MD Whistleblower

St. Anthony plagued by demons. 15th century work. I read a thoughtful post at See First entitled, What Really Matters. The blog’s name, See First, is taken from a quote from Sir William Osler, one of medicine’s greatest luminaries who emphasized the importance of learning medicine at the beside. The post is a plea for physicians to strive to achieve caring and compassionate bedside manners. It emphasizes the importance of attentiveness, communication and empathy with patients. Though it is not stated, the author clearly understands that the doctor-patient relationship is the essential element of the healing art. While every physician knows this, we still need to be reminded of this truth, from time to time. I commented on his blog that the piece was spot on. I agree unreservedly that patients deserve compassion and caring from their physicians. They deserve appointments without bleating pagers and phone calls. They deserve eye contact. They deserve an opportunity to say 3 or 4 sentenc...

In my 20 years of medical practice, no issue provokes more physician angst than the unfair medical malpractice situation we physicians endure. It is the wound that will not heal. Physicians pursue one primary strategy to protect ourselves at the expense of our patients and society; we practice defensive medicine. Defensive medicine is omnipresent and burns up billions of health care dollars that we need so desperately. Defensive medicine, I strongly believe, is practiced by nearly every physician in the country. If you suspect that this is hyperbole, ask your own doctor, although you may find him defensive about the subject. It’s not actual lawsuits that are suffocating doctors; it’s the fear of of being sued. The aura of litigation hovers in your doctor’s office during your office visits. It's like carbon monoxide. You can't see it or smell it. But, it is real and it is potent. Attorneys and others reject our defensive posture. They argue that we should simply perform tests ...

Which doctors practice defensive medicine? Only those who are breathing. The president, however, wasn’t convinced of this reality when he spoke to the nation on September 9th at a joint session of Congress. “I don’t believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs.” May be contributing? Mr. President, if I may , in the gray and nebulous world of medicine, one truth is certain; defensive medicine cost billions of health care dollars every year. Physicians hold this truth to be self evident. One month after the president’s speech, the non-partisan Congressional Budget Office (CBO) issued a report that reversed it’s own prior conclusions on the value of tort reform. It now states that tort reform could reduce “the use of diagnostic tests and other health care services when providers recommend those services principally to reduce their potential exposure to lawsuits.” The report als...

The U.S. Supreme Court has opined that we cannot falsely scream Fire! in a crowded theater, despite our sacrosanct right of free speech. Even sacred rights have limits. When individual rights collide with societal rights, then each side’s arguments must be weighed to determine whose rights will prevail. This is not a clean or satisfying process as each claimant brings passion and legitimate arguments to the table. I have been involved in a cyber colloquy with Maggie Mahar at Health Beat discussing if health care is a right. Maggie is well known in health care circles and examines health care policy from a liberal perspective. She’s on the left and I’m not. I hesitate to define health care is an absolute right before considering some of the broader ethical ramifications. Is health care a human right? Is health care a constitutional right? Is health care a privilege? Is health care a commodity to be purchased at the discretion of the consumer? Is health care a responsibility? A laudabl...

A new term has been introduced into the medical lexion - Never Events. This refers to medical misadventures that should never occur, such as removing the wrong limb or leaving a pair of pliers in a patient’s abdomen. These terms can be confusing for ordinary folks who are not medical policy wonks. Words and terminology matter here. 'Never events' are not medical complications, which are blameless events that occur in a small percentage of cases. Complications, as purely defined, are not medical malpractice events as no negligence has occurred. Here’s a primer. Medical Complication : A patient denies medication allergies. A physician prescribes penicillin and a rash develops. There is no culpability. Medical Malpractice : A physician prescribes penicillin without inquiring about drug allergies. The patient has a known penicillin allergy. Penicillin is prescribed and a serious allergic drug reaction ensues. This is medical negligence. The physician messed up. Never Event : A phys...

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 ...