MD Whistleblower

“I have a food allergy.” “I have a parasite.” “I have ‘leaky gut’.” “I have esophageal spasm.” These are examples of speculative diagnoses offered to me by patients.   It is natural in the era of the internet, with artificial intelligence (AI) looming, that patients will search for explanatory diagnoses for their symptoms. Who knows?    In time, and sooner than we think, AI’s performance may exceed that of human physicians, as well as other human endeavors.   At that time, AI may be preparing my weekly blog posts as it interferes and takes over the rest of my life. I won’t succumb willingly to this omnipresent and overpowering force, but I acknowledge that it will not be a fair fight. Most often, patient offered diagnoses are wrong, even though an internet search seems to have nailed the diagnosis precisely.   I have fever, fatigue, muscle aches, headaches and digestive issues.   Google let me straight to malaria!   How did my doctor miss thi...

I was recently queried on a product called Deplin, which claims to have anti-depressant effects when added to a conventional anti-depressant.   Not surprisingly, as a gastroenterologist, I have never prescribed this, although a psychiatrist I contacted has never prescribed it either. Although a prescription is required, Deplin is not classified as a drug by the Food and Drug Administration (FDA).   It is labeled as a medical food, an important distinction that the public should be aware of. Years ago, a medical food product, EnteraGam, was introduced as a ‘treatment for diarrhea.   This is when I first became acquainted with the medical food designation. Let me offer readers some 'medical food' for thought. The FDA does not assess medical foods as they do for conventional drugs and medical devices.   The prescription drugs that you are taking have passed through years of intense testing under the scrutiny of the FDA, whose approvals means the medicines are bo...

I recall when urgent care offices proliferated and were often housed within pharmacy chains.  This latter arrangement was symbiotic in that the pharmacy provided a convenient venue for patients who then purchased their new prescriptions in the pharmacy.  And a patient entering the pharmacy for a medical visit is likely to make unrelated purchases while strolling the aisles. These sites are generally staffed by nurse practitioners (NPs).   I have worked with these excellent professionals for many years now,.  Beyond urgent care settings, NPs also work in hospitals and many other venues caring for patients with complex medical issues. When the urgent care option came onto the scene, there was stiff pushback from doctors who railed that the quality of care would be below par.   “Nurse practitioners are not doctors,” they warned.     My suspicion then was that doctors had unspoken concerns unrelated to medical quality.   The reason that NP-directe...

All of us have viewpoints on various issues and policies.   We have opinions on the criminal justice system,  immigration issues,  and eligibility for health care benefits, to name 3 examples. For many of us, our opinions evolve as we gain life experience and wisdom, which change how we view the world.  I regard this as personal growth which we should all welcome and aspire to.  I acknowledge that there are some bedrock principles that should remain stable. For instance, the tenet that physicians should serve their patients’ interests and not their own should persist.   With age, comes wisdom. We have also seen folks change their positions, sometimes rapidly, using a pathway different from the personal growth process I noted above.  Views can change rather suddenly when an issue affects someone or a loved one more directly.  For instance, a champion of strict law and order might feel that leniency is in order if his own son faces expulsion from a ...

Physicians, at least most of us, are not businessmen.  Yet, we are negotiators.  When I was in private practice, for instance, we were running an actual business.  There were negotiations with our landlord, with insurance companies, with vendors and with new hires.   Now, as an employed physicians, all of these issues – and many others – are out of sight and out of mind.  But I am still negotiating.  With whom, you wonder? I negotiate with my patients. I’m not suggesting that my doctor-patient relationships are cold, transactional events.   Hardly.   But every relationship, either business or personal, requires give and take.   Sometimes one party gives up some space to accommodate a compromise, and other times the partner behaves similarly.   Indeed, every successful relationship that I have participated in or witnessed is a breathing and flexible organism.   Negotiating with patients is less formal than is depicted here. ...

I've never worn the uniform.  The military draft was long gone by the time I came of age.  My father served in the Navy for 39 months in World War II.  One of his brothers was a Marine and other served in the Army.  I regard them and millions of others as part of the greatest generation.  Defending America and its interests was inbred then.  There was unity of purpose.  What were the stakes?  Merely saving the world from domination and conquest.  They understood that this was a fight worth fighting. Had President Truman not ended the war in August 1945, my father, along with hundreds of thousands of others, may have been deployed to Japan.  Had that occurred, it is possible that these posts and it's author may never have existed.   What would America and Americans do today if free peoples on faraway shores were threatened?  Does our turning away from Ukraine as they defend against a ruthless and revanchist dictator guide o...

Some time ago, a patient was sent to me for a scope test.  This is hardly a newsworthy event since I do thousands of scope exams every year.  This patient had a known, benign narrowing at the lower portion of the esophagus, which is called a ring.  Years ago, another gastroenterologist stretched the ring which had been catching food on the way down.  My assigned task was to examine the ring and determine if a stretching was necessary.   This introduction of this case is the set up for the point I wish to make.   Too often, medical decisions are based on objective data without sufficient consideration of the patient.   Consider a few hypothetical examples. An MRI of the back shows disc protrusions in the lumbar spine.   A surgeon reviews the study with the patient and explains the rationale for surgery.   However, a detailed review of the patient’s symptoms suggests that the back pain may not be caused by disc protrusion at all.   I...