:p></p>
<p class="MsoNormal">I work hard for my patients.<span style="mso-spacerun: yes;">
</span>I listen to them very carefully.<span style="mso-spacerun: yes;">
</span>I care about them.<span style="mso-spacerun: yes;"> </span>I offer my
best advice.<span style="mso-spacerun: yes;"> </span>I admit when I have
erred.<span style="mso-spacerun: yes;"> </span>Would a white coat add anything
to this?<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com36tag:blogger.com,1999:blog-7323692122514281455.post-48752546035779793872023-11-26T06:00:00.001-05:002023-11-26T06:00:00.142-05:00Trying to be Thankful in 2023<p> I feel it is more challenging than ever to carve away the chaos and destruction so that we can focus on what we should be thankful for. </p><p>Yes, there is beauty in the world which we must seek out and cherish. </p><p>Yes, there is kindness and generosity in our midst which we must champion and promulgate.</p><p>Yes, there is dialogue and open mindedness which we must resurrect and cultivate.</p><p>Skimming national and international current events on any day reinforces the reality that the space to find gratitude is smaller that it used to be. But it is there.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg06X_R_AxDunSc-QO5bim7WjKccYxqPpC2pjYnwY_zDB0VeNaPkYujdnVQG0HfP8ToI1r88PY5kqCd-tPmTZRtgrZOt8Qwy1XR1EndMKeHfJKIT2Nb9M9hXvKB8lcoRO1qRONx-Qu7kQWM1ozLpIwSH4SmWOFrcrAv-V4lhzYuAVMQpq9uOo9ZP3m1MGlT/s2016/IMG_2078.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2016" data-original-width="1512" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg06X_R_AxDunSc-QO5bim7WjKccYxqPpC2pjYnwY_zDB0VeNaPkYujdnVQG0HfP8ToI1r88PY5kqCd-tPmTZRtgrZOt8Qwy1XR1EndMKeHfJKIT2Nb9M9hXvKB8lcoRO1qRONx-Qu7kQWM1ozLpIwSH4SmWOFrcrAv-V4lhzYuAVMQpq9uOo9ZP3m1MGlT/s320/IMG_2078.jpg" width="240" /></a></div><div><br /></div><p style="text-align: justify;"><i style="text-align: left;">Never doubt that a small group of thoughtful and committed citizens can change the world; </i></p><p style="text-align: justify;"><i style="text-align: left;">indeed it's the only thing that ever has. </i><i style="text-align: left;">Margaret Mead</i></p><p>On this recent Thanksgiving, I hope that all of you had blessings to celebrate. Perhaps the task will be easier for all of us next year.</p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p><br /></p><p><br /></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com0tag:blogger.com,1999:blog-7323692122514281455.post-27962647139512928262023-11-19T06:00:00.007-05:002023-12-04T21:53:09.283-05:00Signs and Symptoms of Cancer<div class="MsoNormal">"Doctor, do you think I have cancer?"</div><div class="MsoNormal"><br /></div><div class="MsoNormal">In a prior post, I did my best to point out that handling
questions from patients and their families in a skillful manner requires a measured and cautious
approach.<span style="mso-spacerun: yes;"> </span>Paradoxically, physicians have
not received much training, if any, in this aspect of doctoring, which
physicians engage in dozens of times each day. In the unlikely event that you
have not yet perused the prior post, here’s the <a href="https://www.blogger.com/blogger.g?blogID=7323692122514281455#editor/target=post;postID=7053709423935640004;onPublishedMenu=template;onClosedMenu=template;postNum=11;src=link" target="_blank">link</a>, which will serve as a
brief prep course for this current posting.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
All of us hope and pray for a salubrious life.<span style="mso-spacerun: yes;"> </span>Sickness scares us.<span style="mso-spacerun: yes;"> </span>We fear any worsening of our illnesses,
future mental decline, loss of physical function or any unforeseen change in our
medical fortunes.<span style="mso-spacerun: yes;"> </span>The fear of cancer
hovers over all of us.<span style="mso-spacerun: yes;"> </span>And,
understandably, patients want to be reassured that their symptoms are benign
and transient.<span style="mso-spacerun: yes;"> </span><o:p></o:p><br />
<span style="mso-spacerun: yes;"><br /></span>
<span style="mso-spacerun: yes;">There is another genre of questions that are directed at physicians that requires a deft response.<span style="mso-spacerun: yes;"> </span>Below, I will list some hypothetical queries that every physician hears regularly.<span style="mso-spacerun: yes;"> </span>And, in most cases, we simply cannot offer the desired response.</span><br />
<span style="mso-spacerun: yes;"><br /></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-3-13RngTSR4/XdWfs0GLB7I/AAAAAAAADoc/JHv3Er_9OJMvzimzFFxMug9TrsBljUFLACLcBGAsYHQ/s1600/330px-Lung_cancer.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="598" data-original-width="330" height="320" src="https://1.bp.blogspot.com/-3-13RngTSR4/XdWfs0GLB7I/AAAAAAAADoc/JHv3Er_9OJMvzimzFFxMug9TrsBljUFLACLcBGAsYHQ/s320/330px-Lung_cancer.jpg" width="176" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
Cancer Phobia is Everywhere</div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: x-small;">Picture above - Lung Cancer is a White Lesion</span></div>
<span style="mso-spacerun: yes;"><br /></span></div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"><br /></span></div>
<div class="MsoNormal">
Physicians are imperfect and cannot see beyond the present. We cannot deliver clarity to every inquiry.<span style="mso-spacerun: yes;"> </span>We cannot resolve all doubts when you ask us
questions such as these.</div>
<div class="MsoNormal">
</div>
<ul>
<li>Doctor, are you sure it’s not serious?<span style="mso-spacerun: yes;"> </span></li>
<li>My cousin has the same symptoms as I have, and she was
diagnosed with lupus. Could I have
lupus?</li>
<li>Will my pain be gone if I go through the operation?</li>
<li>As long as you tell me it’s not cancer, I’ll be fine.</li>
<li>I know you said my back pain was just arthritis, but It’s
been 3 weeks and I’m no better. Do you
think it could be more than just arthritis?</li>
</ul>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
It is not possible to respond to questions like this
definitively, because the medical universe does not operate in absolute and
quantitative terms.<span style="mso-spacerun: yes;"> </span>It’s nuanced and
amorphous.<span style="mso-spacerun: yes;"> </span>This is why seasoned
practitioners are careful with their language.<span style="mso-spacerun: yes;">
</span>We use phrasing such as, “…it would be very unlikely that”, “…your
symptoms are not typical for”, or “…in my experience cases like yours usually
resolve on their own”.<span style="mso-spacerun: yes;"> </span>In other words,
we leave the door open a crack.<span style="mso-spacerun: yes;"> </span>Why?<span style="mso-spacerun: yes;"> </span>Because it’s the best we can do and we want to
maintain our trust and credibility with you.<o:p></o:p><br />
<br /></div>
<div class="MsoNormal">
Any questions?<o:p></o:p></div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<br />Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com0tag:blogger.com,1999:blog-7323692122514281455.post-59413778206542705642023-11-12T06:00:00.008-05:002023-12-04T21:54:06.563-05:00When Your Doctor is Running Late<p>One pleasure that engage in regularly is taking time to
simply think and to collect my thoughts.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">I don’t have a dedicated time for this pursuit; I can seize
the moment at any time.<span style="mso-spacerun: yes;"> </span>Often, I am on a
walk or maybe simply driving somewhere.<span style="mso-spacerun: yes;">
</span>I use these times to rove through recent happenings in my life and in
the lives of those I care about.<span style="mso-spacerun: yes;"> </span>Or, I
might reflect – some might say ruminate – over a news item or opinion piece
that I have read.<span style="mso-spacerun: yes;"> </span>There is no
agenda.<span style="mso-spacerun: yes;"> </span>My mind simply roams and wanders
stopping periodically at various unplanned destinations.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Think of this experience as akin to entering a large bookstore (younger readers may need to google here) without a specific title in
mind.<span style="mso-spacerun: yes;"> </span>You simply start ambling through
the aisles sampling various books until you find one or two that meet your
fancy.<span style="mso-spacerun: yes;"> </span>The journey, as I see it, is a
central part of the adventure.<span style="mso-spacerun: yes;"> </span>Contrast
this with purchasing a specific book on Amazon.<span style="mso-spacerun: yes;">
</span>I’ve purchased books both ways, but one of these options offers me a
much richer experience.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Most readers are aware that I am a medical practitioner.
Decades ago, when patients arrived at their doctors’ offices, they would select
from several out-of-date magazines that were either stacked in racks or strewn
across a table.<span style="mso-spacerun: yes;"> </span>This is where I first
became aware of periodicals such as Popular Mechanics and Field & Stream,
two magazines that were never required reading in my world.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p><p class="MsoNormal"><span style="mso-spacerun: yes;"><br /></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-mr8l6b3EHr0/YZpC3AAkWZI/AAAAAAAAEgk/KlZCD2IBCg0-kPA6B_R17Z1VeE0FR8IJACLcBGAsYHQ/s1067/800px-The_Thinker%252C_Rodin.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="800" height="320" src="https://1.bp.blogspot.com/-mr8l6b3EHr0/YZpC3AAkWZI/AAAAAAAAEgk/KlZCD2IBCg0-kPA6B_R17Z1VeE0FR8IJACLcBGAsYHQ/s320/800px-The_Thinker%252C_Rodin.jpg" width="240" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><i>Have you Taken Time to Think Today?</i></div><span style="mso-spacerun: yes;"><br /></span><p></p>
<p class="MsoNormal">Magazines are an endangered species in doctors’ offices today.<span style="mso-spacerun: yes;"> </span>But, there’s a new kid in town.<span style="mso-spacerun: yes;"> </span>When I enter my exam room to greet a patient,
almost invariably the patient is transfixed to their phone.<span style="mso-spacerun: yes;"> </span>I presume the tasks range from checking
e-mails, texting, and scanning the web to playing games. This practice is not
restricted to my office.<span style="mso-spacerun: yes;"> </span>It is
omnipresent.<span style="mso-spacerun: yes;"> </span>Folks are not only on their
phones while waiting for an activity but are texting away even during an
activity! <span style="mso-spacerun: yes;"> </span>Haven’t you seen folks out to
dinner who simply can’t enjoy the dining experience for its own sake and have
their phones beside them so they won’t miss a life-altering text message?<span style="mso-spacerun: yes;"> </span>Is addiction too strong a term for this?<o:p></o:p></p>
<p class="MsoNormal">Here’s my plea to readers.<span style="mso-spacerun: yes;">
</span>Then next time you are in your doctor’s waiting room, consider this time
to be a special gift to you.<span style="mso-spacerun: yes;"> </span>Savor the
silence. <span style="mso-spacerun: yes;"> </span>Lose the technology. Engage in
a human pleasure that no app can replicate.<span style="mso-spacerun: yes;">
</span>Just think.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com1tag:blogger.com,1999:blog-7323692122514281455.post-27593614227546971492023-11-05T06:00:00.020-05:002023-12-04T21:54:45.918-05:00Can I Trust my Doctor?<p>We all recall President Reagan’s adage, <i>trust but verify</i>,
with regard to the then Soviet Union. President
Reagan’s choice of words indicated that trust could not be assumed. I challenge this notion as I
feel that to trust another person, an organization or even a country that trust
must be assumed to exist. That’s what
trust means. Conversely, if one has to
verify its presence, then true trust is clearly not there. If a spouse, for example, hires a private
investigator to prove that his or her partner is behaving honorably, is trust
present?</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">I think that overall the public trusts their doctors, although they
are wary about the medical profession writ large.<span style="mso-spacerun: yes;"> </span>The public may view their physicians in the
same way that it views politicians – they see systemic dysfunction and
self-interest in both professions but folks give higher integrity marks to
their personal doctor or representative.<span style="mso-spacerun: yes;">
</span>Often, patients who I know have confidence in me voice criticisms over
various frustrating aspects of the medical world including billing absurdities,
poor physician access, waiting times in emergency rooms, lackluster bedside
manners, costs of pharmaceuticals, the reality that medicine is a business and
the sense that they are outmatched in an unfair fight.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">How much trust can a patient have in a system that won’t
cover a drug that they need to get well?<o:p></o:p></p>
<p class="MsoNormal">There is a dichotomy between a strong bond between most
patients and their doctors and a deep skepticism the public has with the
medical-industrial complex.<span style="mso-spacerun: yes;"> </span>I understand
this both as a physician and when I have been a patient.<span style="mso-spacerun: yes;"> </span>If medicine has truly morphed into a business,
can we expect it to behave reliably as a professional calling?<span style="mso-spacerun: yes;"> </span>I suggest that readers review the very brief
fable of the Frog and the Scorpion which illustrates my stinging point very
well.<span style="mso-spacerun: yes;"> </span>I’m not saying that the profession
cannot behave nobly, only that there are forces present opposing this.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4qaid1-XUR49Nq83IInADTw5vEmJRzyES378SBmQBD6is-7pw2zU8B38GaTRfVYOT-dlw7ebnmFTXb1QINIxlCQt-tzVCCxv2FM5Y_mys2XMagpcsLbcEiclpfft5XzMJFdxEVukN8uwSqm1yeyvDwiqk2GkWbDJXUIVb198yR8e7R-vAbobCqiXjPQ/s1146/Sidney_Hall_-_Urania's_Mirror_-_Scorpio.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1146" data-original-width="800" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4qaid1-XUR49Nq83IInADTw5vEmJRzyES378SBmQBD6is-7pw2zU8B38GaTRfVYOT-dlw7ebnmFTXb1QINIxlCQt-tzVCCxv2FM5Y_mys2XMagpcsLbcEiclpfft5XzMJFdxEVukN8uwSqm1yeyvDwiqk2GkWbDJXUIVb198yR8e7R-vAbobCqiXjPQ/w169-h243/Sidney_Hall_-_Urania's_Mirror_-_Scorpio.jpg" width="169" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><i>"It's my nature."</i></div><div class="separator" style="clear: both; text-align: center;"><i><br /></i></div>If trust between medical professionals and patients erodes,
then the doctor-patient relationship is fractured and optimal medical care may
no longer be possible. A patient needs
to know that when medical advice is offered, that the only consideration is the
patient’s welfare. I still have patients
query me from time to time if the reason I am counseling against a diagnostic
test is to conform with insurance company policy. And patients need to be truthful with
us. If physicians are misled about
addiction issues or if patients are taking their medicines as prescribed, then
the medical recommendations may be wrong. Tell the truth.<p></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">Overall, I think the health of the doctor-patient
relationship is intact, but like any relationship, it needs to be nurtured and
protected.<span style="mso-spacerun: yes;"> </span>Each side has a
responsibility to maintain it. <span style="mso-spacerun: yes;"> </span>If
one side is falling short, then the partner needs to call him or her out to
restore the equilibrium.<span style="mso-spacerun: yes;"> </span>That’s how a trusting relationship stays strong. <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com2tag:blogger.com,1999:blog-7323692122514281455.post-63262568222174231512023-10-29T06:00:00.004-04:002023-12-04T21:55:09.725-05:00Loss of Trust in America<p>Trust is the central element in our national motto. Do you recall this 4-word phrase? If you need a reminder of this iconic
verbiage, just grab a coin or some paper money and you’ll find it there. Perhaps, you can’t recall the motto. Since we don’t study our money when making a
transaction, our trustful motto may remain buried in the background – invisible
while in plain sight. I’ll bet that some
curious readers are scanning a dollar bill right now! </p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p>As our trustful motto seems out of view, so has trust across
society become much less visible. When
we do stumble across it, it can feel as if we have struck gold. Years ago, for example, I wrote a post about
a proprietor who showed me such a high level of trust that I <a href=" https://www.blogger.com/blog/post/edit/7323692122514281455/6868315315819406759" target="_blank">memorialized the incident</a> in this blog and will never forget the vignette. </p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">The trust vacuum seems most evident in our political
space. The citizenry does not trust elective
officials, particularly those of the opposing political party. This phenomenon has spread widely now that the
political space has metastasized far beyond conventional political boundaries. Examples of this political mission creep are
widespread. Hard to believe that a
public health campaign in a deadly pandemic – which in a prior era would have
been welcomed by all – has become as political as tax or immigration
policy. Public health leaders were lambasted
as being lying and corrupt tools of the government or the pharmaceutical
industry. Trust in the media continues
to decay with some legitimate justification.
Folks or organizations who espouse a viewpoint on an issue are often assumed
to have an unspoken and stealth agenda. Consider a politician who wants to retain a
military base in his district that the Defense Department argues should be
closed. How about a political leader who
claims election fraud but only if the desired candidate loses? Once these conflicts of interest are exposed,
then distrust explodes. Would it have
been more honest at the onset of the pandemic for public health leaders to
state that masks were advised for medical professionals and not the general
public because of a limited supply rather than to suggest that they were not medically
necessary?</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">Credibility squandered may be hard to recover.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Recently, I was on a road trip and came across a scene that
impressed me enough to photograph it and share it here with readers.<span style="mso-spacerun: yes;"> </span>A flower shop was closed but an array of
plants remained outside.<span style="mso-spacerun: yes;"> </span>Clearly, this
proprietor has trust in the community.<span style="mso-spacerun: yes;"> </span>I
think we all know what the fate of these plants might be in many other locales.<span style="mso-spacerun: yes;"> </span>I have lived years ago in NYC and have never
witnessed such a scene.<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxTyshWz46d5SstEUFo6InQ0s0iROif6mf6T6seXevD3ByxD7ssUQr_84anfqwBLDBDD9p5XcinisgpnP5Q1JTlTODAb-P_WS0_IKGbc96bXs3RLybqazXifj-ZYSxi_uN0k7NjZhjQV9EDzAxOJRxvuKfOKXC6dRSP__G7K5jOWCi0n0KkBfwKTziRA/s640/IMG_0894.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="480" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxTyshWz46d5SstEUFo6InQ0s0iROif6mf6T6seXevD3ByxD7ssUQr_84anfqwBLDBDD9p5XcinisgpnP5Q1JTlTODAb-P_WS0_IKGbc96bXs3RLybqazXifj-ZYSxi_uN0k7NjZhjQV9EDzAxOJRxvuKfOKXC6dRSP__G7K5jOWCi0n0KkBfwKTziRA/s320/IMG_0894.jpg" width="240" /></a></div><div><br /></div><div style="text-align: center;"> A Trusting Scene from Worthington, Ohio</div><div style="text-align: center;"><br /></div>
<p class="MsoNormal">Trust must be earned.<span style="mso-spacerun: yes;">
</span>And it requires letting oneself be vulnerable.<span style="mso-spacerun: yes;"> </span>If you confide a secret to a good friend, then
you are trusting that the information will remain secure.<span style="mso-spacerun: yes;"> </span>Trust is the connective tissue that strengthens
all vibrant and successful relationships.<span style="mso-spacerun: yes;">
</span>This applies to business partners, romantic couples, teachers and
students, law enforcement and the public, members of a team, doctors and patients,
lawyers and clients, and even bloggers and readers.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com1tag:blogger.com,1999:blog-7323692122514281455.post-20325790151693675692023-10-22T06:00:00.002-04:002023-10-22T06:00:00.144-04:00Should Doctors be ACLS Certified?<p>Since I started practicing medicine a few decades ago, I
have been recertified every 2 years for Advanced Cardiac Life Support
(ACLS). Readers might not perceive any
newsworthiness regarding this issue.
After all, I am a doctor and I should know how to respond to unexpected
medical emergencies. Except I have barely a clue.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">Yes, I pass the exam every other year.<span style="mso-spacerun: yes;"> </span>The truth is that I do so because all of the
institutions that I have worked for require this certification.<span style="mso-spacerun: yes;"> </span>There must be a group of bureaucrats
sequestered somewhere who decided that physicians should be ACLS certified, at
least doctors like me.<span style="mso-spacerun: yes;"> </span>But, as is so
often true in life, mission creep sweeps in participants who should have been
excluded in the effort.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">The only moments that ACLS has my attention are those 2
hours every other year when I recertify. In between these episodes, I don’t
read about it, dream about it and certainly never do it.<o:p></o:p></p><p class="MsoNormal"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-OKQHleswUoE/YXFNSAn6S4I/AAAAAAAAEfI/fOPqgq7ik54URRdFG-8qzLR_fsWfBiSUQCLcBGAsYHQ/s800/800px-SinusRhythmLabels.svg.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="789" data-original-width="800" height="316" src="https://1.bp.blogspot.com/-OKQHleswUoE/YXFNSAn6S4I/AAAAAAAAEfI/fOPqgq7ik54URRdFG-8qzLR_fsWfBiSUQCLcBGAsYHQ/s320/800px-SinusRhythmLabels.svg.png" width="320" /></a></div><p class="MsoNormal"><br /></p>
<p class="MsoNormal">Advanced life support is not simply a certification status –
it’s a profession.<span style="mso-spacerun: yes;"> </span>Physicians and other
medical professionals who truly have these skills are highly trained and
retrained and practice in the field.<span style="mso-spacerun: yes;">
</span>They are similar to trained athletes who are always ready to be called
up for service.<o:p></o:p></p>
<p class="MsoNormal">When any of us calls 911 and paramedics arrive, these ACLS
professionals know what they’re doing.<span style="mso-spacerun: yes;">
</span>They are constantly training to remain current in their field exactly as
I do in my medical specialty.<span style="mso-spacerun: yes;"> </span>I am a
gastroenterologist whose expertise does not include interpreting complex and
abnormal cardiac rhythms, knowing the doses and means of administration of
drugs I’ve never prescribed or knowing how to insert a breathing tube into
someone’s trachea.<o:p></o:p></p>
<p class="MsoNormal">I do think that all of us should be able to perform Basic
Life Support (BLS) so that we might keep someone alive until the paramedics –
the actual professionals – arrive on the scene.<o:p></o:p></p>
<p class="MsoNormal">Similarly, over the years I have come across various ‘weekend
courses’ that aim to teach physicians a new procedure or technique.<span style="mso-spacerun: yes;"> </span>Perhaps, I’m a slow learner but the procedures
and techniques I use have taken me quite a bit longer than a weekend to
learn.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">So, if I confront an urgent medical situation, before
relying upon my ACLS muscle memory, I will be dialing 911.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com0tag:blogger.com,1999:blog-7323692122514281455.post-33226044366204146302023-10-15T06:00:00.010-04:002023-10-26T13:30:12.921-04:00Do Doctors Talk to Each Other?<p> I will share with readers a recent occurrence between me and
another doctor that was both rare and refreshing. I was serving as the gastrointestinal
consultant on one of the doctor’s patients.
I performed a scope examination of the stomach and obtained some routine
biopsy specimens. The pathology results
were abnormal, but benign. No urgent
action was needed, but a full airing of the significance of the results would
require a conversation between me and the patient in an office visit. I notified the patient that there was no
medical threat at all and we would unpack it all during his next visit.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">The referring physician wondered about this delay, which
perhaps is a different style from other gastroenterologists (GI’s) who he works
with. <span style="mso-spacerun: yes;"> </span>(My guess is that other GI’s may
opt to handle the issue with the patient on the phone or via the portal. I
think, however, that there’s too much complexity to fully address this issue in
this manner.) So, here’s what the referring doctor did.<span style="mso-spacerun: yes;"> </span>He called me.<span style="mso-spacerun: yes;">
</span>I was delighted to hear from him and have an opportunity to have a real
time dialogue about a patient we shared.<span style="mso-spacerun: yes;">
</span>Before even entering into the substance of the issue, I told the doctor
how rare it is to have such a conversation which always ends up benefiting the
patient.<span style="mso-spacerun: yes;"> </span>After our conversation, the
doctor completely understood my point of view.<span style="mso-spacerun: yes;">
</span>I promised to keep him informed after the patient and I met in the office,
and I did.<o:p></o:p></p>
<p class="MsoNormal">I rarely receive direct communications from referring
medical professionals who are referring patients to me. Yes, I can usually
deduce the reason for the visit from either the patient or the beloved
electronic medical record (EMR).<span style="mso-spacerun: yes;"> </span>This
can be challenging.<span style="mso-spacerun: yes;"> </span>The consultation
request may be buried in the EMR months ago requiring some high level sleuthing
on my part.<span style="mso-spacerun: yes;"> </span>And more often that you
would think, patients do not always know why they are seeing me.<span style="mso-spacerun: yes;"> </span>And the EMR is not always clear.<span style="mso-spacerun: yes;"> </span>The record may indicate that the patient is
being sent for a screening colonoscopy but the patient also has abdominal distress.<span style="mso-spacerun: yes;"> </span>Does the referring doctor want me only to do
the screening procedure or to evaluate the patient’s symptoms?<o:p></o:p></p>
<p class="MsoNormal">Of course, we physicians and medical professional do
communicate via the electronic medical record regularly.<span style="mso-spacerun: yes;">
</span>But this method has obvious limitations.<span style="mso-spacerun: yes;">
</span>I send an electronic message to a doctor.<span style="mso-spacerun: yes;"> </span>I may not hear back for a day or two.<span style="mso-spacerun: yes;"> </span>Or the doctor may be on vacation.<span style="mso-spacerun: yes;"> </span>The doctor’s response may not fully address my concern so I send another message. This can become frustrating and
inefficient.<span style="mso-spacerun: yes;"> </span>And doctors today are
busier than ever and busier than we should be so we tend to be very clipped in
our communications which has obvious drawbacks.<span style="mso-spacerun: yes;">
</span>And let’s face it.<span style="mso-spacerun: yes;"> </span>If a doctor
calls me on the phone, the likelihood is that I will be available at that moment
is quite low – a disincentive for initiating actual conversations.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRMVx7mOvLuVel0HaBazD13HDJAL7VPQW3pv6jycHhdPq07_fJuspcSUlCuIznAo8VRsSOjyd8ARZ-hPWGCYNjtUFSyFsbm_VP-JvQGMFEz-I19hGkhhdsnNTPjBRaj8aAh-eD0ledR1s6incSS_vsM5gbPCGNoYdFEHe0mqx1mKHaXB_mDk-V4HF4hw/s498/Tr%C3%A5dtelefon-illustration.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="329" data-original-width="498" height="211" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRMVx7mOvLuVel0HaBazD13HDJAL7VPQW3pv6jycHhdPq07_fJuspcSUlCuIznAo8VRsSOjyd8ARZ-hPWGCYNjtUFSyFsbm_VP-JvQGMFEz-I19hGkhhdsnNTPjBRaj8aAh-eD0ledR1s6incSS_vsM5gbPCGNoYdFEHe0mqx1mKHaXB_mDk-V4HF4hw/s320/Tr%C3%A5dtelefon-illustration.png" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><i>Person to person is best.</i></div><span style="mso-spacerun: yes;"><br /></span><p></p>
<p class="MsoNormal">Actual conversations between medical professional is clearly
optimal In one conversation, the course of a patient’s treatment can radically
change for the better.<span style="mso-spacerun: yes;"> </span>For instance, I
may favor surgery for a patient, but back off after having a dialogue with the
surgeon who convinces me otherwise.<span style="mso-spacerun: yes;"> </span>This
can’t be replicated with a voice mail or succinct e-mail.<o:p></o:p></p>
<p class="MsoNormal">I’m sure most doctors would agree on the value of
conversations among colleagues.<span style="mso-spacerun: yes;"> </span>This is
how medical care used to be conducted.<span style="mso-spacerun: yes;">
</span>Why has this become an anachronism?<span style="mso-spacerun: yes;">
</span>There are two reasons.<span style="mso-spacerun: yes;"> </span>Electronic
communications have taken over the communications realm in medicine and beyond.<span style="mso-spacerun: yes;"> </span>And physicians who are overstretched simply don’t have the time to reach out regularly with
colleagues.<span style="mso-spacerun: yes;"> </span>Efficiency wins over
quality.<span style="mso-spacerun: yes;"> </span>But guess who really loses out the
most here.<o:p></o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com5tag:blogger.com,1999:blog-7323692122514281455.post-61520956470533393192023-10-08T06:00:00.004-04:002023-10-08T06:00:00.144-04:00Has the Hawthorne Effect Affected You? The Answer is Yes.<p>Here is a reality of human behavior. Folks behave differently when they know they
are being watched. Consider two examples
that we have all seen. We are sitting in
the driver’s seat of our parked car. The
driver in the adjacent car sees us and then opens his door with particular care
so as to avoid dinging us. We wonder what his car door action might have been
had our own car been empty. Similarly,
in most business scenarios, I suspect that the staff perform at a higher level
when the boss is around.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">This phenomenon is referred to as the Hawthorne Effect,
whose name derives from some industrial research done in the Hawthorne suburb
of Chicago nearly a century ago.<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjG56mFtgaI1EMO6nA8hRDZ6QbfpurmoUmFdJEEaToUhn4e4ZRzwBpJ9Wgnj7myddhdH93vej4AKmqlsCRgpqXgwztbiVl9Uhc0GByB1N7LN-6qWoZnxmrxySD5SDMTVB2YZnXv8_25lTc-kob4DnNbg7Rdkl0nG1sfyurpTpq00PeIXpNHZZJ5lE3dUA/s938/Jim_Hutton_Ellery_Queen_1976.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="938" data-original-width="707" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjG56mFtgaI1EMO6nA8hRDZ6QbfpurmoUmFdJEEaToUhn4e4ZRzwBpJ9Wgnj7myddhdH93vej4AKmqlsCRgpqXgwztbiVl9Uhc0GByB1N7LN-6qWoZnxmrxySD5SDMTVB2YZnXv8_25lTc-kob4DnNbg7Rdkl0nG1sfyurpTpq00PeIXpNHZZJ5lE3dUA/s320/Jim_Hutton_Ellery_Queen_1976.jpg" width="241" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><i>Do you behave the same way when someone's watching?</i></div><p class="MsoNormal"><br /></p>
<p class="MsoNormal">And yes, this truth exists also in the medical profession.<o:p></o:p></p>
<p class="MsoNormal">Consider the following proposed studies and if the results
might be distorted by the Hawthorne Effect.<o:p></o:p></p>
<p class="MsoNormal"></p><ul style="text-align: left;"><li>The Chairman of the Department of Surgery announces an
initiative to improve patient satisfaction.<span style="mso-spacerun: yes;">
</span>Surveys have indicated that patients #1 gripe is being kept waiting for
their appointments.<span style="mso-spacerun: yes;"> </span>The chairman
announces that physician punctuality will be monitored over the next 8 weeks to
assess the extent of the behavior and who the outliers are.</li><li>A hospital system is disturbed by an increase in breast cancer
diagnoses over the past 6 months. There is
a concern that physicians may not be performing breast examinations adequately
or at all. The medical staff is informed
that all female patients will be surveyed asking if they were examined and taught
of the importance of breast self-examination.</li><li>An orthopedic department wants to assess how well it is
controlling post-operative pain. Trained
nurses will be interviewing all patients for 5 days after surgery. Afterwards,
the data will be shared with the department and with individual practitioners.</li></ul><p></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">Clearly, the potential of a Hawthorne Effect in all of the above
examples is self-evident.<span style="mso-spacerun: yes;"> </span>This effect extends
beyond medicine into all spheres of society.<span style="mso-spacerun: yes;">
</span>It’s a psychological phenomenon and we need to be aware of it.<span style="mso-spacerun: yes;"> </span>As an example, when I am reading a medical
study that shows that an action benefits patients, is the action responsible or
are the patients behaving differently because they know they are being
studied?<span style="mso-spacerun: yes;"> </span>This can be rather tricky and
if you’re not tightly tuned in, the Hawthorne Effect will blow right past you.<o:p></o:p></p>
<p class="MsoNormal">Of course, managers and leaders can utilize the Hawthorne
Effect purposefully just to influence behavior.<span style="mso-spacerun: yes;">
</span>They may announce a new ‘research study’ when the intent is really to
modify behavior.<o:p></o:p></p>
<p class="MsoNormal">Is this all just psychobabble?<span style="mso-spacerun: yes;"> </span>Does your own behavior change when there’s
another set of eyes on you?<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com0tag:blogger.com,1999:blog-7323692122514281455.post-20664597599097180652023-10-01T06:00:00.031-04:002023-10-01T06:00:00.149-04:00When Should I Get a Second Opinion?<p> Now that I am employed by a colossal medical center whose
reach extends internationally, many patients land on my schedule seeking a 2<sup>nd</sup>,
3<sup>rd</sup> or even a 4<sup>th</sup> opinion on recalcitrant and unexplained
digestive issues. Many of these patients
travel from neighboring states coming with the hope that yet another
gastroenterologist will crack the code of their illness. Obviously, any patient who seeks another
medical opinion is already dissatisfied, hence the reason for seeking additional advice..
Here is a sampling of some reasons why patients solicit or are sent for new medical
opinions.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"></p><ul style="text-align: left;"><li>Persistent symptoms</li><li>Search for an explanatory diagnosis for unexplained
symptoms.</li><li>Quality check to verify that the original doctor’s advice is
correct.</li><li>Encouragement of family or close friends to seek another
opinion.</li><li>Dissatisfaction with the doctor’s bedside manner.</li><li>Friction with the office staff or the billing personnel.</li><li>Office schedule of original doctor is booked out for months.</li><li>Fear that a serious diagnosis has been missed.</li><li>Wanting to be told that they are not crazy.</li></ul><p></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">Sometimes, obtaining a new medical opinion is an excellent
idea.<span style="mso-spacerun: yes;"> </span>But second opinions can also confuse
and bewilder rather than clarify a medical situation – a point not appreciated
by most patients and families.<span style="mso-spacerun: yes;"> </span>Remember that medicine
is an art where excellent physicians evaluating identical medical circumstances
might offer different advice.<span style="mso-spacerun: yes;"> </span>In medical
conferences that occur every day throughout the country, medical luminaries
discussing a case may have wildly different views on how to proceed.<span style="mso-spacerun: yes;"> </span>So, when your 2<sup>nd</sup> opinion doctor
offers new advice, it may not be better advice, it may just be different.<span style="mso-spacerun: yes;"> Both sets of advice may be rationale and defensible. </span>I recognize that when different advice is
suggested, it reinforces to the patient the wisdom of having sought a new
opinion.<span style="mso-spacerun: yes;"> </span>“I knew my first doctor was
wrong.<span style="mso-spacerun: yes;"> </span>The new doctor suggested something
entirely different!”<span style="mso-spacerun: yes;"> </span>Keep in mind that
a 2<sup>nd</sup> opinion physician also knows the patient was unhappy with the first
doctor’s advice making it more likely that a new path forward will be suggested.<span style="mso-spacerun: yes;"> </span>Will the new route truly lead the patient
forward?<span style="mso-spacerun: yes;"> </span>Hard to say.<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWuX84i1QsrkPrCxwo9uN00JgsfuSGDSnnv3cdEnV0pEqnCnSeze00ZSHT5UwkgxQf_W_NdclS6URXILo4tviAcDQVR-kcAqDwItWUAuUJbJLeRtHssGVAs_XTox5i4edX1SbZXukqDA3WOfuqCNe12RGVJwnUB3ReiGzwiqxW4rXTfPvW0y67q87PnA/s896/Longleat_maze.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="896" height="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWuX84i1QsrkPrCxwo9uN00JgsfuSGDSnnv3cdEnV0pEqnCnSeze00ZSHT5UwkgxQf_W_NdclS6URXILo4tviAcDQVR-kcAqDwItWUAuUJbJLeRtHssGVAs_XTox5i4edX1SbZXukqDA3WOfuqCNe12RGVJwnUB3ReiGzwiqxW4rXTfPvW0y67q87PnA/s320/Longleat_maze.jpg" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><i>The Second Opinion World May Leave You Lost.</i></div>
<p class="MsoNormal">Is it possible that several capable specialists have missed a
diagnosis?<span style="mso-spacerun: yes;"> </span>Of course, but it is
unlikely.<span style="mso-spacerun: yes;"> </span>Medicine never reaches 100%
certainty.<span style="mso-spacerun: yes;"> </span>How much testing would you
consent to or pay for a few additional percentage points of certainty?<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">If I am the 3<sup>rd</sup> or 4<sup>th</sup> opinion on a
patient who has been thoroughly and repeated evaluated, should I simply pile on
more testing?<span style="mso-spacerun: yes;"> </span>Doctors can always find
another test or two that wasn’t done.<span style="mso-spacerun: yes;">
</span>Or, should we counsel these patients that it does not appear that the
specialty of gastroenterology holds the solution to their frustrating
quagmire.<span style="mso-spacerun: yes;"> </span>How many months or years
should any of us proceed in the same direction without making progress?<span style="mso-spacerun: yes;"> </span>For many of these patients, choosing a new
direction makes more sense to me.<span style="mso-spacerun: yes;"> </span>There
is a huge reservoir of healing pathways available ranging from conventional
medicine to complimentary medicine with much in between.<span style="mso-spacerun: yes;"> </span>While I may not know the precise pathway to
recommend, I try to open the patient and myself to new possibilities. This conversation requires a very openminded patient.</p><p class="MsoNormal">If the direction you're traveling never reaches the destination, isn't it time to try a different route?</p>Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.com1