MD Whistleblower

Physicians and nurses deal with the deepest issues of the human condition – life and death.   Our profession brings new life into the world and does our best to bring comfort and peace at the journey’s end.   It is a profound and emotional experience for medical professionals to be with a patient and family when life ends. There are other professions who routinely confront loss of life.   Law enforcement personnel, paramedics, firefighters and soldiers all are exposed to events that most of us would never wish to experience. The medical profession and society is struggling to preserve our humanity in a 'cut & paste' world where one's worth is determined by the quantity of twitter followers.   Hugging a child.  There's no 'app' for this. On my very first day of medical internship in Pittsburgh, I was called by a nurse to pronounce a patient dead.    I had never seen the patient before.   The only deceased individual tha...

There is a confluence this weekend of holy days from two venerable monotheistic religions.   Today is Easter, which represents the anniversary of the resurrection of Jesus Christ, a foundational theological principle of Christianity.     Christians await the Second Coming, when they believe that Jesus will return to establish a world of peace and justice. Passover, which began on Friday evening, celebrates the iconic and gripping tale, chronicled in the Book of Exodus, of the emancipation and liberation of the Jews who were enslaved under a cruel Egyptian regime.   The yearning for freedom and resistance against tyranny carefully documented in the Torah, is truly a universal template that is relevant to this very day.   Jews Crossing the Red Sea Leaving Bondage Behind The religions are so deeply intertwined.   While I am neither a Christian nor a scholar, I have taken some effort to study the New Testament so that I might gain some understan...

Among the many tools that insurance companies wield to save money is a technique called ‘step therapy’.  This is a technique that exasperates patients and physicians.  Here’s how it works.  A patients comes to his doctor with a medical issue.  The doctor, who presumably has a decent measure of medical training, experience and judgment, decides to prescribe a medication, in an effort to ameliorate the patient’s distress.  Let us call this magic elixir Pill A.  The doctor zaps this prescription to the pharmacy at the speed of light using the ever trustworthy electronic medical record.  The satisfied patient leaves with the mistaken impression that his cure is just around the corner. Here’s where the fun begins.  Of course, the patient may receive the typical denial as Pill A is not on the formulary.  Keep in mind that an insurance company’s denial doesn’t mean the patient can’t fill the prescription.  Insurance companies would neve...

You're fired!  We've all heard this directive that was popularized by our current chief executive. It is much more common for a patient to fire a physician than it is for a doctor to cut a patient loose.   Yet, I sent 2 of my patients termination letters in the month prior to my penning this post, which represents a firing surge on my part.   This has been a very rare event in my practice.   Since physicians are patient advocates by training and practice, we tend to extend leniencies to our patients, giving out 2 nd and 3 rd chances routinely.   But, the doctor-patient relationship is not unbreakable and both sides have responsibilities to maintain it.   The Doctor-Patient Relationship Should be a Partnership - not a Duel. Here are some reasons that patients have offered justifying seeking a new physician.   Keep in mind that these given reasons represent patients’ perceptions, which may not necessarily represent absolute truth. Po...

“Does my insurance cover this?” I cannot calculate how often a patient poses this inquiry to me assuming wrongly that I have expertise in the insurance and reimbursement aspects of medicine.   If I – a gastroenterologist –  do not even know how much a colonoscopy costs, it is unlikely that I can speak with authority to a patient’s general insurance coverage issues. Of course, patients assume that we physicians have an expansive expertise of the medical universe, both in the business and the practice of medicine.   Often, friends and acquaintances will informally present a medical issue for my consideration that is wildly beyond my limited specialty knowledge, and yet they expect an informed opinion.   “Hey, aren’t you a doctor?”    Yes I am, but if you think a gastroenterologist – a Colonoscopy crusader – can advise you on your upcoming hip surgery, psoriasis treatment retinal detachment, or cardiac rehab, think again.   And, I likely know m...

Our practice will no longer see nursing home patients in our office.  If a nursing home patient is already established with us, then we will see him; but, we have decided not to accept new patients. Of course, we believe that these individuals – like the rest of us – deserve medical care.  This demographic not only deserves care, but has the greatest need for medical services.  Our practice will see every person who wants to see us, including the uninsured.  Why, then, would a welcoming practice like ours close our door to new nursing home patients?  We just couldn’t take it anymore. These patients, who often have serious physical and mental challenges, would typically arrive to our office accompanied by a driver, who naturally has no medical knowledge.  The patient often had no awareness of the reason for the visit.  The ‘medical record’ consisted of a nearly indecipherable list of medications of uncertain accuracy.  Typically, no reaso...

One thing that gastroenterologists know about is stool.   But, I’m not referring to that kind of stool in this post.   Follow along . When we do a colonoscopy, for example, we are relying upon stool, or more accurately a stool, as in a three-legged stool.    This metaphor illustrates that the three legs must be equally strong or the stool will not stand.   The three pillars of support that a colonoscopist needs include: Knowledge Skill Judgment All 3 Legs Needed As the gastroenterologist guides the colonoscope along your long and winding colon, he may discover a lesion.    He needs knowledge to identify the intruder.   Is it a cancer or a benign polyp?   Could it be Crohn’s disease or some other form of colitis?   Is it a normal structure that simply appears atypical? Obviously, the more experienced the gastroenterologist is, the more likely he will be able to identify the abnormality. But, every gastroenterolo...