MD Whistleblower

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 anger.   How can we emerge from this labyrinth?    There

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 studying, two longstanding personal pleasures, could be ext

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 has no clue what the reaction might have been.  

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 fast-food establishment, anno

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 actions committed by PE justify sus

 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.

One pleasure that I engage in regularly is taking time simply to think and to collect my thoughts. I don’t have a dedicated time for this pursuit; I can seize the moment at any time.   Often, I am on a walk or maybe simply driving somewhere.   I use these times to rove through recent happenings in my life and in the lives of those I care about.   Or, I might reflect – some might say ruminate – over a news item or opinion piece that I have read.   There is no agenda.   My mind simply roams and wanders stopping periodically at various unplanned destinations.   Think of this experience as akin to entering a large bookstore (younger readers may need to google here) without a specific title in mind.   You simply start ambling through the aisles sampling various books until you find one or two that meet your fancy.   The journey, as I see it, is a central part of the adventure.   Contrast this with purchasing a specific book on Amazon.   I’ve purchased books both ways, but one of these o

Trust is the central element in our national motto.  Do you recall this 4-word phrase?  If you need a reminder of this iconic verbiage, just grab a coin or some paper money and you’ll find it there.  Perhaps, you can’t recall the motto.  Since we don’t study our money when making a transaction, our trustful motto may remain buried in the background – invisible while in plain sight.  I’ll bet that some curious readers are scanning a dollar bill right now!    As our trustful motto seems out of view, so has trust across society become much less visible.  When we do stumble across it, it can feel as if we have struck gold.  Years ago, for example, I wrote a post about a proprietor who showed me such a high level of trust that I memorialized the incident in this blog and will never forget the vignette.  The trust vacuum seems most evident in our political space.  The citizenry does not trust elective officials, particularly those of the opposing political party.  This phenomenon has sp

The nation celebrates Labor Day on the morrow.  This holiday was created in the later part of the nineteenth century in response to immoral and abusive conditions for workers.  In that era, 12 hours shifts, 7 day workweeks and child labor were all routine.  Organized labor expanded over the ensuing decades leading to legislative and societal guardrails protecting workers from abuse and exploitation. Despite continued reforms of the workplace and fairer treatment of workers, tensions remain between management and labor.  At this very moment, the United Auto Workers has overwhelming authorized a strike in the event that union leaders decide that this is necessary. A typical Labor Day scene While this holiday has deep roots in organized labor, keep in mind that most American workers are non-union, and their work should be honored as well. Regrettably, but understandably, the true meaning of Labor Day and many other federal holidays is not top of mind for most Americans.  These commemorati

Increasingly, physicians today are employed and most of them willingly so.  The advantages of this employment model, which I will highlight below, appeal to the current and emerging generations of physicians and medical professionals.  In addition, the alternatives to direct employment are scarce, although they do exist.  Private practice gastroenterology practices in Cleveland, for example, are increasingly rare sightings.  Another practice model is gaining ground rapidly on the medical landscape.   Private equity (PE) firms have   been purchasing medical practices who are in need of capital and management oversight.   PE can provide services efficiently as they may be serving multiple practices and have economies of scale.   While these physicians technically have authority over all medical decisions, the PE partners can exert behavioral influences on physicians which can be ethically problematic. For example, if the PE folks reduce non-medical overhead, this may very directly affe

We celebrate Independence Day this year at a time when the country is fracturing deeply along political, ideological, moral and religious lines.   The nation hasn’t been this divided since the turbulent 1960’s when we were rising in anger over the lies of Vietnam, the boiling over of the civil rights movement, the heated struggle for racial equality, the assassination of political and moral leaders and the women’s liberation movement.   But we managed to get through all of this even though many elements of these struggles are ongoing.   Important progress has been made and must be acknowledged.   Hate and anger today are omnipresent.   Yesterday’s heroes -police officers, judges, the FBI, public health leaders, news anchors, college professors – are now demonized.   How did we allow this to happen?   Are we supporting these darker forces or pushing back?   Is there a way out? I believe there is but enough of us will have to decide that comity, civility and serving the greater good

For most of my life, there has been a tipping disorder in this country.  Too many of us were undertipping those who served us and depended upon tips for their livelihoods.   At times, servers in restaurants would be stiffed receiving a paltry tip when they deserved more.  In general terms, increasing a tip from 15 to 20% means much more to the server than it does to the patron. Other occupations such has hotel workers, airport porters, cab drivers, tour guides, bartenders, valets and food deliverers – to name a few – depend upon the generosity of their customers.   Traditionally, a tip was a reward for good service.   Indeed, this provided an incentive for workers to perform well.   Better service led to better tips. We now have an entirely new strain of tip dysfunction in this country.   Tipping is no longer tied to service and has become an expected surcharge from classes of workers who heretofore would never have been eligible for a tip.   A few years ago, would a tip be consi

I have not personally suffered an addiction and I have no expertise in addiction medicine.   But I have treated large numbers of individuals with gastrointestinal issues who also are in the midst of an addiction or are recovering from this illness.   I have tremendous admiration for a person who has – with the help of professionals – unshackled himself from the suffocating tentacles of addiction.   As I have not faced this challenge,   I cannot begin to contemplate the journey. This nation has not settled on a coherent strategy to battle this plague.   Is it a medical issue?   Is it a law enforcement issue?   Which treatments are evidence based?     Should insurance coverage for treatment be required as are other benefits such as preventive care?   Can treatment be compelled on an unwilling addict?   I read a poignant opinion piece recently in The New York Times by David Sheff whose son ultimately prevailed against his addiction.   The article refers to a study that concluded that

I have never served in the armed forces, but I have enormous respect for our veterans and for those  who serve now.  My father served for 39 months during World War II.  Fortunately, he was not placed in harm's way.  During that era, nearly every young male served joining together in an existential conflict between good and evil.  This experience bound the entire nation together in a shared purpose with shared sacrifice.   Our nation so desperately needs an experience that will transcend our divisions to unite us as Americans.  Is there a moonshot out there that we could all rally behind?   Is there a leader in sight who can bring us together?  What if we could agree on our country's top 3 goals and then join forces to achieve them? Hey wait, I have an idea.  What if a deadly pandemic swept across the nation that could have the potential of causing over a million fatalities?  Facing this common enemy, we would surely become united against a deadly foe that was striking wildly w

It can be a struggle in a turbulent and violent world to find space to give thanks, but we must try. I hope that we can commit ourselves to making the world better one day at a time accumulating a series of small acts of kindness.  While each individual action may seem insignificant, if enough of us step up, then the world can change.  A rainbow is the effect of millions of drops of water. Perhaps, next year there will be more to be thankful for. Wishing blessings to all.

ROI (return on investment) is an investment principle.   If we contemplate an investment – whether money, time or training – we often speculate on what return on our investment we can expect.    What is the ideal ROI?   There is none.   One’s view of a financial ROI depends on the investor’s goals, risk tolerance, financial portfolio and stage of life.    For example, two experienced financial experts might completely disagree on the worth of a particular investment. What if I offered you an investment that costs nearly nothing but promised a huge yield?   Interested?  Am I sounding like a 2 a.m. telemarketer promising to make you rich on some 'no money down' scheme? If you follow my advice, you may surely become enriched, but don’t expect that you would enjoy any financial enhancement.   You can decide if it would be worthwhile to include these ‘investments’ in your life’s portfolio.   Here are some life investments that I think might make our lives better.    I’m ce

Our favorite restaurant has closed. A child’s toy is left behind on a trip. Our dog ran away. We have all observed that the value of something in our lives becomes well known to us when it is missing.  The loss of a job, a friendship, financial security or one’s health are cold reminders of the worth of these items in our lives.  How important are the people in our lives?  We’ve all been taught this lesson the hard way.  Of course, it is human nature to take one’s advantages and blessings for granted.  I do my best to pause from time to time to meditate on the gifts that have fallen my way, many of which are undeserved.  I certainly need to do this more often. In fact, I don’t think one can do this often enough. Do Flowers Really Matter? I think most of us would agree that life is richer when we appreciate what we have while we still have it.   In the course of a long medical career, I have met so many inspiring individuals – happy and content with their lot in life.   They are

 After the Civil War, which had more casualties than in any other American conflict, Decoration Day was established to honor the war dead.  Over time, this sacred commemoration transitioned to Memorial Day, which became a federal holiday in 1971.  This day honors all who have fallen in the service of the nation’s armed forces.  Although our debt to them can never be satisfied, we can at least pause and reflect on the inestimable sacrifice that they and their families have offered this nation.   We salute you all. Gettysburg National Cemetery on the 50th Anniversary of the Battle. As we all see at this very moment in eastern Europe, freedom is never guaranteed.   It must be protected and defended from those who fear it and aim to destroy it.   Threats may emerge both from without and within.   It’s easy and understandable that we take our freedoms for granted – the freedom to criticize the government, the right to equal justice under law, the right to peaceably protest, the right

The day before writing this, I had two unusual experiences in the office.  I am not referring to the patient whom I had not seen in years who gifted me yesterday with a full size New York style cheesecake.  I now must decide how I will apportion those 15,000 calories.  Perhaps, if I have 1 teaspoonful a day for a year that my BMI won’t be unduly affected.  The newsworthy events had nothing do with my medical skills.   I did not nail down a rare diagnosis or provide a cure that evaded other practitioners.   In fact, the events that I will highlight below occurred prior to my entering the exam room. When I enter an exam room to greet patients, they are generally engaged in the same activity – they are on their phones.   They are watching videos or playing games.   They are checking their e-mails.   They are pecking at the keyboard as they are issuing forth text messages of monumental importance.   Where did this come from?   How did we find ourselves in a world where no spare momen