MD Whistleblower

It can be a struggle in a turbulent and violent world to find space to give thanks, but we must try. I hope that we can commit ourselves to making the world better one day at a time accumulating a series of small acts of kindness.  While each individual action may seem insignificant, if enough of us step up, then the world can change.  A rainbow is the effect of millions of drops of water. Perhaps, next year there will be more to be thankful for. Wishing blessings to all.

I’ve never subscribed to the caveat to scrub politics and religion from my discourse.   Indeed, you will find these two subjects riddled throughout this blog.   I think we need more dialogue, not less.   I do agree, however, that dialoguing is a skill.   But it’s not brain surgery.   Any of us can become adept practitioners of this seemingly lost art, if we so desire.   It requires listening with an open mind.   It implies that your view on an issue might be modified in the face of a persuasive argument.   And your responses should respond to what has just been said to you indicating that the other side has been heard. So, now let’s talk some politics.   First, assess your political acumen by answering the following quiz question. Which of the following issues should not be handled by elected officials? (a) Tax policy (b) Zoning ordinances (c) Which chemotherapy regimen should be permitted for breast cancer patients (d) Parks and ...

ROI (return on investment) is an investment principle.   If we contemplate an investment – whether money, time or training – we often speculate on what return on our investment we can expect.    What is the ideal ROI?   There is none.   One’s view of a financial ROI depends on the investor’s goals, risk tolerance, financial portfolio and stage of life.    For example, two experienced financial experts might completely disagree on the worth of a particular investment. What if I offered you an investment that costs nearly nothing but promised a huge yield?   Interested?  Am I sounding like a 2 a.m. telemarketer promising to make you rich on some 'no money down' scheme? If you follow my advice, you may surely become enriched, but don’t expect that you would enjoy any financial enhancement.   You can decide if it would be worthwhile to include these ‘investments’ in your life’s portfolio.   Here are some life investments that ...

I am a parsimonious practitioner.  While I can’t cite statistics, I strongly suspect that I order fewer laboratory studies, prescribe fewer drugs and order fewer diagnostic tests than do my peers.  Medical minimalism has always been my medical world view.  This can feel a bit lonely at times in a profession that is rife with over-diagnosis and over-treatment.  I am not suggesting that my approach is the only reasonable medical approach, only that it’s the style that I’m most comfortable with.  All of us should consider the philosophy of the professionals we engage.   And the professionals need to gauge the goals and risk tolerance of those they serve.   These relationships may need to enter into negotiations from time to time in order to agree on which pathway to pursue. Physicians, judges, law enforcement professionals, teachers and others are not homogenous philosophically.   While folks may (hopefully) agree on the facts, the interpretation...

Life can be vexing.   Life is not a math problem that has one indisputable correct answer.   We are constantly weighing options as we make decisions.  How much risk would we tolerate in order to hope to capture a reward?  Does an NBA star go for the three pointer or drive to the rim?  Does a defense attorney put his client on the stand or leave him mute hoping that the prosecution hasn’t met the required burden of proof?   Does a surgeon recommend an operation today or should the patient wait another 24 hours to see if his condition improves without surgery? All of us struggle where to draw the line.   Look at the ongoing debates in the public square regarding national security.   While some government officials deny this, most of us acknowledge that there is a tension between guarding our civil liberties and protecting our security.  Civil libertarians claim that we can do both, but I believe that trimming civil ...

Pepto Bismol remains one of the most popular over-the-counter medicines that my patients swallow. They take it for all kinds of digestive distress.   Does it work?   Hard to say.   The elixir does have anti-bacterial and anti-diarrheal properties, but I suspect that there is a potent placebo effect at play also.   I personally think that these sales are largely the result of decades of brilliant marketing by the company.   We can all remember their television commercials in the days of yore when we would watch the pink liquid oozing down the esophagus and then gently coating the stomach creating a blanket of healing and protection.   What a graphic!   Many patients have internalized this marketing believing that this medicine is the fire extinguisher that can quiet their internal flames.    Right out of the doctor's 'black bag'. Patients are generally unaware of two important properties of this product. First, Pepto Bismol can turn the st...

Colonoscopy became ‘breaking news’ about a week ago.  The preeminent medical journal, The New England Journal of Medicine (NEJM) published a randomized trial assessing the effectiveness of screening colonoscopy in reducing the risk of contracting colon cancer and dying from it.  The results were lackluster. While there is accumulated evidence that colonoscopy can reduce colon cancer risk, the bulk of this data has not been the results of randomized controlled trials, the gold standard in medical research.    In the NEJM study, there was a group who was offered a screening colonoscopy and a separate control group who was not. Gastroenterologists, along with the medical community at large, have been preaching the lifesaving benefits of screening colonoscopy for decades.   The simple strategy is to remove ‘pre-cancerous’ polyps that are lurking silently in the colon and to remove them before they have an opportunity to transform into cancer.   What makes c...