MD Whistleblower

 I feel it is more challenging than ever to carve away the chaos and destruction so that we can focus on what we should be thankful for.   Yes, there is beauty in the world which we must seek out and cherish.   Yes, there is kindness and generosity in our midst which we must champion and promulgate. Yes, there is dialogue and open mindedness which we must resurrect and cultivate. Skimming national and international current events on any day reinforces the reality that the space to find gratitude is smaller that it used to be.  But it is there. Never doubt that a small group of thoughtful and committed citizens can change the world;  indeed it's the only thing that ever has.    Margaret Mead On this recent Thanksgiving, I hope that all of you had blessings to celebrate.  Perhaps the task will be easier for all of us next year.

"Doctor, do you think I have cancer?" In a prior post, I did my best to point out that handling questions from patients and their families in a skillful manner requires a measured and cautious approach.   Paradoxically, physicians have not received much training, if any, in this aspect of doctoring, which physicians engage in dozens of times each day. In the unlikely event that you have not yet perused the prior post, here’s the link , which will serve as a brief prep course for this current posting. All of us hope and pray for a salubrious life.   Sickness scares us.   We fear any worsening of our illnesses, future mental decline, loss of physical function or any unforeseen change in our medical fortunes.   The fear of cancer hovers over all of us.    And, understandably, patients want to be reassured that their symptoms are benign and transient.   There is another genre of questions that are directed at physicians that requires a deft response....

One pleasure that I engage in regularly is taking time simply to think and to collect my thoughts. I don’t have a dedicated time for this pursuit; I can seize the moment at any time.   Often, I am on a walk or maybe simply driving somewhere.   I use these times to rove through recent happenings in my life and in the lives of those I care about.   Or, I might reflect – some might say ruminate – over a news item or opinion piece that I have read.   There is no agenda.   My mind simply roams and wanders stopping periodically at various unplanned destinations.   Think of this experience as akin to entering a large bookstore (younger readers may need to google here) without a specific title in mind.   You simply start ambling through the aisles sampling various books until you find one or two that meet your fancy.   The journey, as I see it, is a central part of the adventure.   Contrast this with purchasing a specific book on Amazon.   I...

We all recall President Reagan’s adage, trust but verify , with regard to the then Soviet Union.  President Reagan’s choice of words indicated that trust could not be assumed.  I challenge this notion as I feel that to trust another person, an organization or even a country that trust must be assumed to exist.  That’s what trust means.  Conversely, if one has to verify its presence, then true trust is clearly not there.  If a spouse, for example, hires a private investigator to prove that his or her partner is behaving honorably, is trust present? I think that overall the public trusts their doctors, although they are wary about the medical profession writ large.   The public may view their physicians in the same way that it views politicians – they see systemic dysfunction and self-interest in both professions but folks give higher integrity marks to their personal doctor or representative.   Often, patients who I know have confidence in me voice cr...

Trust is the central element in our national motto.  Do you recall this 4-word phrase?  If you need a reminder of this iconic verbiage, just grab a coin or some paper money and you’ll find it there.  Perhaps, you can’t recall the motto.  Since we don’t study our money when making a transaction, our trustful motto may remain buried in the background – invisible while in plain sight.  I’ll bet that some curious readers are scanning a dollar bill right now!    As our trustful motto seems out of view, so has trust across society become much less visible.  When we do stumble across it, it can feel as if we have struck gold.  Years ago, for example, I wrote a post about a proprietor who showed me such a high level of trust that I memorialized the incident in this blog and will never forget the vignette.  The trust vacuum seems most evident in our political space.  The citizenry does not trust elective officials, particularly those of...

Since I started practicing medicine a few decades ago, I have been recertified every 2 years for Advanced Cardiac Life Support (ACLS).   Readers might expect that all medical professional receive this training so that they are locked and loaded if an emergency arises.  Let me share a little secret with you.  If a situation develops that requires a true ACLS response, then I'm not your guy.  I barely have a clue.   Yes, I pass the exam every other year.   The truth is that I do so because all of the institutions that I have worked for require this certification.   There must be a group of bureaucrats sequestered somewhere who decided that physicians like me should be ACLS certified.   But, as is so often true in life, mission creep sweeps in participants who should have been excluded in the effort.   The only moments that ACLS has my attention are those 2 hours every other year when I recertify. In between these episodes, I don’t...

 I will share with readers a recent occurrence between me and another doctor that was both rare and refreshing.  I was serving as the gastrointestinal consultant on one of the doctor’s patients.  I performed a scope examination of the stomach and obtained some routine biopsy specimens.  The pathology results were abnormal, but benign.  No urgent action was needed, but a full airing of the significance of the results would require a conversation between me and the patient in an office visit.  I notified the patient that there was no medical threat at all and we would unpack it all during his next visit. The referring physician wondered about this delay, which perhaps is a different style from other gastroenterologists (GI’s) who he works with.   (My guess is that other GI’s may opt to handle the issue with the patient on the phone or via the portal. I think, however, that there’s too much complexity to fully address this issue in this manner.) So, her...