MD Whistleblower

Stomach Pain and Mind-Body Relationship This is a delicate issue and must be approached by medical professionals with care.  Of course, it is an established fact that psychic distress can be responsible for physical ailments.  Did you ever get a headache after having an argument?  Were you one of those students who experienced diarrhea before final exams? This past week, I saw 3 new patients in my practice with abdominal distress all of whom volunteered that they felt that emotional stress and anxiety were the culprit, or at least a major contributor to their gastro issues.   Obviously, when the patient has this level of insight and expresses it to the physician, it paves the way for a fruitful conversation. But, this is not always the case. When I see new patients with long histories of unexplained abdominal complaints, I do not initially raise the possibility of a psychic connection.   I think this is arrogant and has the potential to communicate the wrong message to the patient,

Would a doctor ever order a diagnostic test that was not medically necessary?  I’ll give you a hint to this ‘yes or no’ question; the answer has 3 letters. Of course, in a perfect medical world, every medication would perform flawlessly with no adverse reactions.   All medical tests would be justifiable and painless.   Physicians’ diagnoses would always be accurate.   Drugs would be affordable.  All patients would recover from whatever ails them. And doctors would never be late for their appointments! Sound like the medical world you know?   I doubt it.   The medical universe that I inhabit is riddled with flaws and imperfections.   It is, after all, a human endeavor which guarantees variable outcomes. Sometimes, the patient just doesn’t get better. So why would doctors like me at times order medical tests that are not necessary?  Wouldn't this violate my professional oath and code of conduct? Years ago, when the plaintiff’s bar was on fire suing doctors, many physicians or

My last blog post contrasted the experience of being an employed physician with being a private practice doctor. I expressed that at this stage of my career that I much preferred being employed to running a medical practice. (This means that I can now spend all of my time just being a doctor!) But there are desirable features of private practice medicine that simply do not exist in the medical megalopolis where I now work. Not surprisingly, the vibe is different in a gargantuan organization that employs tens of thousands of caregivers, staff and support personnel who serve millions of patients domestically and overseas.  It is simply not possible to recreate the intimacy that I enjoyed in my prior small practice with my patients and my own staff.   Here’s an example that will illustrate my point effectively. Here's how I found my doctor! For as long as I’ve been practicing medicine, I’ve queried every new patient who came to see on how they ended up with me.   Yes, there were a

 Over the past few weeks, several patients I saw faced a common challenge.  This is a situation I have confronted in the past, but what was unique recently is that multiple patients in a short period of time were in the same situation. This was not a medical issue.   In fact, many of the individuals were feeling perfectly well.   This was not a financial issue, such as the patients were in the dreaded ‘doughnut’ or their particular medications were not covered by their insurance companies.   This was not a second opinion request from patients who suspected that their gastroenterologist (GI) of record may have missed something. Here’s what happened.   A gastroenterology practice that had been in the community for decades closed down.   Suddenly, tens of thousands of patients with an array of digestive maladies were let loose to find a new digestive nest to occupy.   I’m sure that every GI within 20 miles of my office has been affected.   Many of them have landed on my schedule and I

Recently, I read about a judge’s decision on a legal dispute.   The facts aren’t important here.   As I read my newspaper’s summary of the decision, it was clear to me that one side won and the other side lost.   Yet, both sides claimed victory.   This is commonplace in the public square where a clear loser boasts of a victory that even a casual observer recognizes to be magical thinking.   In the case above, the loser who claimed victory wasn’t a corporate PR spinner, but was the county prosecutor. Folks seem to have such a difficult time admitting error, poor judgment or failure.  Here’s a hypothetical.  A man sues a company alleging wrongful termination.  In addition to demanding that he be re-hired, he has asked for an apology, a public clearing of his name in boldface on the weekly company newsletter, back pay with benefits, and $5,000 to cover medical and psychological expenses incurred as a direct result of his firing. The judge awards the man all of his demands, bu

As my readers know, I have been a parsimonious practitioner during my entire career.   By this, I mean that I believe that less medical care leads to superior medical outcomes.   I have devoted several dozens of posts on this subject within this blog.   This is my medical philosophy.    Other physicians who see the world differently would challenge me suggesting that I deny patients necessary diagnostic tests and treatments.   Personally, I think that I have the better argument, but so do they. Interestingly, over time patients tend to select and stay with physicians who share similar philosophies.   For example, a patient who believes that regular diagnostic testing, frequent labs, a CAT scan now and then, prescriptions for various symptoms is unlikely to remain my patient because of a philosophical gulf between us.     If that individual, for example, expects antibiotics – as his former physician obediently provided – for what the patient believes is ‘diverticulitis’, and I demur

Some time ago, I flew with my youngest kid, then a high school senior, on a college visit.  He’s the last of 5 youngsters, so I’ve had my share of these visits to various centers of knowledge where young minds are molded to face uncertain and unknown futures.   While I’ve never found these visits to be substantively valuable, they were of great value to me as it was fun to be with them on these exciting excursions. The Hallowed Halls of Higher Learning Photo Credit The formats of the school presentations are superimposable.  There’s an information session, which serves as an infomercial that tries to draw students to apply.  Schools favor receiving large volumes of applicants so that their acceptance rate will be lower and they will appear to more selective than they actually are.   How cynical of me to suggest that there are forces in academia that might be pursuing a self-serving agenda! These sessions are led by effervescent young cheerleaders who present a power po

I don’t advise patients to quit smoking. I don’t exhort alcoholics to stop drinking. I don’t preach to my obese clientele to slim down. And I don’t lecture patients to get the COVID-19 vaccine. This may be the point were some readers are wondering, “What kind of doctor are you?” For the record, I do not endorse or advise cigarette smoking, alcohol addiction, obesity or careless behavior during the pandemic.   I favor temperance in my own life.   I exercise.   I am attentive to my BMI. And I wear a mask and have received my COVID-19 injections with enthusiasm. But it has never been my style, either professionally or beyond the office, to tell people what to do.   Once folks reach a certain age, which for many are the teenage years, you just can’t make them do stuff.   Every parent understands this.  This does not mean that I don’t have influence over people who trust me.   I do and I use it.   However, i t’s a process issue.   How best can we help individuals make sound deci

Most of us recognize that Operation Warp Speed was the name given to COVID-19 vaccine development, which succeeded brilliantly and in record time.   Early on, no one predicted that by the end of 2020, two safe and highly effective vaccines would gain emergency use FDA approval.  There were other developments that also rolled out at warp speed.   Telemedicine is now omnipresent.   Prior to the pandemic, telemedicine existed in pockets throughout the country, but most physicians and patients had never participated in it.   The plan was for it to gain a much larger footprint in the medical landscape in the years to come.   Instead, the transformation occurred in weeks.   Physicians and patients who previously would have rejected the notion of a distant and impersonal virtual visit were now enthusiastic participants.   Patients and caregivers of all ages became quite conversant with Zoom and other similar platforms.     'The Doctor Will See You Now' The urgency for warp speed a

It is a pleasure to give patients favorable medical news.  It’s an even greater pleasure to receive it.  Technology has replaced so much of our wholesome and human interactions.  Book stores are disappearing.  Handwritten thank you notes?  Nearly extinct.  The corner hardware store where the owner knows your family?  Today, we have Big Box warehouses where, if you hire a private investigator, you might be able to find a hiding salesman.  Need a salesman?  Hire Sherlock! The joy and relief that a patient and family feel when the physician says that all will be well has no technological equivalent.   We have all had anxiety about our own health or the well-being of those we care about.   When the physician enters the room to deliver news, there is fear and tension knowing that lives may change after just a few sentences are uttered. Fortunately, the vast majority of the news I deliver is just what patients and families want to hear. The biopsy result was benign. The

 The nation’s racial upheaval, particularly vis a vis law enforcement, has shown us the value of the skill of de-escalation.   A situation arises and several outcomes are possible, although some are clearly preferred.  The specific technique and approach utilized may determine the end result.  A range of options are often available.  What can make these situations so difficult to unravel afterwards is that an option that may lead to escalation may be deemed to be acceptable, according to the training protocol.  In other words, even the approach taken was acceptable, there may have been a better way. Obviously, we all endorse training and practices that has the highest probability of bringing calm to a potential combustible situation.    I expect law enforcement – the professionals – to pursue de-escalation as their default mode.   But, the citizenry can and should do its part to de-escalate.     If all parties share the desire for a calm denouement, then it is much more likely that t

  I have seen many alcoholics during my gastroenterology career.   It is likely in the majority of cases that I was not aware of their abuse history.   Patients often deny or minimize their alcohol history when queried.   “Do you use alcohol regularly?” “Only socially.” At this point the physician and the patient engage in a linguistic tete-a-tete on the precise meaning of ‘socially’. Patients are more forthright about their habits when they have a medical condition that has a clear an obvious connection to alcohol, such as jaundice or liver injury.   And, if family members are present, they often serve as fact checkers and truth tellers. What is my approach to these patients?    Do I wave my arms and preach like an evangelist that they should throw their bottles away?   Do I tell them that they must quit or face medical damnation?  Do I threaten to sever them from my practice if they persist with their addiction?   I have adopted a rather different approach.   I do not advis