MD Whistleblower

In the medical profession, there is often more than one correct answer.  Present the same case to 10 seasoned medical practitioners and you will likely hear numerous rational plans of action.  This scenario would be bewildering to patients and their families and is one reason that I have warned patients of the hazards of pursuing a second opinion.  Medicine is not mathematics where there is a single correct answer that can be proved. Medicine is not like math. How does a patient reconcile divergent recommendations offered by medical professionals? Should a formal debate competition be held before patients and their families? How does the medical team reconcile our differing views amongst ourselves? Can we expect ordinary patients and their families to decide if surgery, medication or watchful waiting is the best option?  Despite the current culture of patient autonomy, shouldn’t it be the physicians’ task to direct patients toward wha...

There is extraordinary medical care being practiced in the United States.  While medical breakthroughs do not occur linearly, there is a clear forward trend of progress.  Naturally, there are setbacks and failures which are learning opportunities in medicine as they are in life.  My own medical journals are increasingly populated with studies examining the use of artificial intelligence.  Endoscopic scope journals present examples of technical wizardry which only years ago would have been thought to be science fiction.   Sooner than we imagine, medicine will be offering widespread personalized or precision medicine when treatments will be customized according to a patient’s genetic profile.   Up to now, most of our treatments follow a one-size-fits-all model which is already recognized as a clumsy tool.  Ten patients might both have rheumatoid arthritis, for example, but these genetically unique individuals would likely benefit from tailored ...

Quite regularly, I am asked to comment on the care of folks who are not my patients.  Often, these are friends or their relatives who are suffering gastrointestinal (GI) distress.  “Would you be able to give her a call”?  On other occasions, a member of my own family wants me to connect with someone who has a GI issue. This is tricky terrain and I navigate it very cautiously.   Obviously, I am not the individual’s doctor and would never assume this role.   The individual shares with me only his version of the facts which may not represent the totality of the medical situation. I don’t have the data and have not performed my own examination..   It would be highly irresponsible and unethical for a physician from afar, who has no professional attachment to the individual, to dispense medical advice or to sow doubts about the quality of the medical care rendered.   Indeed, a physician who crosses a line here can cause confusion and doubt which can have d...

 From time to time, I arrange diagnostic testing to ease patients’ minds.  “Could you scope my esophagus?   My boss was just diagnosed with esophageal cancer.”   “I know I’m not due for my colonoscopy for another 2 years.   But I’d like to do it now just to be on the safe side.   My wife is worried.” “No, the abdominal pain hasn’t changed since I had a CAT scan for it months ago, but maybe I should have another scan now just in case something new developed?” When these requests are offered, I do not automatically acquiesce.   I try to understand better the genesis of the anxiety.   Is it rational?   Is it emotional?   Is there a true medical indication to justify a diagnostic test?   I interpret requests for tests as invitations for dialogue.   Very often, the ensuing conversation can settle the issue entirely obviating the patient’s testing request.   These patients don’t really want a test; they want to be reassu...

In the olden days, physicians had the dominant role in the doctor-patient relationship.  During this era of medical paternalism, physicians gave their best medical advice and patients accepted it.  If the gastroenterologist felt that his patient’s gallbladder had to go, for example, then surgery was sure to follow.  Informed consent – as we now understand its meaning – was not fully practiced.  Patients provided consent but were only partially informed. While medical paternalism has largely become extinct, and is inconsistent with today’s societal and medical mores, it was the template for medical practice until only decades ago.   And while we regard the subjugation of patient autonomy to be a fundamental ethical breach, both physicians and patients during that era were perfectly satisfied with the arrangement.   A patient came to the doctor with medical issues.   The doctor -the medical professional - offered advice that the patient accepted. ...

One of the advantages of the computer era is that patients and physicians can communicate via a portal system.  A patient can submit an inquiry which I typically respond to promptly.  It also offers me the opportunity to provide advice or test results to patients.  Moreover, the system documents that the patient has in fact read my message.  Beyond the medical value, it also provides some legal protection if it is later alleged that ‘my doctor never sent me my results’.  I have always endorsed the concept that patients must accept personal responsibility.   Consider this hypothetical example. A patient undergoes a screening colonoscopy and a polyp is removed.   The patient is told to expect a portal message detailing the results in the coming days.   Once the analysis of the polyp has been completed, the doctor sends a message via the portal communicating that the polyp is benign, but is regarded as ‘precancerous'.   The patient is advise...

Gastroenterologists are equipped to assist folks with fecal incontinence (FI) – an awful symptom for reasons that need not be explained.  While many of these individuals experience leakage only occasionally, the fear of an impending episode is ever present.  They leave home wondering if this will be a day when they will experience a lapse in control.  Many remain at home or curtail social activities because of fear and anxiety. So, while the condition is not life threatening, it is an assault on an individual’s quality of life. It’s more common in women and the elderly and is associated with a host of medical conditions.   Fecal incontinence is extremely common in extended care facilities which can result in medical consequences. This post is not to discuss the diagnosis and treatment of this condition.   Indeed, this blog is a medical commentary site, not an ‘ask a doctor’ site. Here’s the point of this post.   More often than not, individuals suff...