MD Whistleblower

Last week, I related a vignette where a routine medication refill was denied by a patient's new insurance company.  The patient had developed symptoms 2 weeks after he ran out of the medication. I surmise that 100% of gastroenterologists surveyed would have agreed that refilling the medication was the next step. So, even though the best medical option was to refill the medicine that we know has worked, the new insurance company won’t cover it and the patient cannot afford to pay retail for the drug.  (As a separate point, I challenge anyone including those with PhD's in economics to explain retail drug pricing.)   The patient did his best to navigate the insurance company’s website and found a colitis medicine that is covered, but it is medically inferior.   Should we just cave and prescribe it to save money and a hassle?  Is this an issue that we want on our sick patients' agendas?  How would you like to face surgery and be told that the newer cla...

A patient came to see me recently with a suspicion that his colitis was recurring.     In general terms, colitis describes a condition when the large intestine is inflamed or irritated.   Typical symptoms are diarrhea, abdominal cramping and rectal bleeding.   This patient was concerned as his last 3 bowel movements were diarrhea.   He had been on a medicine called mesalamine, a safe and effective treatment for colitis, but he ran out of it 2 weeks ago.   While he was taking the medicine, he felt perfectly well.   So, his bowel change developed 2 weeks after he ran out of his medicine.   For readers who like to play doctor, choose among the following options: Schedule an urgent colonoscopy to verify that nothing has changed since his colonoscopy 6 months ago. Observe the patient without any treatment to give him time to heal himself. Recommend probiotics to restore his digestive health. Refill the mesalamine at his usual dosage. Reque...

First there was Bitcoin, a cryptocurrency that utilizes blockchain, a decentralized system of data collection and transactions that we are told will defy hacking.   (Wasn’t the Titanic said to be unsinkable?)    We read that cryptocurrency and other blockchain functions will be a societal gamechanger, much like the internet was when Al Gore invented it some years ago. My own state of Ohio will now accept Bitcoin as payment for commercial taxes.   And, of course, there are many other cryptocurrencies mushrooming around us.   In my life, many innovations seem to be solutions in search of problems.   I don’t find my current methods of transacting business – cash and credit cards – to be so onerous that I am screaming for a new way to conduct commerce.   But, I will admit that I have security concerns about my credit card number and other highly personal data being ‘safely stored’ all over the internet.   Some years ago, I enjoyed the thril...

Many organizations solicit private donations from benefactors and philanthropists.   Is there a stadium in the country that does not bear the name of a prominent donor?   There are also anonymous donors who are not cursed with egos that require their names to be emblazoned in giant font on a building’s façade.   But, most donors want recognition which is often used as an incentive when soliciting the donation. Donors understandably receive perks and privileges that ordinary folks will never be offered.   If you give a ton of money to a theater, you might receive prime season tickets as a gift.   If you make a sizable donation to a symphony orchestra, you may be invited to a private event to meet the conductor and leading musicians.   If you make a robust financial contribution to your city’s art museum, you won’t have to worry about competing for limited tickets to view the visiting Picasso exhibit.   You may very well have your own private tour....

It seems that there is an epidemic of obstructive sleep apnea (OSA) out there.  Snoring, a harbinger of OSA, seems to have captured the national attention, at least judging by the ubiquitous ads I am subjected to hourly on the radio.  Gastroenterologists routinely inquire about the presence of OSA in our patients as this may increase the risks of sedation and anesthesia.  Most patients with OSA are undiagnosed.  Many of them are not aware that the condition troubles them, but experts warn of potential long term consequences if the condition is not treated.  The diagnosis is classically made after an overnight sleep study when the patient is monitored.  I have equal confidence in the diagnostic skills of those who sleep in the same room as the individual at home.  For example, if a patient’s wife tells me that her husband regularly (and fortunately temporarily!) stops breathing during sleep, I think that the diagnosis has been securely made.  ...

Although I have confessed that I am not a seasoned expert in this field, here are some tips and pointers I’ve gleaned over the years. Slow and Steady Wins the Race! Avoid gimmicks.  We’ve all seen ads and telemarketing pitches that promise to melt off pounds by the hour.   These products are very effective for the companies, but not for you.  They don’t work.  Yes, you may enjoy some short term weight loss for as long (or short) as you can stay motivated, but the chance of keeping the weight off is vanishingly small.  You don’t have to be perfect.  Allow yourself some backsliding and seek continued motivation from these events.  The path to your successful destination may include some zigzagging. Weight loss medications don’t work well.  Of course, the notion of a pill solving any medical problem is seductive, but the history of weight loss medications includes an array of side effects and relatively modest results.  Ba...

Is there corruption in the medical profession?   Recall Captain Renault’s iconic rejoinder to Rick in Casablanca. “I’m shocked, shocked to find there is gambling going on in here!” In any enterprise with billions of dollars at stake, and when different players have competing interests which may not coincide with the public’s interests, there will be skullduggery.   How do you think our Defense Department and its relationships with vendors would look if we were able to shine a bright light on all its faces?   Do you think it’s possible that a weapons manufacturer might argue, through lobbyists and salesmen, that its weapons are essential to national security and superior to those of a competitor?    How about when a congressman argues for the continued purchase of military equipment manufactured in his district that military experts state is no longer needed?   And, there’s the quintessential and craven corruption of legislators refusing to clos...