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. Why is the medical history – the patient’s narrative – so critical?  I have opined in this blog repeatedly that the medical history is paramount, much more valuable than the physical examination or the laboratory and other data.  Of course, there are instances when a finding on the exam or abnormal data cracks the case, but in general, the patient’s own story is most significant most of the time. Indeed, medical professionals, if we are not being careful, can permit abnormal data results to lead us to a trap door which will take us far away from where we should be.   Consider this to be a medical ‘wag the dog’ phenomenon.   Our focus should be squarely on the patient ...

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 numerous posts within this blog cautioning against pursuing second medical opinions.  This can be a tough argument to make as most patients  believe that obtaining additional medical advice is all upside. What could go wrong?  They argue that a second opinion either confirms the existing medical advice or provides new & improved recommendations.  It's not that simple. If readers enter second opinion in the search function of this blog, you will find several posts that point out potential pitfalls of seeking medical advice from new doctors.  It's not all upside. How do I regard my role when offering a second opinion? I generally regard my second opin...

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. Patients regularly initiate inquiries starting with, ‘ could it be …’   This usually follows my opinion on their symptoms and the available diagnostic or therapeutic options.  Patients have often conducted their own research, generally on the internet, or have received diagnostic advice from folks they know who have suffered similar symptoms.  It’s perfectly natural, for example, if a patient’s roommate had his gallbladder removed for the same stomach issues, that the patient may believe that his gallbladder needs to be donated to science also.  (Note to reader:  just because the roommate underwent gallbladder removal doesn’t necessarily mean that this was the...

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. In our office, sometimes our secretaries listen to background music.  A few days before writing this, while walking through the office, I heard an iconic song, written and performed by a songwriting legend.  Even someone like me, who was never deep into the music scene, automatically recognized the song.  I asked our receptionist, a young lady in her 20’s, if she knew the song that was playing.  She didn’t.  I identified the song for her and asked if she knew it.  She didn’t.  I named the singer and asked if she knew him.  She didn’t.   In order to maintain a high level of suspense, I will unmask the song and the artist for readers at the ...

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, a young man came to see me in the office accompanied by his mother.  I cannot recall a single detail of what led him to see me.  But I remember very clearly a medical intervention that he had as an infant that bore no relevance to the forgotten reason for his visit.  One of the tasks that physicians perform on patients we see is to review the past medical history (PMH).   We do this to assemble a medical portrait of the individual who is before us.   Oftentimes, the historical medical events are not directly relevant to the issues at hand.   But often they are.   For example, if a patient has been experiencing chest discomfort, and the PM...

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 written about labor unions on the blog from time to time.  I have lambasted the teachers unions , for example, for their self-serving positions during the Covid-19 pandemics.   On the other hand, I have supported hospital nurses organizing as the power imbalance between them and their employers has stifled needed reform.  And I have mused about employed physicians who are threatened with burnout and endless burdens seeking union protections. Earlier on the day that I penned this post, I read of a labor agreement between a dockworkers union and its employer.   Fortunately, a strike was avoided.   The agreement has yet to be formally ratified.   ...

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 ...