MD Whistleblower

Massachusetts General Hospital (MGH), perhaps the most prestigious hospital in the United States, has just announced that it is joining the concierge medical universe.  Concierge medicine offers patients Rolls Royce care for an extra fee.  This model has gained popularity across the country and is attracting both patients and physicians.  Patients receive white glove treatment on demand and physicians have more time with each patient as they no longer are pressured to increase patient volume to pay bills.  I’m sure that some of these physicians have increased their incomes, but others may be paid the same, but enjoy seeing 6 patients per day instead of 20.  I was struck by $6,000 annual feel that MGH was charging concierge patients, the highest I had ever seen before.  The typical fee I had seen was in the $1,500 per year range.  Six grand per year will get Bay Staters personalized care whenever they want.  They will never wait for an appointment.  I imagine that the waiting rooms

I am known by my patients and friends for my calm, imperturbable manner.  Yes, I am equipped with the full range of human emotions, but few folks have ever seen me raise my voice or demonstrate bulging next veins.  I am not suggesting this is a virtue or a character flaw, but is just the way I am wired. Sure, I get irritated and frustrated with the absurdities of life, as we all do.   For those who cannot relate here, may I suggest calling any airline carrier to discuss changing your ticket reservation.  If that fails,  then have a go at reaching out for tech support when your home internet goes ‘poof’! Last week, I did become irritated when I was notified one evening about a patient’s abnormal blood test result.  I was on-call for our gastroenterology group, so I would be the designated physician to notify with concerning test results.  Why, then, was I miffed? Our community hospital uses a ‘new and improved’ system for notifying physicians after hours of significantly abn

May I whine for a few sentences please?  My staff and I have a high-deductible medical insurance plan.  As the costs of coverage increased each year, we had to find a product that we could afford for our small private practice.  As any small business owner knows, margins are tight, revenue is declining and expenses inexorably rise.  And physicians, unlike other retailers, cannot raise our fees.  Would you want to invest in a company with this business model?  If so, then contact me directly. High-deductibles health plans are painful for consumers.  The first several thousand dollars are borne by the individual.  While we have an HSA (Health Savings Account), which confers a tax advantage, it is still painful to fork over wads of one's wages to cover medical expenses.  Isn’t that what medical insurance is supposed to do? Would we expect fire insurance to cover only part of our house if it burned down? Will fire insurance cover a fire? But, I recognize that high-de

Years ago, I was having dinner with 2 members of The Cleveland Orchestra, one of the finest orchestras in the world.  I asked them, with my kids present, how much time they devoted to their craft.  As many parents know, getting kids to commit to practicing a musical instrument is about as easy as splitting the atom.  The musicians told us how much time they practiced, which was mind boggling.  Any artist or athlete or Green Beret or similar professional, has to demonstrate extraordinary commitment to maintain a superlative level of excellence and preparedness. every day. I asked one of the musicians, the violinist, how long he could stay away from playing his instrument before he noted some professional slippage.  Guess your answer.   At the end of this post, I will relate his reply. How long can you be away from your job before your performance ebbs? For most of us, we can take weeks or longer on holiday and return back to our positions seamlessly.  A few examples.

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 their guests free Wi-Fi, while top tier hotels might charge $1

You see your gastroenterologist with long standing stomach pain.  You have undergone a reasonable evaluation and all the endoscopic bodily invasions and imaging studies of your abdomen have been normal.  Repeated lab work provides no clue explaining your distress.   You have been twice to the emergency room and were sent home with  prescriptions that didn’t work.  You are frustrated and so is your gastro guy.  You are convinced that there is a diagnosis that has been missed and you have the Google search to prove it. Every physician has had patients who come into the office with reams of paper from an internet search.  Usually, this approach uses a net that is just slightly over-sized for the task at hand.  It would be like using a butterfly net to catch a paramecium. Paramecia - Use a Small Net to Catch these Critters! Plug a few symptoms into a search engine, and then be prepared to take a year or so to review the results.  Pick a symptom, any symptom. Whistleblow

A patient came to the office and refused to see me, although I was quite willing to see him.  I’ll present the scenario followed by the patient’s reason he took an abrupt U-turn.   Then, if you are inclined, you may offer your own advice and comment. I performed a colonoscopy on this patient and found a large polyp in the upper part of the large intestine, or colon.  The upper part of the colon, or right side of the colon, has been receiving a lot of press in gastroenterology in recent years.  Medical studies have observed that cancers in this region are more easily missed for reasons that don’t need to be explained here.  For this reason, gastroenterologists are particularly vigilant when examining this region. The polyp was large and somewhat hidden behind a fold of tissue.  I suspected that this was a benign lesion.  I removed the polyp using one of the gadgets in our bag of tricks, but knew at the time that I had left some polyp tissue behind.  I was unable to remove the e