MD Whistleblower

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. When an individual is hired to do a job, one would think that his or her skills would be carefully assessed prior to tendering a job offer.  Let me offer some examples. If one is applying to a newspaper (yes, they still exist but print editions will soon be visible only in journalism museums) seeking to become a reporter, the hiring professionals will carefully scour through the applicant’s prior writings.   If writing well and under pressure are job requirements, then the newspaper will want to verify that the applicant has these skills.   It’s possible that the applicant would be asked to submit a writing sample on the spot. If a man is applying to become a salesman in...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. I have had 3 jobs in my long career in gastroenterology.  My current one will be lead me to retirement, but I have no firm date in mind.  In fact, it could be years away.  I have reached a station in life where I asked routinely if my retirement is imminent.  I hope that these patients are inquiring wanting me to stay on rather than to leave the scene! My current employed position has been the most enjoyable and satisfying, particularly at this stage in my professional life.   In my current post, I have divested myself of the most onerous aspects of medical practice – hospital medicine, nights & weekend work and on-call responsibilities.    Yes, it’...

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

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

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

Medicine is based on science.  But it’s not all science.  There are phenomena that occur that physicians simply cannot explain.  Folks recover from devastating illness, for example, when the medical professionals were resigned to another fate.  And while doctors and scientists rely upon the scientific method and medical evidence, the public has a wider reservoir of tools for healing and support.  Sometimes physicians do as well.  Hope and prayer are in heavy use every day even though these actions fall outside of the traditional scientific paradigm.  All rational creatures behave irrationally at times.   It is still true that many hotels will not have an official 13 th floor in order not to spook superstitious guests.   Crazy or good business practice?   Some may even say it is not rational for a scientist to be religious claiming that science and faith pose a conflict.   Do Faith and Science Intersect? Patients and the rest of...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. My readers know of my trepidation and angst regarding the unstoppable artificial intelligence (AI) tsunami that will disrupt our world.  It will make the arrival of the internet seem quaint by comparison.  Just as we cannot fully contemplate the potential benefits, we cannot fathom the potential harm and destruction it will wreak.  There will AI actions that will cause harm and benefit simultaneously.  For instance, once perfected, driverless vehicles will operate more safely than human controlled cars and trucks.  Former drivers will now be passengers who are free to engage in professional or leisure activities.  However, if you currently earn your living as ...

Cologuard has become a popular colon cancer screening option.  Indeed, it has many advantages over the traditional colonoscopy. Refer to the list below. No prep! No prep! No time off of work. No driver needed. No procedural risk. Done at home. No driving or other restrictions afterwards.\ Much less expensive. Did I mention there is no prep:? Wow, Cologuard sounds like it will be hard to beat.  Not so fast! Cologuard is a sophisticated stool DNA test that detects altered DNA as well as microscopic blood in the stool. Studies have shown that it detects over 90% of colon cancers.   Keep in mind that the overwhelming number of patients undergoing colonoscopy do not have cancer so that this statistic doesn’t apply to them.   How does this stool DNA test perform with respect to colon polyps, which are the target lesions during colonoscopy?    Cologuard detects only 42% of larger precancerous polyps which seems to me to be rather lackluster performance.  ...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. I did hospital work for 30 years until I accepted a position almost 7 years ago as an employed staff gastroenterologist at a rather renown Cleveland-based medical institution.  I have been enjoying the luxury of practicing outpatient gastroenterology exclusively, freed from the rigors of hospital work and weekend and on-call responsibilities.  It’s a job description that I feel I have earned after 3 decades of hard labor, but I was lucky that this position was available to me. During my hospital career, I estimate that I have placed a hundred or so feeding tubes, primarily in elderly patients, many of whom were demented.   (In retrospect, gastroenterologists like me were p...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. Last week, I shared my thoughts on the essential physician skill of delivering serious medical news to patients. This week, as promised, I share a dialogue between me and a patient with some editorial comments intercalated in italics.  This is not a real patient, but the scenario I created is highly realistic and familiar to medical professionals and to many readers. While I welcome reader comments of all stripes, please keep in mind that I did not endeavor to cover every aspect of this issue.   I tried to emphasize some major points.   Now, onto the vignette. Comments of all stripes welcome on this and every post. Joe is a 50-year-old man who is about to undergo a routi...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. Life changes in an instant.  This truth becomes more self-evident as we age, although even the young may have to learn hard lessons before their time.  We may be comfortably coasting along in a carefree manner only to have a single phone call or a text shatter our equilibrium.  Certainly, every reader of these posts has had this experience.  I am referring here to an unexpected change of fortune.   It’s quite a different scenario if one has time to prepare for a disruption, such as knowing that you will lose your job in 6 months.   In this example, there is time to prepare and to forge an alternative pathway so that when the current job ends, in a best-case ...

I spend most of my time these days in the endoscopy suite.  Most of these patients are meeting me for the first time. The patients seem quite accepting that a perfect stranger will be performing their medical procedure.  This is one of the realities of practicing in an institution that manages an enormous volume of patients.  The patients assume that they have been linked with a competent practitioner.  This is analogous to a patient who is scheduling a chest x-ray or a CAT scan.  The patient has no idea or concern over which physician will be interpreting the films. They assume competence and no longer need an established rapport.  What I will state next may seem bizarre to readers, but stay with me on this.   From time to time, I have difficulty ascertaining the reason that a patient has been sent for a scope examination.     More often than you might think, the patient is unclear why the test was scheduled.   “My doctor ordered it,”...

 A few days prior to penning this post, I had an unexpected but valuable educational lesson.  The experience was brief but its effects are still lingering with me. Not surprisingly, when a physician becomes a patient, he or she views the medical profession through a different lens. For instance, much of the medical advice that we doctors blithely dispense to patients, feels a little less casual when we doctors are on the receiving end.   Consider the following example. Physician Dispensing Medical Advice:   So, it’s time for your yearly labs.   I see that you are due for your colonoscopy, so I’ll arrange this. And, are you ready to get that hernia fixed? Physician Receiving Medical Advice: So, it’s time for your yearly labs.   I see that you are due for your colonoscopy, so I’ll arrange this. And, are you ready to get that hernia fixed? I’ll let my discerning readers decide which of the above scenarios is easier on the doctor.   Time for your...

On a regular basis, physicians receive calls or communications from patients who want to schedule their own scope examinations of their colon or stomach regions.  These requests are solely from patients without any input from medical professionals.  A few days before writing this, a patient contacted our office to ask if we would perform an scope exam (EGD) of the esophagus and stomach regions at the same time as his previously scheduled colonoscopy to evaluate his cough.  This was his idea.  No physician or medical professional was involved. We summarily decline these requests.   If one of my own patients is making a scope exam request, I may acquiesce but only after having a dialog on the issue.   I do not extend this leniency to patients I do not know and aim for access onto my scope schedule. I believe that patients should not be permitted to order diagnostic tests and procedures.   While this may seem self-evident to readers, I surmise that ma...

While folks across the country will gather around their holiday tables, I suspect that conversations won't be focused on the First Thanksgiving when the Pilgrims broke bread with the Wampanoag Native Americans over a 3 day feast in 1621.  There was no pumpkin pie or cranberry sauce served then, and it was more likely that venison was on the table than turkey.  Sometimes, myths are more fun than facts. The First Thanksgiving at Plymouth The space for thankfulness has narrowed, but it is still there and we must do our best to seek it out. This task, of course, does not need to be restricted to only one day each year. It seems more challenging than ever for us to carve away chaos, polarization and discord so that we can focus more clearly on what we should be thankful for.   Yes, there is beauty in the world which we must seek out and celebrate.   Yes, there is kindness and generosity in our midst which we must champion and emulate. Yes, there is dialogue and ...

I think that I’m now practicing the best medicine of my  career.  What’s the explanation for this?  Am I smarter now?  Have I simply aged well like fine wine?  Am I delusional?   Have I lowered my professional standards? Consider this traditional Jewish fable, which will help me to explain my newfound enhanced professional performance. A man complains to his rabbi that he is overwhelmed in his small apartment filled with children, his wife and his in-laws.   The walls are closing in on him and he is desperate for relief. The rabbi counsels the man to bring a goat into the apartment.   The man is perplexed and believes this will only worsen his dilemma. The rabbi persists and the man complies Months later, the man returns and wails that the situation is worse than ever.  The goat has made the situation intolerable.   The rabbi directs him to remove the goat as soon as he returns home. Days later the man return and than...

Many referrals to gastroenterologists like me originate from emergency rooms.  Patients seen there with all manners of abdominal pain, nausea and vomiting, bowel disturbances and rectal bleeding are typical examples of this.  Chest pain is another common issue that emergency rooms and primary care specialists send to gastroenterologists, which we often find to be vexing to explain.  I have been through this exercise for a few decades now.  Here’s how it goes down. A patient experiences chest pain and seeks care in an emergency room fearful that his heart is the culprit.   Emergency room personnel take a careful medical history, examine him and do all of the necessary testing and confidently conclude that the heart is well.   No explanation for the pain is determined.   Here’s what this patient should be told. ‘Your heart is fine.   We’re not sure what’s causing your chest pain.   Please arrange to follow up with your primary care physic...