MD Whistleblower

Not long ago, Telemedicine was something that I read about.   Now, it’s something I do.   Over the past weeks I have been evaluating patients over the phone from home.   It has been an adjustment, but it has been smoother than expected.   First, I have always thought that the physical examination is overrated.   Yes, I recognize that such a declaration constitutes medical blasphemy, but I stand by it.   Don’t extrapolate beyond my actual meaning.   I am not suggesting that the physical exam is superfluous.   Indeed, there are many circumstances when the exam is absolutely critical.   However, for a good bulk of the routine gastroenterology patients I see, particularly for those who are returning to my office for a follow up visit, the exam contributes little value. Here is a sampling of patient visits where the history alone is largely sufficient. A patient with years of chronic constipation returns to see me for a 6 month follow up...

Tomorrow will be a Memorial Day worth remembering.   Of course, its core meaning – to remember and honor those we have lost in the service of this nation – remains paramount.   I have thought over the years that the day’s essence has become blurred as the day has become one of family picnics and barbecues.   I confess that I have not sufficiently paused and meditated on the day's meaning in year's past as I think I should have.  I placed a small American flag on our front lawn today, the smallest of gestures to honor a very solemn remembrance.     But this Memorial Day is different.  To those of us like me who have never served, this may feel as close to a war atmosphere that we will hopefully ever know.  Lockdown.  Shelter in place.  Commerce shuttered.  Empty streets and concert halls.  Fear.  Desperation. Hope.  Propaganda.  Supply chain disruption. Heroes.  Victims.  Agony an...

A few months ago, most of us had never heard of an N95 respirator or mask.   I had never heard of it. It is an essential element of Personal Protective Equipment, or PPE, which we have all heard so much about. The N refers to ‘non-oil’, meaning that the mask should not be used in the presence of oil-based substances.   The 95 means that 95% of airborne particles are screened out if the mask is worn properly.   Keep in mind that 95% is less than perfect.   It means that the mask will fail 5% of the time.   And, if the mask is not worn with a tight seal, the efficiency percentage will drop further.   And, the mask wearer is instructed not to adjust the mask during use which will break the seal.   So, the 95% standard is likely under idealized circumstances.   As of this writing, I have only worn the N95 mask on two occasions.   My initial experience donning the mask was for a fit testing by an occupational health specialist to ve...

Prior to the pandemic, patients who entered my office building were greeted by 2 staff professionals who would assist patients in checking in and performing the usual logistical tasks that occur prior to a medical appointment.   Shortly after the pandemic commenced, I would arrive to work to witness these 2 ladies in rather different garb.   They were now fully gowned, masked, gloved and goggled.   Each carried a bottle of hand sanitizer.   If not for their voices, I would not have recognized either of them.   Patients and medical personnel passing by would extend one an open palm to receive a squirt of the precious cleansing elixir.   While I acknowledge the necessity for staff interfacing with the public to don protection, it was an eerie site for me to witness, even as a medical professional. It is simply a scene that is foreign to most Americans. I recall when I traveled to Israel for the first time, I was struck at the site of uniformed and armed s...

In a recent post , I presented why I believe that the fragmentary and anecdotal medical evidence supporting the use of chloroquine and hydroxychloroquine for COVID-19 does not justify its use. Certainly, if I become infected with the coronavirus, I would be reluctant to accept a recommendation to take either of these 2 medications, based on what is currently known. Ordinary people, especially when they or loved ones are afflicted with a disease, will readily accept unproven remedies, especially when conventional medicine has no effective treatment.   We all understand this.   But the lack of a treatment, in my view, does not justify abandoning our usual standards that physicians rely upon when we make treatment recommendations.   Shouldn't Physicians Weigh the Risks and Benefits? Here are some reasons why I object to coronavirus patients taking chloroquine and hydroxychloroquine for COVID-19.    The principles outlined below certainly extend b...

Folks love quizzes and puzzles, especially now when most of us are spending most of our time hunkered down at home.   I had attempted to send one my kids a jigsaw puzzle that I ordered on line, only to discover a few weeks later that the item was out of stock.   Apparently, like hand sanitizer and foster dogs, jigsaw puzzles are in very high demand. Scarcer than toilet paper. In an earlier phase of my life, I prepared ‘quizzes’ that were passed around on holidays and family dinners when guests competed for valuable prizes such as stickers, packs of gum and other treasures that are sold at dollar stores.    Not only were these experiences ‘fun for the whole family’, but they were effective educational tools.    Ask a Kirsch kid even today whose portrait is on the $50 bill or how many neck bones are inside a giraffe’s neck, and he or she (I hope) will nail it. So today, I will offer readers a lighter fare.   Here’s a coronavirus quiz ba...

In the weeks ahead, there will be growing tension between forces wanting to open up the economy and those who demand that we hold the line.   And no one can tell us now when it will be okay to pull the trigger.   It is so much easier to endure a challenge if there is a firm end date to focus on.    In this case, not only is there no clear trigger-date, but there will never be agreement on when it will be acceptable to pull back.   I’m no expert, but here’s a brief list outlining the complexities of this conundrum. Public health experts will disagree on the economic relaxation date. Corporate leaders will likely favor a sooner and broader opening of the economy. Governors will have diverging views from national leaders about what actions their state should take. Businesses who are not permitted to open may howl and protest as competitors are given a pass. Can schools, for example, be reopened while we are still urged to maintain social distancing? Will...