MD Whistleblower

Over the years I have had countless conversations on how to select a competent physician. Advice on this issue is easy to find, but the desired result is more difficult to achieve. In the last posting, I listed many of the recommendations of ‘experts’ and indicated the pitfalls of their advice. The New York Times recently published a column offering their advice on choosing a physician. If you review the piece, make sure to peruse also through the deluge of readers’ comments, including one from your humble blogger. While the Times piece is informative, it does not offer a surefire prescription for selecting a high quality physician. There simply is no easy formula to assess physicians’ competence, like the magazine Consumers Reports might use to rate microwave ovens. Nevertheless doctors are being evaluated and compared by insurance companies, employers, the government and now even on Angie’s List! The reason that this task is so challenging, and the results so suspect, is because tw...

What is the definition of medical quality?  Perhaps we should take a defining lesson from Justice Potter Stewart who in 1964 offered an iconic definition of pornography -   I know it when I see it .  I think this template works well for doctors also.  Every participant in the health care arena - physicians, pharmacists, insurance companies, hospitals, pharmaceutical companies, our government and the public - all support the mission to deliver medical quality. But what is medical quality and how do you measure it? What stultifies this project is that no one agrees on the definition or even how to accurately measure it. You can test this yourself. Ask a friend about the quality of his or her physician. You may hear a glowing testimonial about the 'excellent' physician, but what does this really mean?  Understandably, patients may equate a good bedside manner with physician quality. I know how important the bedside manner is to patients, but it is not a s...

I was flummoxed that the man designated as my trained surgical assistant needed me to ‘talk him through’ the procedure. I wonder if he would be willing to be ‘talked through’ flying an airplane or defusing a bomb for the first time. I’m sure that the patient’s family seated nervously in the waiting room would be reassured by his brash confidence to proceed on their elderly relative. Was I nervous? Not at all because I knew that this man wasn’t going to touch my patient. I relieved him on the spot and arranged for the procedure to be performed by an individual trained to do so. What if I had decided to ‘talk him through’ the procedure? What if he didn’t disclose that he was inexperienced? How much do patients really know about the competence of their physicians and those who assist them? Studies have shown that most patients believe that their personal physicians are highly qualified, but how do they really know this? The scary truth is that they don’t and they can’t. Even experts in qu...

This blog launches today, but it’s been germinating in my mind for at least 10 years. I am a full time physician for 20 years and have seen the good, the bad and the just plain ridiculous. I’ve finally decided to blow the whistle. These postings will take readers ‘behind the curtain’ to see an insider’s view of the medical profession. I warn you – much of it is not pretty. My purpose is not to highlight physician billing scams or outright fraud, although if reader comments lead the conversation there, I will respond. I will concentrate instead on what has gone wrong with legitimate medical care in America. There is not a day in my practice that I don’t confront another symptom of our broken health care system, and I am only 1 doctor. Imagine what the collective observations and anecdotes of our nation’s physicians would amount to. I hope that we hear from some of them. It is staggering how much excessive, inappropriate and unnecessary medical care is delivered – nearly all of it justif...