MD Whistleblower

We live in an era now when workers have leverage over their employers.  Although the pandemic is over, many establishments are struggling to hire employees.  It’s mysterious why so many folks have chosen not to return to work, but also how they are paying their living expenses.   Remote work, particularly for younger workers, has become a non-negotiable red line.  If you are an employer who expects full time in-person presence, then good luck finding willing candidates.  Telemedicine has also permeated the medical profession.   Ten years ago, physicians would have howled that there could never be a replacement to the in-person visit when doctors could read body language and engage in the age old hands-on physical examination.   That was then.   Now, many physicians prefer to offer virtual care and many patients demand it. I’ve given up virtual visits, but not for the reasons that you may think. During the early months of the pandemic, w...

A patient came to see me recently for a second opinion on an abnormal blood test result.  He was accompanied by his parents.  They had driven a considerable distance for this visit.  The patient’s mother announced at the outset of the visit that she had been assured that all of the relevant records had been transferred.   My forthcoming comment will shock neither patients nor medical professionals.   Nary a single page of records was anywhere in sight. This vignette illustrates two incredibly frustrating and recurrent realities. Medical records that referring offices promise they have sent me often never arrive.  They are dangling somewhere within a extraterrestrial black hole.   On a regular basis, conscientious patients see me in the office assuring me that they were told that their records have been forwarded.   They may have been forwarded somewhere, but all I know is I don’t have them.   This drives patients to a state of apop...

There are joys and satisfactions in the practice of medicine.   Indeed, they have sustained me for the past few decades.   I enjoy the work and I continue to be honored that my long-term patients as well as new ones place their trust in me.   Despite my best efforts to deliver perfect advice to every patient every time, I confess that I am a member of the imperfect human species.   I have reminded patients that while I try to offer sound medical advice, I am neither omniscient nor clairvoyant.    If I knew, for example, that the medicine I am prescribing wouldn’t work, or would cause you an unpleasant side effect, then I would not have prescribed it. If you become a ill a week after you have been discharged from the hospital, it does not mean that you were thrown out prematurely.     Excellent medical judgement doesn’t guarantee an excellent outcome.   Conversely, a favorable medical result may occur after mediocre medical care.   Th...

Readers of this blog, and those with whom I have shared my philosophy of medical practice, know that I am a conservative practitioner.   I rail against overdiagnosis and overtreatment.  Less medicine results in more healing and protection.  In an example, I have explained previously why I advise patients not to undergo total body scan s , despite the lure that they offer a cancerophobic public.  I’ve never undergone a CXR in my life.   I’ve never entered medicine’s Tunnel of Adventure, also known as a CAT scan.  My fear would be that the scan would show various internal imperfections of no meaning that would generate anxiety, expense and a cascade of medical tests to follow up on the ‘abnormalities’.  Any real patient reading this who has been around the block once or twice, will validate my scanophobia.   Not a week goes by in my practice, that I am not facing a worried patient who was found to have some trivial finding on a ...

I am writing this now, prior to the pandemic, from my new favorite coffee shop not far from where I live and work. It’s called Couchland and is located in Wickliffe, Ohio.   As the name suggests, every seat is comfortable.   The large space has several couches and plush armchairs that beckon customers to sink in and stay a while.   This is quite different from many of the other coffee shops I patronize, where upon entering, I scan the room like a seasoned detective to see if any of the few comfortable chairs that are present are still available. Otherwise, I must enjoy the discomfort of a hard wooden chair, a larger version of what I sat on in 3 rd grade.  It’s a cat and mouse game as customers compete for premium seating in an adult version of musical chairs.   And, there are rules of etiquette that at times require adjudication.   For example, is it permissible to plop your backpack on a favorable available seat before standing in line to order? ...

Here is a potpourri of medical vignettes.   All are real life scenarios that I have experienced in my practice.  The absurdities of life also permeate the medical profession.  An insider’s view of medicine, as in any profession or industry, may be less sanitized than its public face.  Here are some Scenes from Scopesville, Ohio. Act I, Scene I Patients are routinely told that they should not eat or drink on the day of their colonoscopy.   Recently, a patient decided that these instructions did not prevent him from eating a full breakfast.  This is where the phrase, ‘you prepped for nothing’, applies. A patient comes to see me on the advice of his primary care physician.  He has no idea why he has been sent.  Let the sleuthing begin! A patient asks for a work excuse for the entire week following his colonoscopy. I am asked to fill out disability papers for a patient I saw once a year ago. A patient complains to me and my staff a...

Earlier this week, as I write this, our office lost a skirmish against technology.  It was my procedure day, where lucky patients file in awaiting the pleasures of scope examinations of their alimentary canals.  A few will swallow the scope (under anesthesia), but most will have back end work done.  We are a small private practice equipped with an outstanding staff.  We do our best every day to provide them with the close personal attention they deserve. The first patient of the day is on the table surrounded by the medical team.  The nurse anesthetist and I have already briefed the patient on what is about to transpire.  Propofol, the finest drug in the universe, is introduced into her circulatory system, and her mind drifts into another galaxy.  I pick up the colonoscope, which is locked & loaded for action, and the screen goes dark.  Our nurse goes through a few steps of messing around with plugs and doing a quick reboot, but we are st...

I am always always been irked when a hotel charges me for Wi-Fi use. This pick-pocketing is resented by hotel guests across the fruited plain.   This money grab is taken right out of the airlines’ playbook, who now charge us for carry-on bags, an aisle seat, a candy bar, a working flotation device ‘in the unlikely event of a water landing’ or a functioning oxygen mask.   Need to change your reservation?  Easily done for $150.  On what basis can this fee be deemed reasonable?  It constitutes consumer abuse of the first order.  Although airline profits are soaring, and fuel costs have tanked, there has been no trickle-down effect to travelers, who are left with little recourse except to pen cranky blog posts.  Airlines Heading Back to No Frills Hotels know that Wi-Fi is like oxygen.  Since we can’t live without it, why not extort a few dollars for it.  A paradox in this exploitative practice is that cheap hotels give the...

Everyone is familiar with the acronym HIPAA, which is the 1996 edict called the Health Insurance Portability and Accountability Act.  Isn’t that a smooth and melodious name? These are rules & regs that are designed to protect your confidential protected medical information.  I support the mission.  I don’t think that your medical records should be deliberately or inadvertently shared with those who are not lawfully permitted to view them.  Medical charts (remember when there were medical charts?) should not be left open on the counter. A physician should not yell to front desk personnel within earshot of others to give the patient a psychiatric referral. Elevators are not proper venues to have medical discussions about specific patients. Medical information should not be disclosed to inquiring friends and family without permission. I maintain that HIPAA has been OperationOVERKILL for many physicians and staff.  Keep in mind that doctors, at ...

Medical practices, particularly private businesses like mine, strive for efficiency. This has become more necessary as medical reimbursements inexorably decline while overhead and other expenses rise. This may be the point in this post when a reader will jump to the comment section below and carp how I and every other doctor are only in it for the money. Not so fast here. Yes, I would like to make a living and I believe that I deserve a decent one. In my case, I do not seek, and have never sought wealth. For small private medical groups, particularly in northeast Ohio, we are aiming to survive more than to thrive. These days wasted time during the work week can be the tipping point that buries a private practice. Where are the time sinkholes in medical practice? No show patients – This is the ‘Wonder Bread’ of medical practices. It torments doctors in 12 different ways. Younger readers may need to Google to get this reference. Late Patients – While these folks are ...

Image Depicts Doctor'sWaiting Room Flow Plan On a prior posting, I opposed using secret shoppers to evaluation medical offices. I admit, however, that physicians’ office practices do need some healing. Patients who phone their doctor pray they will reach living breathing human beings, but often find themselves trapped in the expanding phone menu universe. Waiting room patient ‘flow’ can be stagnant. Getting medical records transferred, a reasonable and routine request, can test the mettle of even the most steeled and seasoned patients. Office staff, who are often multitasking machines, may be impatient with patients. I don’t need a secret shopper to make these diagnoses in my practice. We already know them and struggle to improve them. We have made progress where we could and tried to mitigate the damage when we couldn’t remedy a particular situation. Our most important resource of identifying our flaws is our patients. When they point out when we have missed the mark, they ...

A paperless society is approaching for all of us, which sadly will include the demise of my beloved New York Times, which I cherish each day. Our medical practice will have electronic medical records (EMR) in the foreseeable future, if we can mollify the objections of one of our technophobic physicians. There are several reasons why most physicians haven’t made the move to EMR yet. First, it is not easy to learn. This is not like getting a new e-mail address. It is a complex software system that is like a giant onion with endless layers of functions that will perform office tasks that have been successfully done manually for decades. It introduces an entirely new computerized culture into the office. This adjustment is particularly difficult for doctors who were not trained in the I-pod era. However, even for the cybersavvy, learning these complicated systems takes months. During this training period, patients, doctors and staffs become frustrated when it takes 10 minutes or longer to ...

The Obama administration will be devoting billions of dollars to promote electronic medical records (EMR) for doctors. Today, EMR vendors run in and out of doctors’ offices trying to hawk their software. Each one claims to be the holy grail of electronic records. I admit that the concept seems intoxicating. The promise of a paperless office is certainly seductive. The notion of physicians and patients having access to their medical records from any computer would improve medical quality and efficiency. Every doctor knows how frustrating it is to see a patient in the emergency room when the relevant medical records are sitting in the primary doctor’s office or in a hospital across town. Conversely, EMR permits the primary physician, who may not have been the hospital treating physician, to be easily updated after hospital discharge when the patient returns to his office. Many patients I see today in my office don’t know their medications and can’t recall prior illnesses or even operatio...