MD Whistleblower

Would you rather your physician be an astute diagnostician or a compassionate and empathic practitioner? Of course, we want our physicians to be blends of these qualities. We want it all.  We want them to be chimeras of Drs. House and Welby. But, is this possible? I can't say. I suspect that it is easier to cultivate soft bedside manners than it is to teach medical acumen, although the latter was the overriding priority when I was in medical training. No points were awarded in our morning reports with the chief of medicine for holding a patient's hand during the night. Big win, however, if the intern could recite 14 causes of hypercalcemia.  The message was that 'hard medicine' is what really matters. Where's the bedside manners site?  The importance of bedside manners depends upon the specific medical circumstance at hand.  Good bedside manners may mean less if you are going to see a physician once for a procedure than it would if the doctor-patient r...

During my college years, we loved the album Bat Out of Hell by Meat Loaf. We would wail along with Meat Loaf as he screamed out his passionate interpretation of Paradise by the Dashboard Lights. Another memorable song on that album was Two out of Three Ain’t Bad, which offers an important lesson to those of us interested in health care reform. No, Meat Loaf was not a medical policy wonk who offered health care solutions via allegory in his ballads. It’s the song title that caught me as I read yet another article on accountable care organizations (ACOs). Take a look at this banal 3 word description. Accountable Care Organization These new organizations have much more to do with accountability and organization than they do with care . In other words, Two Out of Three Ain’t Bad. ACOs are another coercive mechanism to track and compare physicians using quality metrics that are far removed from true medical quality measurements. As practicing physicians understand, and governmen...

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 ...

Why does Pay for Performance (P4P) make most physicians reach for Maalox? I have devoted a good portion of this blog’s real estate to dismantling the fallacy that pay for performance improves medical quality. It’s easier to argue that this clumsy and robotic approach diminishes medical quality by incentivizing physicians and hospitals to game the system to maximize their quality scores. When an irritating high school student raises his hand and annoys the teacher with the inquiry, ‘is this gonna be on the test?, it is a forerunner of the concept of pay for performance. The Ivy League seeking student won’t study material that he knows won’t appear on the exam. Similarly, physicians and medical institutions will focus their attentions on achieving those outcomes that will be measured and graded, which might be at the expense of patients who ‘are not on the exam’. For example, if irritable bowel syndrome isn’t being measured, but GERD is, then will these patients be treated the same? ...

President Obama enjoyed a towering victory days ago that I feel leaves the GOP reeling, although they are spinning the Supreme Court’s validation of Obamacare as a great gust of wind at their backs. While I would not have expected a different response from them, I fear that there is a developing wind that may blow them away in November. I offer this analysis as a tepid Romney supporter who will be voting more against Obama than I will be voting to support Romney. The phrase Obamacare is peppered throughout this blog. I was recently chastised by an unabashed whale-saving tree hugger that I should abandon this derisive term which detracts from my otherwise unvarnished objectivity. On the evening that the Supreme Court's decision was announced, I was watching CNN and its pontificating pundits. Various panelists were spewing forth verbal pabulum telling us benighted listeners what we were supposed to think. John King, the moderator, and many members of the spin squad all used ...

When I see patients in the office, I try to guess their occupations from their demeanor and mannerisms. Salesmen are the easiest to ID. In general, they are gregarious males with manly handshakes. They laugh loudly and like to tell jokes. Teachers are more reserved and often give their narrative in a logical and chronological order, as would be expected. Another clue that the patient is an educator is that their appointments are usually in late afternoons. I have a solid record picking out the engineers and scientists. (For physician readers, I estimate that with regard to engineers, my sensitivity and specificity are 60% and 90% respectively.) Engineers can be tough patients for gastroenterologists to treat. They operate in a computational universe, where numbers add up and problems have concrete solutions. Doctors, particularly gastroenterologists, function in an entirely different milieu. Our world is nebulous. Engineers see mathematical truths, while GI physicians see fog. When ...

I’m a gastroenterologist and I should be against obesity. I should counsel patients who have reached a designated rung on the body mass index (BMI) ladder on the risks of carrying excessive poundage and the benefits of achieving a more streamlined silhouette. I should encourage them to pursue a regular pattern of exercise and to choose food and beverage items wisely. I should advocate that the optimal tactic to achieve and maintain weight loss is to adopt a sustainable lifestyle change, rather than engage in a short distance sprint. Any controversy so far? I doubt it. While I want my patients, and indeed everyone, to make wise choices in life, I won’t make them do it. Doctors advise and patients decide. Intelligent folks who know the risks of their choices are entitled to make them freely. Mayor Michael Bloomberg, a RINO (Republican in name only), has recently issued a citywide sugary drink ban that has made news across the country and beyond. While there are loopholes that will ...