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 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. 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...

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...

Labor Day will greet us on the morrow.  As a reminder, this became a federal holiday in 1894 after President Grover Cleveland signed a congressional act into law.  Although at first the holiday applied to federal workers, over time all US states, territories and the District of Columbia observed the holiday. I have written over the years that our observance of many of our federal holidays has drifted far from their original purposes. I find this disappointing although I am as culpable as anyone. Consider, for example, how each of us marks Independence Day, Memorial Day or Christmas, and compare this to the holidays' original meaning. Labor Day should recall the struggles to achieve fairness and safety in the workplace that began well over a century ago.  And while enormous progress has occurred, the task has not been, and may never be, completed.  Celebrate Labor Day! Labor Day, like many other holidays, is a day that one is encouraged to purchase cheaper mattresses,...

 E pluribus unum has been regarded as our national motto since 1776.  This motto has remained the same but I wonder if we have remained true to its meaning. This Latin phrase in English means, out of many, one.   This certainly encapsulated the dream of the Thirteen Colonies who aspired to join together to form one nation.   Coincidence that the motto has 13 letters? This motto appears on the Great Seal of the United States and on our currency.  I just pulled out a $1 bill and verified this.  If you wish confirm this yourself, then I suggest having a magnifying glass in hand! For the purists among you, our official national motto, In God We Trust , was established in 1956 by an act of Congress. It seems that the forces of division in our country have gained strength and momentum, particularly over the past decade.  Our legislature and the populace are sharply polarized.  Politics does not seem to be a forum for a respectful exchange of views...

All of us have viewpoints on various issues and policies.   We have opinions on the criminal justice system,  immigration issues,  and eligibility for health care benefits, to name 3 examples. For many of us, our opinions evolve as we gain life experience and wisdom, which change how we view the world.  I regard this as personal growth which we should all welcome and aspire to.  I acknowledge that there are some bedrock principles that should remain stable. For instance, the tenet that physicians should serve their patients’ interests and not their own should persist.   With age, comes wisdom. We have also seen folks change their positions, sometimes rapidly, using a pathway different from the personal growth process I noted above.  Views can change rather suddenly when an issue affects someone or a loved one more directly.  For instance, a champion of strict law and order might feel that leniency is in order if his own son faces expulsion from a ...

I've never worn the uniform.  The military draft was long gone by the time I came of age.  My father served in the Navy for 39 months in World War II.  One of his brothers was a Marine and other served in the Army.  I regard them and millions of others as part of the greatest generation.  Defending America and its interests was inbred then.  There was unity of purpose.  What were the stakes?  Merely saving the world from domination and conquest.  They understood that this was a fight worth fighting. Had President Truman not ended the war in August 1945, my father, along with hundreds of thousands of others, may have been deployed to Japan.  Had that occurred, it is possible that these posts and it's author may never have existed.   What would America and Americans do today if free peoples on faraway shores were threatened?  Does our turning away from Ukraine as they defend against a ruthless and revanchist dictator guide o...

Next month my schedule will change.  I will henceforth be off on Fridays with my work week truncated to Monday through Thursday.   I am excited to be enjoying a long weekend every weekend.  And while the schedule change is relatively minor, this event does feel like an important career moment for me.  It is the first step on a journey that will ultimately lead beyond my professional career.  It is this recognition that makes this modest schedule modification more significant than one would think it deserves.  As some readers know,   my current employed position has been a dream job for me.   Prior to this, I was in a small private practice, which I loved, but was much more challenging professionally and personally.   My partner and I ran the business.   Working nights, weekends and holidays were routine for decades.   On an on-call night, if I slept  through until morning, I felt as if I had won the lottery.   And w...

Over the last decade, I’ve shared many vignettes about many gastroenterology medical conditions, diagnostic strategies and treatment options.  However, this is not a medical blog; it’s a medical commentary blog.  In other words, these posts are not a resource for readers who want understand how the pancreas works or how best to treat Crohn’s disease.  My angle would be more likely discussing why patient with Crohn’s might think twice before pursuing a second opinion.  I don’t present the diagnostic possibilities of abdominal pain that could serve as a primer for patients.  But I might point out why a CAT scan casually ordered on patient with stomach pain can tear open Pandora’s box. Pandora should have 'kept a lid on it!' So, in this spirit I’ve prepared a 3-question quiz for readers with the answers found at the foot of this post.   Regular Whistleblower readers will cut through all three of them like a buzz saw    Even t wo of correct answers ...

I am a casual viewer of professional football.  I have come to realize that sports for many who live in Cleveland is a religion.  Many of these religious zealots who have invested so much time and devotion to the Cleveland Browns have become apostates after what have been seasons of disappointment and failure.  Indeed, as of this writing I suspect that it is unlikely that the Browns will reach the Super Bowl this coming February 9 th , but one can always hope for divine intervention. But I am not writing to opine on the Browns’ performance.   For decades, I have been jarred by the violence of the game and the devastating injuries that routinely occur.   Indeed, one can expect players to be walked off or carted off the field in just about every game.   I treated a Cleveland Brown in his later years who had played for the team for 13 seasons in the 1950’s and 60’s.   I think every part of this body either hurt, didn’t work well or both.   He was a...

Readers of this blog are well aware of my frustrations and criticisms and even a soupcon of anger regarding the disappearance of customer service in our society.  This unfortunate reality is undeniable and is only going to worsen.  Corporations and businesses – with few exceptions – abuse their customers because they can, knowing that we have no recourse available.  Do you think the battle of Man vs Airline Industry, for example, which I fantasize over, will achieve a just outcome?  Two recent developments are relevant to this rant.   First, businesses are poised to start charging a fee to customers who are returning unwanted items.    And secondly, Amazon Prime will soon be showing commercials during their broadcasts.    Of course, for a surcharge, customers can still enjoy Amazon streaming without ads.   Let me distill this down using plain language.   We are going to further squeeze our already squeezed customers because we c...

Recently, the CEO of UnitedHealthcare was gunned down in a brazen and calculated act by a murderer. The alleged killer had a life of privilege with top drawer education.  He was the valedictorian of his high school class.  We still do not know the reasons underlying his radicalization against the health care establishment. It has been astonishing to hear and read many voices expressing sympathy and understanding for this heinous act.   The enemy of my enemy is my friend.     Really?   It is galling that some out there believe that acting against a health insurance executive should be considered a mitigating factor in a murder.   Indeed, a U.S. senator commenting on the murder decried violence but then added that ‘people can be pushed only so far’.     Public outrage to this forced her to do some clean up a day later, but her initial instincts and analysis remain in plain sight. The senator needed to 'clarify' her initial remarks. If a m...

We can all be thankful that the election is over although half the nation is less than thankful for the results.  Hopefully, raw feelings were set aside this year's Thanksgiving a holiday that has often been the setting of spontaneous political combustion.  My own electoral success rate in this year’s election would translate to a grade of ‘F’.  Nearly all of my selections lost.     But in a democratic republic, we must respect the process and the results regardless of the outcome.   Indeed, I am doing so now. He's thankful he was spared! We have heard the perennial whining about the Electoral College urging its abandonment in favor of relying instead upon the popular vote.   Not surprisingly, these proponents are usually, but now always, those whose candidates have lost elections and they are seeking a new pathway to success.   Casting the Electoral College aside would require a constitutional amendment, a very heavy lift. I would assume th...

A few days hence, Independence Day will be upon us.  This commemorates the date that the Continental Congress adopted the Declaration of Independence.  Two days prior, the Congress voted unanimously to separate from Great Britain, but the document had not yet been printed.  One would hope and expect that this occasion would summon our better angels as we draw together to celebrate the miracle of the American experiment, particularly as authoritarianism abroad has gained strength.   Sadly, division and disunity have established a firm foothold in our national psyche.   Even the very symbol or the United States – the Star-Spangled Banner – has become a separating force.   Recently, an American flag was flying upside down at the home of a Supreme Court justice.    Legal?   Yes.    Unifying and proper?   No. A looming presidential election – heretofore a unifying exhibition of patriotism – has infected us with partisanship and ...

I am asked with some regularity whether I am aiming to retire in the near term.  Years ago, I never received such inquiries.  Why now?   Might it be because my coiffure and goatee – although finely-manicured – has long entered the gray area?  Could it be because many other even younger physicians have given up their stethoscopes for lives of leisure? (Hopefully, my inquiring patients are not suspecting me of professional performance lapses!) Interestingly, a nurse in my office recently approached me and asked me sotto voce that she heard I was retiring.    “Interesting,” I remarked.   Since I was unaware of this retirement news, I asked her when would be my last day at work.   I have no idea where this erroneous rumor originated from.   I requested that my nurse-friend contact her flawed intel source and set him or her straight.   Retirement might seem tempting to me as I have so many other interests.   Indeed, reading and ...

Tomorrow is the last Monday in May, Memorial Day, now a federal holiday whose origins began in the postbellum era.  My father was among the Greatest Generation having served for 39 months during WWII.  Fortunately, he remained stateside. Presently, no one in our family is wearing the uniform.  We are not mourning a fallen soldier.  But many families are.  For many of them, every day is Memorial Day. I’ve been writing this blog for 15 years.   Several posts have criticized our government, politicians, various industries and even my own profession.   What might my fate be if I were blogging from some other nations? American Military Cemetery in Normandy Freedom is not free.   Authoritarianism seems to be on the rise, even here at home. To all those who are honoring the memory of a loved one who served, we can never thank you enough. May their memory be a blessing  

You might think that gastroenterologists like me are conversant with food allergies.   You would be wrong.   Here is a second misunderstanding you likely harbor.   Most individuals who believe or suspect that they are suffering from a food allergy have no allergic condition at all.   A true allergic reaction involves the firing off of one’s immune system in response to an external stimulant resulting in a rash, wheezing and other characteristic allergic responses.   Poison ivy, for example, is an allergic reaction.   Nausea resulting from an antibiotic is not an allergic reaction.   Physicians, of course, appreciate this distinction.   This is why when you tell us you are ‘allergic’ to a medication, we will ask you specifically what the reaction was.   In my experience, most of these ‘allergic reactions’ are routine non-allergic side effects.   Often enough, a patient will claim to have a penicillin allergy, for example, but ha...

Euphemisms are omnipresent.  Recently, I learned a human resources term called rightsizing.  This sanitized version sounds a little softer than employee layoffs, but they mean the same thing.  In the near term, New York City will implement congestion pricing when new Yorkers who drive through Manhattan’s central business district will be forking over 15 bucks for this privilege, $36 if you’re a large truck.  These fee amounts will vary depending upon the time of day traveled.  I suppose the marketing folks felt that the term congestion pricing was more palatable than driver shakedown .  Just a year ago, I railed against another form of customer extortion known euphemistically as a resort fee, when guests' money is essentially confiscated each day that they could have used to purchase goods or services they didn’t need or want.  Here’s the resort fee link but make sure you’ve taken your blood pressure medicine before clicking. Recently, Wendy’s, the...

Advertisers are masters at knowing how certain words and phrases will affect us.  Consider some of the seemingly innocent words and phrases below and how they have an emotional impact. IRS Big Tech Police officers Corporate profits Millennials Congress The Nursing Profession. Over time we have been conditioned to experience emotional responses to various phrases and labels.   For instance, there is nothing intrinsically evil in businesses earning money since this is an expected and desirable outcome.   Yet, ask us to react to the term corporate profits and I suspect that most of our reactions would trend negatively.   It’s unlikely that a political candidate would proclaim in an ad or a speech that he or she wants to be a Champion of Corporate Profits! Private Equity certainly merits inclusion in the above list.   Most folks have an unfavorable opinion of PE even if they don’t fully understand this business model.   And some of the action...

 I feel it is more challenging than ever to carve away the chaos and destruction so that we can focus on what we should be thankful for.   Yes, there is beauty in the world which we must seek out and cherish.   Yes, there is kindness and generosity in our midst which we must champion and promulgate. Yes, there is dialogue and open mindedness which we must resurrect and cultivate. Skimming national and international current events on any day reinforces the reality that the space to find gratitude is smaller that it used to be.  But it is there. Never doubt that a small group of thoughtful and committed citizens can change the world;  indeed it's the only thing that ever has.    Margaret Mead On this recent Thanksgiving, I hope that all of you had blessings to celebrate.  Perhaps the task will be easier for all of us next year.