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. 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...

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. So often, our views on an issue change when we are personally affected or exposed.  When this occurs, I believe it reveals hypocrisy on our part.  Shouldn’t our points of view be the same whether we are affected or not?  Of course, it should be but we all know that this is not the case. Here’s a stark example illustrating my point.   Many of us support a policy prohibiting paying ransom for hostages.   Doing so, we argue, only encourages the taking of future hostages.   However, might our intellectual view on this issue be different if one of our loved ones was taken hostage?   I suspect that it would be.   I could have cited ransomware as anothe...

Here’s a scenario that I face fairly regularly in my endoscopy and colonoscopy practice. As readers know, over the past 6 or so years I have been employed in a rather well-known Cleveland-based health care institution.  Prior to that, I was a private practitioner.  During those earlier days, I personally knew most of our scope clientele as they were our patients.  There was a minority of patients whom we did not know who were referred in by their doctors for routine scope exams.  In contrast, in my current employed role, nearly all the scope patients on my schedule are meeting me for the first time. From time to time, a patient who is scheduled for a colonoscopy will call my office asking if an upper endoscopy can be performed at the same time because their heartburn or some other symptom has been active. Which of the following responses are most appropriate? Yes we will gladly add on the extra scope test to assess your stomach and esophagus as this would be an o...

Patients understandably focus on who will be managing the scope during their procedure.  They expect that the proceduralist – a physician, at least so far – is a highly skilled practitioner.  They want accuracy and safety.  Indeed, from time to time, after I have reviewed the risks of colonoscopy, a patient will query me directly on my complication rate, particularly with regard to the dreaded event of a bowel puncture.  They are hoping to hear, of course, that I have never had a procedural misadventure, but I point out that the only gastroenterologists who haven’t been involved in a complication are new specialists who are just starting out.  This is a mathematical issue.  If the perforation rate is 1/2500 cases, and the GI physician has performed 20,000 procedures, then there will have been some adverse events. As an aside,  the term complication does not imply culpability.  They are blameless events that occur at low frequency despite the med...

As I begin this post, the federal government has been shut down for several days..  Neither the Democrats nor the Republicans were able to reach the 60 vote threshold in the U.S. Senate to advance their respective legislative plans.  The GOP insisted that a ‘clean’ continuing resolution (CR) be passed without conditions. Democrats demanded that the government extend expiring Affordable Care Act (Obamacare) subsidies enacted during the pandemic, and restore Medicaid cuts contained in Trump’s One Big Beautiful Bill Act passed months ago as the price of their CR support.  The GOP expressed willingness to discuss these health issues, but only if a clean CR is passed first.  The Democrats countered that tying their legislative priorities to the CR gives them leverage to achieve their desired health policy objectives.  Interestingly, this past March, many Democrats supported a clean CR without adding on their legislative preferences.  Hmm… By the time this is p...

Kids are smart.  We know this because many of us have kids and all of us were kids.  I’m not suggesting that every kid is an Einstein who regards the laws of physics to be... ‘child’s play’.  But in many circumstances, they punch above their juvenile weights to get stuff done.  At times, they are master negotiators.  Here’s a vignette illustrating one of their master techniques.  Act I, Scene 1 “Mom, can I have ice cream now?” “Johnny, of course not!   You haven’t even had breakfast yet!” Act I, Scene II “Dad, can I have ice cream now?   Mom said it was ok.” “Sure, son.   Go ahead.” Sound familiar?   We parents know that we do better when we speak in one voice to our youngsters.   When we don’t, our wily progeny can exploit this with great skill.   Kid vs parents - n ot a fair fight!   The value of speaking with one voice applies to us adults as well.   Let’s look briefly at some rather conflicting mes...

This is the final posting in a 3-part series on the COVID-19 vaccine and related issues.  The first two installments dealt with the public’s waning interest in the virus and the vaccines, the triumph of Operation Warp Speed and the politicization of the pandemic. If you have not read them, I invite you to review them. The spirited opposition expressed by commenters illustrates the continued polarization of the nation on public health,   I expressed astonishment that a public health scourge that was killing us and filling up intensive care units and hospital beds would divide us rather than unite us against our common foe. These days, there simply is no sanctuary against politics.  Mother’s Day, professional sports, the American flag and the plague of a pandemic, to name a few examples, are prey for controversy. personal attacks, demonization, and political exploitation.  What a sad reality. We know that the government and public health leaders did not hit the bu...

Here is the 2 nd of a 3-part series on the COVID-19 vaccine and related issues.  Last week, I opined that COVID-19 is now greeted with a collective yawn by Americans.  We have moved on but the virus is still here.  COVID-19 vaccine interest has also certainly waned.  Another yawn. Commenters who read last week’s Whistleblower post on my Substack platform vehemently disagreed with me. Indeed, I have received more reaction to that post than to any other in recent memory, and the comments are still coming in.  I will offer them, as well as all readers, some directed comments at the conclusion of this post  How do I regard the COVID-19 vaccine?   Over my long medical career, I have witnessed true miraculous medical milestones.   Operation Warp Speed in Trump’s first administration was one of them, which he himself readily acknowledges.  Trump announced proudly during the pandemic that Warp Speed was “one of the greatest miracles of the ages” a...