MD Whistleblower

The Patient Protection and Affordable Care Act was signed into law earlier this week by President Obama. The ceremony was notable for the president’s use of 20 pens to sign the bill, and for a vice-presidential expletive that has gone viral. Biden’s presumed private verbal ‘high five’ to the president was heard and widely circulated. Don’t these guys know that when they’re in public that they are never off mic? Our macho vice-president was emulating his vice-presidential predecessor who dropped a similar verbal bomb onto Senator Patrick Leahy in 2004. Cheney’s muscular rhetoric was no aerial drone attack; he delivered his message face to face to the Vermont senator. I wonder if Dick ever invited Pat on a hunting trip? Obamacare is now law. Will this lead us to Armageddon or to the Garden of Eden? I confess that I haven’t read the bill, but then neither did the legislators who voted for or against it. Sure, the specifics are important, but what we really crave to know is what the scor...

Photo Credit Eva Kocher First, let me state unequivcally that I am against all varieties of pain, foreign and domestic. Indeed, I wish that we could snuff the varmint out every time and place it surfaces. Pain is a wily opponent that can be difficult to vanquish. In recent years, physicians have been resorting to a ‘shock and awe’ strategy of using excessive force against it. While this may be sound military strategy, in the medical arena it has led to unintended and predictable consequences. I think that we physicians are pulling the narc trigger too quickly and too often. It’s easy to advocate for a more parsimonious approach to pain control, when your humble blogger is pain free. Indeed, my own pain threshold cruises at low altitude, and has never been fairly tested. While this may limit my credibility, I maintain as a physician that my profession, including me, needs some narc reform. When I was in medical training, during the days when my kids insist that I took the pet ste...

Hypocrisy : The practice of professing beliefs, feelings, or virtues that one does not hold or possess; falseness. Which of the following medical tests or procedures do physicians commonly recommend, but state they would never accept themselves? (1) Cardiac catheterization (2) Screening colonoscopy (3) Feeding tube placement (4) PSA screening for prostate cancer (5) Hip replacement surgery Answer appears at the post’s end. Last week, I was asked by a primary care physician to place a feeding tube in an NNHP, a nonagenarian nursing home patient. The patient had a panoply of active medical issues, and was at the end of life. The feeding tube was advised because the patient’s swallowing function was impaired and he was, therefore, at risk for pneumonia if he ate. These swallowing evaluations are generally performed by speech pathologists, whom I have found to be dedicated and competent professionals. As an aside, they often uncover swallowing defects that suggest that eat...

The Intro to the Intro For those who were hoping for a sober or analytical piece this Sunday morning, be warned that you have entered a No Wonk Zone. Today’s post, hopefully will make a serious point, but it is seasoned with some levity and a little silliness. Of course, just because I think it’s silly, doesn’t mean that you will agree with me. The definitions of silly and serious are highly subjective. One man’s ‘dead serious’ is another man’s ‘deadpan'. For example, after watching the recent health care reform summit, I couldn’t tell if it was a serious policy exchange or a silly infomercial.  Could you?  Yes, I confess that this is an entirely gratuitous jab at the President's daytime TV health care reform special. The Intro Every physician has been asked, “Doctor, what would you do if I were your mother?” The patient, who assumes that the doctor likes his mother, erroneously believes that this is a surefire method of receiving premium medical advice. After al...

 Tinkerbell in Bronze I never thought I would have a chance to watch the health care reform summit on live TV this past Thursday. Fate took a U-turn. I didn’t expect to be in a New Jersey blizzard on Thursday morning. I was scheduled to be in the ICU performing an endoscopy examination of the stomach on a patient who I had seen in the emergency room a day before with intestinal bleeding. The plan was to fly to New Jersey on Thursday evening so that we could witness the milestone event of my brother being sworn in as a Superior Court Judge in on Friday afternoon. No human plan, however, can prevail against an Act of God. A torrential blizzard was descending upon the east coast and was threatening to postpone the event that was the result of years of my brother’s work and hopes. Unlike his anonymous gastroenterologist blogging brother, Robert has a deep network of judicial and political luminaries, developed over a career in the U.S. Department of Justice and the U.S. Attorney’s...

It’s been a while since I’ve attended a conventional medical Grand Rounds. These were events where a medical luminary would fly in to give a medical audience a state-of-the-art presentation on a medical subject. Ideally, the speaker was a thought leader and a researcher on the issue. These presentations were usually not a demonstration of the virtue of humility. We physicians, as a class, have generous egos. Academic physicians occupy a higher rung on the ego ladder. Medical Grand Rounders (MGRs), who are on the GR speaking circuit, often must bring their own ladders to assure they will be able to reach their desired atmospheric height. Jacob’s Ladder Photo Credit At least in the old days, before the GR speaker would assume his position behind the rostrum, a designated pre-speaker would offer an introduction. The audience would hear a list of awards, achievements, journal editorial positions, department chairmanships, honorary degrees, publications and book chapter authorships,...

This week, there is no formal Whistleblower post. I am sorry to disappoint the tens of thousands of readers who race to this site each Sunday morning for a weekly dose of amusement seasoned with satire. Did I develop  blogger’s block? Hardly. There is more stuff to write about than any blogger has time to write. I am honored to serve as the host of this week’s Grand Rounds, which will appear on this site on Tuesday, February 23rd. I have been occupied sorting through the many fine submissions I have received this week.  It's been fun getting acquainted with blogs and bloggers that had been outside of my personal blogoverse. For those procrastinators who still wish to submit a post, please note that the deadline is noon today. If you miss the deadline, and you grovel sufficiently, then I will likely grant you an extension. Instructions for submitting posts can be found on the last Whistleblower . As for today, brew the coffee, crack open the New York Times and watch the S...