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Overuse of Colonoscopy - Scoping out the Reasons

In our practice we have an open endoscopy system, as do most gastroenterologists. This means that other physicians – or patients themselves – can schedule a procedure with us without seeing us in advance for a consultation.  Of course, we are always pleased to see any of these patients for an office visit in advance, but many patients prefer the convenience of accomplishing the mission in one stop.  This is reasonable for patients who truly need our technical skill more than our medical advice. Our office screens these procedure requests in advance to verify that no office visit is necessary.  While this process works very well, it is not infallible.  There have been times when a patient arrives to our office poised for a colonoscopy with accompanying medical issues more complex than we had expected. No vetting procedure is failsafe.  Have you seen the TSA statistics when they are tested in identifying dangerous items hidden in luggage?  Even though our trained personnel vet the

Why Did CMS Contact My Office? Medicare Fraud?

In our society, there are absurdities that simply defy reason.   In the past week or so, I have read about an individual who was denied the ‘right’ to bring a peacock on board a plane for comfort.   Just this morning, I read of a women who was cruelly denied to fly with her comfort animal – a hamster.   Readers are invited, if they dare, to use their preferred search engine to discover the tragic denouement regarding this hapless hamster. 'Let me comfort you.' * If a person needs a peacock, a snake, a pig, a kangaroo or a pterodactyl for airborne support and comfort, then perhaps flying is not for you.   The rest of us have some rights also.   Rent a car. The medical world has its own exhibits in the Theater of the Absurd.   Here’s our latest performance. Our medical practice received notice last week from The Centers for Medicare & Medicaid (CMS) that we owed the federal government money.   Apparently, according to federal brain trusts, we had billed a

Top CEOs Aim to Disrupt Health Care Market.

Since the infamous memo released this week by the chairman of the House Intelligence Committee has taken up so much oxygen, other newsworthy events were relegated to a lower priority by the media.  In my view, many of these second tier issues deserve Page 1 coverage, but our media in general has decided that potential or actual scandal must lead their coverage.  Can anyone defend, for example, the prominent and repeated coverage that Stormy Daniels has received?   If CNN received a lurid videotape of Stormy and the president on the same day that North Korea declared that it wanted to denuclearize their country, which would be the lead story?  The editors would be agonizing! Tell the truth, would your rather be reading about Stormy?* A bombshell announcement in health care came this week when when 3 titanic corporations stated they aimed to reform health care coverage from within.  Amazon, JPMorgan Chase and Berkshire Hathaway will combine their resources, ingenuity and

Patients Bill of Rights - Time for Version 2.0?

How often do we read or hear, “I have a right to …”   Everyone wants to have his rights respected.  Gun owners, prisoners, civil libertarians, union members, non-smokers, protesters and ordinary citizens all want our rights to be validated and respected.  What happens when the exercise of my rights encroaches on yours?  It is these questions that occupy much of our judges’ time and attention.  These are not easy calls to make.  The fact that so many of our Supreme Court decisions are decided by a 5-4 vote indicates that these issues are controversial, complex and vexing. While we all pride ourselves here in America on our individual rights, these may be at the expense of our community’s rights.   I don’t envy societies such as China or Russia where the state’s rights are paramount.  But, there is no consensus, even here, as to where to draw the line between protecting an individual and society at large.  Consider how vigorous the debate has been on the tension between protecting i

Amazon's New Headquarters Sweepstakes - A Plan to Win

Northeast Ohio, where I reside, won the lottery and was selected for two Amazon fulfillment centers which will employ thousands.  Let’s leave aside whether those jobs will be sustained, or replaced by robots, drones or some yet to be discovered job-killing advancement.  Of course, our win here was not quite like cashing in on a lottery ticket.  Lottery winners purchase a very cheap ticket and then cash in with a huge return on investment.  That’s why folks buy them; they pursue the dream of winning a huge windfall.  Would lotteries be as popular as they are if ticket prices were ten times as expensive?  I’ll answer that.  No.   It's Time for this Foreigner to Step Down The grand prize of the Amazon Sweepstakes is the site for their 2 nd HQ. Applying to become an Amazon HQ center is no cheap lottery ticket.  Cities across the country have been tripping over each other as they raced to genuflect in front of Emperor Amazon promising him zillions of dollars of tax abate

Is Trump Mentally Unfit for Office? The Goldwater Rule Violated

Many of my readers do not know who Barry Goldwater was, let alone of the Goldwater rule established by the American Psychiatric Association in 1973.  The rule advises against psychiatrists commenting on the mental health of public figures they have not examined.   Obviously, a psychiatrist or any physician who has treated a public figure is prohibited to offer any public comment unless he has been authorized by the patient to do so.  On Tuesday, Dr. Ronny Jackson, the president’s personal physician, will discuss the results of the president’s recent medical examination with the press.  The boundaries of what Dr. Jackson can report will have been set in advance by the president.   Senator Barry Goldwater In the past month, the Goldwater Rule has appeared in our newspapers and all over cable news and commentary programs.  Goldwater has probably been a 'trending topic'.  This is in response to suggestions that the president may be mentally unfit for office.  I have he

Al Franken Fed to the Wolves

Al Franken is out.  He volunteered to be thrown off a cliff.  Now, this gives me one less liberal, or ‘progressive’, that will give this gastroenterologist heartburn.  However, as a man who does his best to use honest weights and measures, I find his ouster to be deeply troubling.  This was not the senate’s finest hour. What caused the stampede of his fellow Democrats last month to demand his ouster?  Yes, there were new allegations, but they didn’t seem to be qualitatively different from the prior ones. What pushed a largely silent Democratic caucus into a chorus of indignation?  Was this fair? 'Mmmm, that was tasty!' If the charges against him – which he largely denies – are true, then he was clearly a sophomoric boor, who behaved improperly during his prior career as an irreverent comedian.  While his prior actions were offensive and wrong, I don’t think he merits being swept into the expanding cesspool of sexual harassers – men who preyed upon women using