MD Whistleblower

As readers know, the unifying theme of this blog is medical quality.  Indeed, the role of a whistleblower should be to raise the performance level of a profession or organization.  One need only scan this blog's category list for evidence of the blog's purpose.  Feel free to sample a post or two. The medical procedure that is fundamental to the practice of gastroenterology is colonoscopy.  I have performed north of 50,000 of these procedures on some very lucky inhabitants of northeast Ohio.  This will be my professional legacy, not quite a true gift to humanity such as music, art or literature.  I’ve been in practice long enough that there are patients whom I’ve performed more than 10 colonoscopies on.  Patients prefer to remain with a doctor whom they are comfortable with.  Long term relationships with patients is one of the joys of medicine. I also routinely perform colonoscopies on patients whom I have not met previously.  They are referred for the procedure by their pri

Over the years, I have treated various medical professionals from physicians to nurses to veterinarians to optometrists and to occasional medical residents in training. Are these folks different from other patients?  Are there specific challenges treating folks who have a deep knowledge of the medical profession?   Are their unique risks to be wary of when the patient is a medical professional? First, it’s still a running joke in the profession that if a medical student develops an ordinary symptom, then he worries that he has a horrible disease.  This is because the student’s experience in the hospital and the required reading are predominantly devoted to serious illnesses.  So, if the student develops some constipation, for example, he may fear that he has a bowel blockage, similar to one of his patients on the ward.. More experienced medical professionals may also bring above average anxiety to the office visit.  Physicians, after all, are members of the human species.  A pulmon

Last week, I presented the U.S Services Task Force’s (USPSTF)recent revision on its mammography guideline.  I agreed with the assertion that lives will be saved.  There is a little more to the story.  When a task force or an organization is devising a preventive medicine guideline, lives are not the only consideration.   First, mammography is a screening test – an exam performed on an individual without symptoms to prevent illness.   For clarification, a mammogram, unlike screening colonoscopies, is not designed to prevent cancer.   The objective is to detect breast cancer at an early phase which should result in a more favorable prognosis. Whenever a screening test’s target population is widened, as just occurred with USPSTF’s mammography revision, more lives will be saved.  For example, if we started performing screening colonoscopies at age 30, of course we would save lives since colon cancer can arise in folks in their 30’s.  However, what are the costs and risks of such an agg

Recently, the U.S. Preventive Services Task Force (USPSTF) issued a groundbreaking draft revision of its screening mammography guideline for women at average risk of developing breast cancer.  The new guideline advises women to undergo screening mammography every other year starting at age 40, ten years earlier than it previously recommended – a major modification.  This will be a two-part blog post. If you find this post of interest, I encourage you to return next week when I will share some ‘inside baseball’ on   mammography and medical guidelines. The USPSTF issues an array of preventive health advisories which it revises periodically.   I have always admired the task force’s measured and conservative recommendations, which reside within the boundaries of medical data and evidence.   The task force is comprised of experts who strive for objectivity, even though none of us are entirely immune to external influences.   They are a sober voice of reason in the medical community. Nor

Yes, with an explanation.  Of course, if your doctor is prescribing a medicine, it must be approved by the Food and Drug Administration (FDA). But, it may not be approved for your specific condition.  Let me explain. The FDA is charged with determining when a drug is considered safe and effective and can be brought to the marketplace.  Bringing a drug from the research bench to the pharmacy is a complex and arduous process that takes many years, even when it’s running smoothly and on schedule.  As you might expect, there are often unforeseen obstacles that will extend the timeline to approval when the FDA requires more studies to address their concerns.  Often, the drug must be abandoned at some point in the process, after millions of dollars of R & D investment.  We should consider this reality before we demonize PhRMA reflexively, which has become sport today.  Guardians of Safety When a drug is ultimately approved, this approval is only for a specific medical in

Some time ago, a patient arrived to my office prepared to enjoy the joy of colonoscopy.  Many of the patients on my endoscopy schedule are scheduled by other physicians and gastroenterologists.   In other words, I meet many of them for the first time on their special day.   My task is simply to perform the procedure and to then refer them back to their medical professionals.   In general, the system works well as we have many checks to assure that there are no safety barriers to performing the requested procedure in an out-patient setting.   Even when I schedule a procedure on one of my own patients, my patient’s medical record will be reviewed in advance by another medical professional. While the system works well on the safety front, it is less effective on the medical necessity front.   When an endoscopy schedule is open to referring medical professionals, there will be instances when the medical necessity of the procedure is questionable.   This is a murky issue as profession

With some regularity, patients contact me requesting antibiotics.   Many patients regard this as a casual and routine request, but I don’t.  When I hit the ‘Send’ button authorizing an antibiotic – or any medication refill – I am declaring that I personally agree that the medicine is medically necessary.  In general, I sign off on most routine medication refill requests without issue, unless the patient hasn’t seen me in the past year or so.  I would hesitate to refill if patient communicates that his heartburn is worse and requests that I double the dose of his reflux medicine.  This patient will be asked to see me in the office. There are times that I will prescribe antibiotics without an office visit.   This assumes that there is an existing professional relationship between me and the patient and that the medical facts support sending in a prescription.   There also needs to be a reservoir of trust such that the patient would contact me if his symptoms are not responding.    I wo