MD Whistleblower

I am flattered that influential U.S. senators must be reading MDWhistleblower for important policy advice. Senator Max Baucus, Democrat of Montana, and Charles Grassley, Republican of Iowa issued proposals that aim to change the Medicare payment system to doctors and hospitals. Payment would be directly linked to quality, rather than to volume of services. Under the present system, if a surgeon operates on a patient 3 times to correct his own complications, he is paid more than a colleague who got it right the first time. However, as discussed in many prior postings on this blog, medical quality is very difficult to measure. One of the senators’ specific proposals receives a 5 Star Whistleblower Award for medical quality. The government will aim to reduce the excessive use of CAT scans, MRIs and other advanced medical imaging techniques that cost a fortune and create unnecessary medical cascades that chase after trivial lesions that will never cause illness. ( Click here for a related...

A paperless society is approaching for all of us, which sadly will include the demise of my beloved New York Times, which I cherish each day. Our medical practice will have electronic medical records (EMR) in the foreseeable future, if we can mollify the objections of one of our technophobic physicians. There are several reasons why most physicians haven’t made the move to EMR yet. First, it is not easy to learn. This is not like getting a new e-mail address. It is a complex software system that is like a giant onion with endless layers of functions that will perform office tasks that have been successfully done manually for decades. It introduces an entirely new computerized culture into the office. This adjustment is particularly difficult for doctors who were not trained in the I-pod era. However, even for the cybersavvy, learning these complicated systems takes months. During this training period, patients, doctors and staffs become frustrated when it takes 10 minutes or longer to ...

The Obama administration will be devoting billions of dollars to promote electronic medical records (EMR) for doctors. Today, EMR vendors run in and out of doctors’ offices trying to hawk their software. Each one claims to be the holy grail of electronic records. I admit that the concept seems intoxicating. The promise of a paperless office is certainly seductive. The notion of physicians and patients having access to their medical records from any computer would improve medical quality and efficiency. Every doctor knows how frustrating it is to see a patient in the emergency room when the relevant medical records are sitting in the primary doctor’s office or in a hospital across town. Conversely, EMR permits the primary physician, who may not have been the hospital treating physician, to be easily updated after hospital discharge when the patient returns to his office. Many patients I see today in my office don’t know their medications and can’t recall prior illnesses or even operatio...

If we are ever to prevail against the CAT scan cascade, we must understand why these tests are ordered. Here are 7 explanations of why doctors scan their patients. Talk to your own doctor and see if I’ve missed a few. While some physicians have financial conflicts of interest, most order scans for other reasons. This is not a ‘choose the best answer’ multiple choice test. Physicians often have more than one reason to scan you. The physician orders a scan to follow trivial lesions identified by accident on prior scans. A patient or the family want a medical test believing that a diagnosis has been missed. The physician orders a CAT scan hastily, without sufficient thought if it makes medical sense. The physician has a financial interest in ordering CAT scans. The physician correctly believes that the scan is medically necessary. The physician orders a CAT scan defensively for his own legal protection. The physician orders a scan to bypass a difficult discussion of a patient’s chronic co...

The last few postings in the Radiology Quality category have detailed the risks of pursing trivial CAT scan abnormalities. Physicians created the term incidentalomas to describe these lesions that were discovered incidentally, or by accident. There is an epidemic of these lesions today as the volume of CAT scanning increases each year. When a scan uncovers an abnormality, the healthy patient is dragged into the medical arena. This unlucky patient may not be healthy for long. These scans are a potent accelerant that fuels the vicious cycle of unnecessary and excessive medical care. Medicare expenditure for radiologic imaging tests, including CAT scans, is exploding. John Iglehart analyzed this trend in the March 5, 2009 issue of The New England Journal of Medicine. Medicare Expenditures for Imaging Studies Year 2000 Annual Expenses: $3.6 billion Year 2006 Annual Expenses: $7.6 billion The government capped fees paid for imaging studies performed in out-patient facilities and doctors’ o...

The superscan in the prior posting, which showed a ‘freckle’ in the right lung, has now created an anxious patient and family. This patient’s worry will be heightened when he is sent to a pulmonologist, or lung expert, to evaluate the ‘abnormality’, which was found entirely by accident. The lung specialist will then advise the patient to have periodic CAT scans over the next 2 years to assure that they lesion does not enlarge. Obviously, this exercise diminishes quality of life and costs plenty of money that could be used to help truly sick people. And, if the nodule does increase in size – which even benign lesions can do – then the doctor may recommend surgery just in case it is cancerous. Consider what tens of thousands of Americans endure evaluating abnormalities that should never have been discovered or investigated. Millions of us are walking around with innocent imperfections in our internal organs. In other words, if any of us were to undergo a CAT scan, many of us would have a...

I am astonished at the diagnostic accuracy of today’s radiologic technology. CAT scanners today, for example, can detect lesions that were invisible 5 or 10 years ago. As a gastroenterologist, I am routinely referred patients with subtle abnormalities seen in their livers, pancreases and digestive tract. Indeed, every medical specialty has been similarly affected. Pulmonary specialists see patients with tiny lung nodules that would not have been seen with older technology. Oncologists see patients with borderline abnormalities that can only be detected with the latest generation of scanners. Shouldn’t we celebrate this futuristic diagnostic accuracy? I’m not so sure. I believe that these phenomenal technologies harm many more patients than they save. Follow my reasoning. Most of the abnormalities that scans detect today are innocent lesions that will never make a patient sick. Our internal organs are not smooth and perfect. New scanners, like the satellites in space mentioned in the pr...