MD Whistleblower

Does anyone out there know why President Obama underwent a virtual  ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year? In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless special risk factors are present. Of course, maintaining the president’s health is in the national interest, so I understand why professional screening guidelines might not apply to him. For similar reasons, airline pilots are subjected to routine cardiac testing, not to protect the pilots' health, but to protect the passengers.  Stricter scrutiny of the president's health is proper. So, if the national interest required that the First Colon be studied prematurely, then why didn’t the president choose the screening test that nearly every physician opts for when we turn 50?  I’m baffled. It is inarguable that a colonoscopy is more accurate than VC and can remove polyps and obtain biopies at the time of the examination. In every i

The Patient Protection and Affordable Care Act was signed into law earlier this week by President Obama. The ceremony was notable for the president’s use of 20 pens to sign the bill, and for a vice-presidential expletive that has gone viral. Biden’s presumed private verbal ‘high five’ to the president was heard and widely circulated. Don’t these guys know that when they’re in public that they are never off mic? Our macho vice-president was emulating his vice-presidential predecessor who dropped a similar verbal bomb onto Senator Patrick Leahy in 2004. Cheney’s muscular rhetoric was no aerial drone attack; he delivered his message face to face to the Vermont senator. I wonder if Dick ever invited Pat on a hunting trip? Obamacare is now law. Will this lead us to Armageddon or to the Garden of Eden? I confess that I haven’t read the bill, but then neither did the legislators who voted for or against it. Sure, the specifics are important, but what we really crave to know is what the scor

Photo Credit Eva Kocher First, let me state unequivcally that I am against all varieties of pain, foreign and domestic. Indeed, I wish that we could snuff the varmint out every time and place it surfaces. Pain is a wily opponent that can be difficult to vanquish. In recent years, physicians have been resorting to a ‘shock and awe’ strategy of using excessive force against it. While this may be sound military strategy, in the medical arena it has led to unintended and predictable consequences. I think that we physicians are pulling the narc trigger too quickly and too often. It’s easy to advocate for a more parsimonious approach to pain control, when your humble blogger is pain free. Indeed, my own pain threshold cruises at low altitude, and has never been fairly tested. While this may limit my credibility, I maintain as a physician that my profession, including me, needs some narc reform. When I was in medical training, during the days when my kids insist that I took the pet ste

Hypocrisy : The practice of professing beliefs, feelings, or virtues that one does not hold or possess; falseness. Which of the following medical tests or procedures do physicians commonly recommend, but state they would never accept themselves? (1) Cardiac catheterization (2) Screening colonoscopy (3) Feeding tube placement (4) PSA screening for prostate cancer (5) Hip replacement surgery Answer appears at the post’s end. Last week, I was asked by a primary care physician to place a feeding tube in an NNHP, a nonagenarian nursing home patient. The patient had a panoply of active medical issues, and was at the end of life. The feeding tube was advised because the patient’s swallowing function was impaired and he was, therefore, at risk for pneumonia if he ate. These swallowing evaluations are generally performed by speech pathologists, whom I have found to be dedicated and competent professionals. As an aside, they often uncover swallowing defects that suggest that eating

The Intro to the Intro For those who were hoping for a sober or analytical piece this Sunday morning, be warned that you have entered a No Wonk Zone. Today’s post, hopefully will make a serious point, but it is seasoned with some levity and a little silliness. Of course, just because I think it’s silly, doesn’t mean that you will agree with me. The definitions of silly and serious are highly subjective. One man’s ‘dead serious’ is another man’s ‘deadpan'. For example, after watching the recent health care reform summit, I couldn’t tell if it was a serious policy exchange or a silly infomercial.  Could you?  Yes, I confess that this is an entirely gratuitous jab at the President's daytime TV health care reform special. The Intro Every physician has been asked, “Doctor, what would you do if I were your mother?” The patient, who assumes that the doctor likes his mother, erroneously believes that this is a surefire method of receiving premium medical advice. After all, who woul

 Tinkerbell in Bronze I never thought I would have a chance to watch the health care reform summit on live TV this past Thursday. Fate took a U-turn. I didn’t expect to be in a New Jersey blizzard on Thursday morning. I was scheduled to be in the ICU performing an endoscopy examination of the stomach on a patient who I had seen in the emergency room a day before with intestinal bleeding. The plan was to fly to New Jersey on Thursday evening so that we could witness the milestone event of my brother being sworn in as a Superior Court Judge in on Friday afternoon. No human plan, however, can prevail against an Act of God. A torrential blizzard was descending upon the east coast and was threatening to postpone the event that was the result of years of my brother’s work and hopes. Unlike his anonymous gastroenterologist blogging brother, Robert has a deep network of judicial and political luminaries, developed over a career in the U.S. Department of Justice and the U.S. Attorney’s Off