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 ...

 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...

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...

A recent article in Cleveland’s primary daily newspaper – which is still printed - discussed an intriguing issue.  An Ohio state representative has offered a bill that would require amusement parks to publicize online if any of their attractions are not running.  The bill is offered as a consumer protection measure to inform patrons of the status of park attractions before they travel distances and face pricey admission costs.  Folks will not be amused to arrive at an amusement park to discover that the ride that brought them there is out of order.  Do you think that a family who is notified at the ticket booth that the roller coaster of their dreams isn’t rolling will simply head back to the car head for home?  Imagine those happy kids in the back seat! “Hey kids, now we have time to go to the library and borrow some educational books!” We’ll see if this proposed bill becomes law.   Amusement park owners may push back on what they feel is government encr...

With some regularity, a patient will contact my office and demand a prompt call back. While the patient may be understandably preoccupied with the issue at hand, in most cases there is no medical urgency present.  I take my customer service responsibility seriously.  In fact, with rare exceptions, before the end of every work day, I or my staff have contacted every patient who has reached out to us.  The system works best when all parties are being reasonable and considerate.   Patients have told me over the years of rude treatment they have received from staff as well as medical professionals.   I believe that this does happen and it is inexcusable.   Medical professionals and staff must maintain decorum and high standards even when challenged.   When patients relate these anecdotes, I do not challenge them but I am aware that there may be competing versions of what transpired. Patients also have a responsibility to tend the doctor-patient relatio...

An important part of the human experience is the connections we forge and cultivate with others.  We all have our own universe populated with a cast of characters who play roles in our personal and professional lives.  You might recall the words of a rather well known playwright who began a monologue with, All the world’s a stage, and all the men and women merely players… Familiarity breeds comfort.   Comfort creates satisfaction.   Change triggers anxiety. The three maxims above are not incontrovertible, but they are often true.   Indeed, we have all experienced them throughout our lives. As of this writing, my mother is 90-years-old.   She is managing reasonably well in her own apartment in New Jersey, in the same town where I was first raised over 60 years ago. During one of my recent visits to her, when she was of the tender age of 89, she prepared an amazing and unforgettable surprise for me.   She made me her special meatloaf, the same one ...

“I have a food allergy.” “I have a parasite.” “I have ‘leaky gut’.” “I have esophageal spasm.” These are examples of speculative diagnoses offered to me by patients.   It is natural in the era of the internet, with artificial intelligence (AI) looming, that patients will search for explanatory diagnoses for their symptoms. Who knows?    In time, and sooner than we think, AI’s performance may exceed that of human physicians, as well as other human endeavors.   At that time, AI may be preparing my weekly blog posts as it interferes and takes over the rest of my life. I won’t succumb willingly to this omnipresent and overpowering force, but I acknowledge that it will not be a fair fight. Most often, patient offered diagnoses are wrong, even though an internet search seems to have nailed the diagnosis precisely.   I have fever, fatigue, muscle aches, headaches and digestive issues.   Google let me straight to malaria!   How did my doctor miss thi...

Physicians, at least most of us, are not businessmen.  Yet, we are negotiators.  When I was in private practice, for instance, we were running an actual business.  There were negotiations with our landlord, with insurance companies, with vendors and with new hires.   Now, as an employed physicians, all of these issues – and many others – are out of sight and out of mind.  But I am still negotiating.  With whom, you wonder? I negotiate with my patients. I’m not suggesting that my doctor-patient relationships are cold, transactional events.   Hardly.   But every relationship, either business or personal, requires give and take.   Sometimes one party gives up some space to accommodate a compromise, and other times the partner behaves similarly.   Indeed, every successful relationship that I have participated in or witnessed is a breathing and flexible organism.   Negotiating with patients is less formal than is depicted here. ...

Some time ago, a patient was sent to me for a scope test.  This is hardly a newsworthy event since I do thousands of scope exams every year.  This patient had a known, benign narrowing at the lower portion of the esophagus, which is called a ring.  Years ago, another gastroenterologist stretched the ring which had been catching food on the way down.  My assigned task was to examine the ring and determine if a stretching was necessary.   This introduction of this case is the set up for the point I wish to make.   Too often, medical decisions are based on objective data without sufficient consideration of the patient.   Consider a few hypothetical examples. An MRI of the back shows disc protrusions in the lumbar spine.   A surgeon reviews the study with the patient and explains the rationale for surgery.   However, a detailed review of the patient’s symptoms suggests that the back pain may not be caused by disc protrusion at all.   I...

I spend more than half of my work week performing endoscopic procedures, the majority of which are colonoscopies.  Many of these colon exams are screening colonoscopies, meaning exams performed in the absence of any symptoms, an effort to reduce colon cancer risk.  This is in contrast to diagnostic colonoscopies which are performed to evaluate symptoms or abnormal lab values such as a low blood count or anemia.  Whether I am performing a screening or a diagnostic exam has no effect on the patient’s experience.  However, it may make a huge difference to the insurance company and your out-of-pocket financial obligations.   But I digress… Many of my procedure patients have previously seen me in the office for consultations.   In other words, they are my patients.   It’s likely that after their procedures that they will be advised to return to my office for continued conversations on their condition.   However, many procedure patients are unkno...

What frustrates patients with the medical profession? What follows is not a scientific survey but merely my recollection of patient gripes over the years. Why is my doctor always late? Poor access to doctors and medical professionals.   This vexes patients more than the other challenges that they endure.   They simply cannot get in to see their doctors who are booked out for months.   What good is having a great physician if his or her schedule is locked down?   Sending these patients to an Urgent Care or an Emergency Room might be a convenient play by the doctors and staff, but this does not serve patents well. Rushed office visits.   I hear this all the time.   I’m sure that I’ve been culpable of this offense at times myself. The doctor is running behind and is under pressure to move the visit along efficiently.   But not all patients operate in this mechanized manner.   They need time to collect their thoughts, and we should permit them to ...

Some time ago, a man came to see me requesting a colonoscopy.  His last colon exam was done about 5 years ago.  He is well into his 80’s and has several significant chronic medical conditions.  He wanted reassurance that he did not have colon cancer.  Who wouldn’t want to be reassured of this?  After questioning him closely and reviewing the medical data I advised him that I was not suspicious that he was harboring a colon malignancy.  The patient, however, was not mollified.  As the professional, I advised that in my judgement the risks of the procedure exceeded the potential benefits.  Indeed, this is the risk calculation that physicians utilize daily when advising patients on diagnostic and therapeutic options. While I didn’t categorically refuse to perform the procedure, I was reluctant to proceed.   I asked the patient’s internist, who knew the patient well, to delve into this issue further with him.   As I did not hear back from ...