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Showing posts with the label General Whistleblowing

Artificial Intelligence in Medicine - Caveat Doctor!

Artificial intelligence (AI) has arrived and will permeate every aspect of our society.  It will touch all of us in our work, in the arts, in entertainment, in our government, and in our culture.  As with all technology, it will deliver us both blessings and curses.  We have been sharply warned of its potential destructive capability even by advocates of this technology.  Will governments, industry, and the public agree on proper guardrails and restraint or will the tiger simply be let out of the cage?  I worry that the strategy will be Ready! Fire! Aim! , instead of adopting thoughtful and prudent measures to keep us safe.  Indeed, I’ve offered some sober thoughts on this issue to my readers in a prior post . My medical journals are now riddled with studies on various medical uses of AI portending an unimaginable future in the medical profession. A few paragraphs further down in this post, I will ask my readers a philosophical question regarding AI and I invite a dialogue.   Until

Will Private Equity Buy Your Hospital?

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

The Risks of Artificial Intelligence

One thing we have all learned about technology is that it cannot be restrained.  With the release of ChatGPT and various competitors, we are aware that an unfathomable technology will disrupt our lives in ways beyond our imagination.  In the coming years 2 nd and 3 rd generation AI will replace its forerunners. My guess is that this technology will dwarf the impact that the internet has had on all of us.  It will be able to create and cure and innovate and communicate and build and teach and protect and even drive your car.   As mentioned, future AI functions and capabilities are beyond the horizon and are out of view. Exciting?   What if your job would be an AI casualty?    It you drive a vehicle for a living, how will you and your family adapt when human drivers are no longer necessary?   Even jobs and occupations that we might believe are beyond AI’s grasp, may be in the crosshairs.   AI’s reach will be boundless.   It’s tentacles will reach through blue collar America and wil

Trying to be Thankful in 2023

 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.

When Your Doctor is Running Late

One pleasure that engage in regularly is taking time to simply 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 opt

Loss of Trust in America

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

Labor Day 2023

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

Why Most Doctors Choose Employment

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

Independence Day 2023

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

Should I Tip My Doctor?

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 fully stiffed, or received 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

Should Addiction Treatment be Compulsory?

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

Memorial Day 2023 - Freedom is not Free

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

A Day of Thanksgiving 2022

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.

A High Reward Investment with No Risk!

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

What are the 10 Most Important Things in Life?

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

Memorial Day 2022 - Honoring the Fallen

 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

What To Do While Waiting for the Doctor

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

Employed versus Independent Physicians - Which is Better?

In my illustrious (or at least long) career, I have had 3 jobs.   After I finished all of my training, I was an employed physician for nearly 10 years.   Afterwards, I joined a small private practice group where I remained for 20 years.   Over time, as partners in the practice left or retired, I became the practice’s president by default.   I don’t really have an authority persona, which my staff was well aware and hopefully appreciated.   In nearly all cases when a decision could either favor the interests of our employees or the practice, I favored our staff. This earned a huge measure of staff loyalty, but no achievement award from the Chamber of Commerce. I am more than content to be regarded as a caring boss than a shrewd businessman.   Three years ago, I joined a rather large Cleveland medical enterprise where I now serve as a physician employee. Employment                         Independent I know the advantages and drawbacks intimately of both models – employment vs business

Fake News - Why are We So Gullible?

It’s certain that you have heard the phrase ‘Fake News’ bandied about these past few years.   It seems there is no consensus defining this term.   Here are a few differing interpretations. Inaccurate reporting where minor, immaterial errors appear, but the essence of the story remains true.   For example, if an article wrongly names a restaurant where a meeting is held, the article should not crumble. Deliberately slanted reporting to serve a political agenda.   I do believe that this happens daily.   Reporters and editors are charged to compartmentalize their own views, similar to judges, but they are human like the rest of us.   The next time you open a newspaper, read the headlines carefully and you will find examples of wording that is less than fair and balanced News reports that are completely on the level, but are attacked by those whom are threatened by the reporting.   I don’t feel that I need to give examples here. Fake or On the Level? A close cousin of Fake

Will Smith Gets Slap Happy at the Oscars!

In my own life, I do my best to use one set of weights and measures.  By that I mean applying the same standard always when judging individuals, businesses, politicians and even nations.  There is not a day that passes that we do not see exasperating evidence of double and triple standards being applied.  We saw Republican senators recently excoriating a nominee under consideration for Associate Justice of the Supreme Court by senators who previously voted to confirm her!  No gloating here, Democrats.  Your treatment of Justice Brett Kavanaugh during his Senate Judiciary hearings was not your finest hour either.  The Cleveland Browns recently acquired a superb quarterback, Deshawn Watson whose 5 year contract will provide him with a miserly $230,000,000. Presumably, after taxes, he should still have enough to live comfortably.   As everyone in Cleveland who is breathing knows, Watson is facing 22 civil lawsuits accusing the athlete of sexual abuse.   In fairness, two grand juries dec