MD Whistleblower

This is a less controversial issue than patients ‘friending’ their doctors on Facebook, which I oppose. Although most physicians’ offices are not emailing with patients, perhaps they should. There are several obvious advantages. Decompress phone lines, which are suffocating nearly every medical practice in America. Relieve patients of the cruel and unusual punishment of languishing on ‘hold’ listening to elevator music or dead air. Allow office staff to efficiently respond to patients’ cyber inquiries at scheduled times. Eliminate the need for the ubiquitous phone menu system, a torture chamber that tests the mettle of even the most robust and seasoned patients Facilitate documention of patients’ inquiries, which is not reliably accomplished with phone calls. Permit staff and physicians to access patients’ emails from remote locations. Allow for emails to be forwarded to other staff and physicians with a keystroke. Available 24/7. Sure, email communications between physicians and pat...

Every physician knows what a black box warning is. This is a special Food and Drug Administration (FDA) requirement to warn doctors about potentially severe drug reactions. Most medicines do not have any black box warnings. Wyeth, a pharmaceutical company, will have to place a black box warning for their drug Phenergan, a medication routinely given for nausea. Phenergan has been on the market for over 50 years. I’ve prescribed it for years with excellent results, and I have never witnessed an adverse reaction. The catalyst for the black box development was a tragic side-effect that a woman experienced in 2000 after receiving an injection of the drug. A physician’s assistant injected the medication improperly into her arm. As a result, she developed gangrene and her right forearm had to be amputated. She argued in court that she was not sufficiently informed about the drug’s risk and the jury awarded her $6.7 million. This past week, the U.S. Supreme Court rejected Wyeth’s appeal. What ...

When it comes to Facebook, I will offer full disclosure, a policy I’ve advocated in my medical ethics postings; I am neither a friend nor a fan of this godfather of social media. In my 7 member nuclear family, 6 of us use Facebook as a portal into their personal worlds. Once again, I am the outlier. I just don’t have the time to create and maintain another universe in my life. It would eliminate the scant discretionary time that is still available to me. Bloggers at the American College of Physicians and KevinMD and have mused about physicians using Facebook to communicate with patients. Earlier this year, Sachin Jain, M.D. wrote a commentary in The New England Journal of Medicine discussing his ambivalance to ‘friend’ a prior patient. While the public might be receptive to ‘friending’ doctors, most physicians won’t be in a hurry to use social media with their patients. Physician Facebookers would not want patients to have access to their vacation photos and personal vignettes, ma...

This past week, the Montana Supreme Court heard a right-to-die case where the plaintiff argued that there is a constitutional right to physician-assisted suicide. A Montana physician had refused this request from a terminal cancer patient, who died in December 2008 without medical assistance. No state in the union currently has a constitutional right to die, although physician-assisted suicide is a legal practice in Oregon and Washington. In 1997 the U.S. Supreme Court ruled that there is no fundamental constitutional right to physician-assisted suicide, although it did not prohibit the practice entirely. Once the balance of the U.S. Supreme Court shifts leftward in the coming years, perhaps a constitutional right to medical euthanasia will be ‘discovered’ in the U.S. Constitution. If the Montana plaintiff’s view prevails, would physicians there be breaking the law by refusing to assist a patient who requested a doctor-assisted death? Would such principled doctors be denying a patient ...

Organ donation is a white hot medical ethics issue. In the last month alone, there have been two scandalous reports alleging criminal and immoral donation practices. First, we read about a man, a rabbi no less, arrested for trafficking in kidneys. He referred to himself as a ‘ matchmaker ’, not quite the Fiddler on the Roof image of the wizened Yenta character who arranged marriages. The second story exploded after an article appeared in a Swedish newspaper that accused the Israel Defense Forces (IDF) of harvesting organs from wounded or killed Palestinians. Unlike the arrested rabbi, the Israeli Prime Minister vociferously denied the scurrilous charges. I suspect that the rabbi is guilty, by his own statements, but I do not believe the diabolical allegations against the Israelis. Charges of this nature should never be publicized in the absence of sufficient evidence. The reason that organ trafficking exists is because there is a shortage of available organs. We need a legal and ethica...

We have spent many dinner discussions with our kids discussing plagiarism. This infraction was verboten even when I was student back when, according to our kids, ‘I used to take the dinosaur out for a walk’. While I don’t think the offense is more serious today, it is much more prevalent. Educators report that there is an epidemic of it in our schools and universities. Perhaps, the practice even crosses national boundaries, which might mean that we are in the midst of a plagiarism pandemic. Unlike ‘swine flu’, there’s no vaccine available for this disease. Of course, the offense is so much easier to commit today, with expansive information on any imaginable subject available with a keystroke. I’m sure I could cut & paste a 10 page term paper on nearly any topic during half-time of a televised football game. Some of these rule-bending kids grow up to be adults who still misunderstand the importance of owning work that appears under their name. Joe Biden, historians Doris Kearns Good...

Consider this hypothetical vignette. Tiger Woods accepts my challenge to play 18 holes. Obviously, the gallery would be packed with golf enthusiasts who would cancel job interviews, vacations and even worship services in order to witness this historic competition. Spectators would be permitted to place bets at even money. Perhaps, my mother would bet on me, but no other sane person would. They would properly conclude that even my best performance against Tiger’s worst would be inadequate. There is nothing I could do to change the outcome. All of my efforts would be futile. Futility cannot be proved with mathematical certainly. After all, Tiger could develop acute appendicitis on the fairway and have to forfeit. He could be arrested. Lightning could strike. Killer bees could take him down. Nevertheless, the overwhelming odds are that I would be vanquished and humiliated. Medical futility is a more serious issue that exists in every physician’s office and hospital in the country. Example...