MD Whistleblower

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. A good friend of mine has contracted with a concierge medical practice. Concierge medicine is also referred to as 'boutique practices' for reasons I will explain below. This is certainly not a new practice model for medical care.  Concierge providers came onto the scene decades ago.  These patients pay a cash fee to the concierge practices, which can be several thousand dollars annually.  This is in addition to the patients’ existing costs for their conventional medical insurance.  In return, these patients get supreme VIP medical care.   For instance, they may enjoy same-day or next-day access for appointments.  The office visits are lengthy and relaxed. And ...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. There is no shortage of non-prescription remedies for all varieties of ailments.  Millions of patients are swallowing zillions of potions to ease their suffering or to prevent disease.  Indeed, doctors need to specifically ask their patients about unorthodox or alternative treatments, as patients may not volunteer this information.  Many of these treatments are untested or even disproven, but they remain popular with the public.  As a gastroenterologist, I am queried from time to time on colonic hydrotherapy, a cleansing procedure that largely cleanses clients of their funds.  If a patient discloses to his doctor that he is benefiting from an unconventional treat...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. Some time ago, I penned a post illustrating the common practice of physicians negotiating with patients.  Here, I will offer other examples of this phenomenon, which is an integral element of the doctor-patient relationship. Patients who understand how this process works will have an additional tool to advocate for their health. These negotiations are give and take exercises that are successful when both parties feel good afterwards. Realize that these negotiations are different from conventional business discussions which tend to be zero sum games between adversaries.   In the doctor-patient scenario, both participants’ interests are aligned; both are on the patients’ side. ...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. The doctrine of informed consent is a bedrock medical ethical principle.  Physicians’ obligation is to present the patient with reasonable diagnostic or therapeutic options with the respective risks and benefits.  Decision-making authority resides with the patient.  While this process sounds straightforward, it can be a bewildering process for patients and their families.  For starters, physicians – as members of the human species - have opinions on the available medical options.   These opinions may be on the basis of medical evidence or professional experience.  Is it possible that a surgeon might prioritize an operative approach by virtue of training and ...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. In the olden days, purchased products were accompanied by instruction manuals. I realize that this anachronistic item will be unknown to today’s technophiles who direct Alexa to turn up the heat or play Sinatra songs during dinner.  Permit me, as a courtesy to them, to offer a working definition. Instruction Manual:    A printed document that explains how to operate and maintain the new item.   I realize this sounds quaint to the Gen XYZ crowd, but we antiquarians relied upon these instructions regularly.   Yes, there was overkill.   We likely didn’t need to be advised that to make toast, we should simply slide a slice of bread into either of the two designa...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. In the olden days, physicians practiced in a paternalistic fashion, simply informing patients of the next steps to be taken.   This anachronistic practice falls well beyond today’s professional boundaries, although several decades ago, this was the norm.   And the public did not object.   They came to their doctors for advice and, in general, they accepted the recommendations that were offered.   Both sides of the relationship believed that the system was functioning well.   There was no preoccupation with autonomy or with shared decision making, the process whereby physicians and patients today collaborate as they tease through various options. While I conform t...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. When a medical misadventure or new symptoms develop, physicians will often consider if the event is a side effect of a medication.  This can be very difficult to establish.  For example, if a patient is given medication to treat colitis and the diarrhea worsens, is this a side effect of the medicine or a worsening of the colitis?   Physicians face these dilemmas all the time.   If a patient develops a symptom, and a side effect is being considered as an explanation, the doctor either knows or researches if there is medical evidence supporting a side effect event in this specific circumstance.   If a patient develops headaches after a new medicine is prescrib...