MD Whistleblower

Recently, I wrote a post on plagiarism in medicine. I advocate a stringent code of ethics for our profession. Once our integrity becomes squishy, then the whole tapestry starts to unravel. We physicians are charged to search for and guard the truth. In 1910, Sir William Osler wrote: No human being is constituted to know the truth, the whole truth, and nothing but the truth; and even the best of men must be content with fragments, with partial glimpses, never the full fruition. Of course, we physicians don’t always succeed in enlightening the truth, but we try. Every day, every one of us faces choices that test us. Some are easy. Most of us would not falsify billing submissions. Other choices are murkier. For example, do we coax a symptom out of a patient so that the procedure or visit becomes a covered benefit? Have we informed a patient whom we are recommending a colonoscopy about the radiologic alternatives? When a patient informs us that his primary care physician has referred hi...

Photo Credit Two Thursdays ago, I took the American Board of Internal Medicine (ABIM) recertification examination in gastroenterology (GI).    Whistleblower readers have already digested some of my musings on this event.   The good news is that there was no penalty for incorrect answers.   The bad news is that I submitted many incorrect answers.   Every one of these standardized tests that we all take becomes a mind game, where the examinee (us) tries to penetrate the psyche of the test makers (them).   We’ve all been there.    We torture ourselves between what we think is the right answer, and what we think that the questioners think is the right answer.    Sometimes, I thought that the ‘correct’ answer on the list is out of date, which confused me.   Or, what I felt was the truly correct answer, wasn’t included in the answer choices.   For example, I am a very conservative practitioner, who often advises observation, rather ...

Photo Credit Two days from this writing, I will go mano a mano with a computer screen.    This will be my second gastroenterology (GI) board recertification.    Last week I suggested that the 490 minutes of unfettered fun might not be money well spent.   A reader could infer my view that the $1200 fee has more to do with securing the finances of the American Board of Internal Medicine than it does to enhance my knowledge of GI.    Perhaps, I was hyperventilating about the cost.   When I calculate the GI board CPM (cost per minute), I determine that the exam only costs $2.45 per minute    In other words, a full minute of quality board testing time costs about the same as a slice of pizza.   Clearly, the test is a bargain, and I retract any prior Whistleblower whisperings that contradict this.   Yesterday, I took another exam, this one to recertify me as a qualified Advanced Cardiac Life Support (ACLS) practitioner.   A...

Photo Credit This coming Thursday, I will have the joy and pleasure of taking the gastroenterology (GI) board recertification exam.    There will be many entertaining elements to the experience, as other board certified physicians already know.   Although there will be many fun delights, some will clearly be more amusing than others. Which of the following features of the GI board examination will be most fun?   While more than one answer may be correct, choose the best answer . (1)     A 490 minute all day exam is a thrill, by definition (2)     Losing a day of income (3)     Paying the American   Board of Internal Medicine (ABIM) $1200 (4)     Pleasing my partners who will cover my practice (5)     Having my palm vein recognition scan to verify my identity every time I reenter the room During this exam, each giddy examinee will be provided with a computer station.   I am nostalg...

Painting of Paul's Damascus Road Conversion Electronic Medical Records (EMR) promises to be the holy grail of modern medicine.    It aims to deliver us from the Smith Corona era into the digital age.    I’m a gastroenterologist who has already been practicing digitally for two decades.   I guess I am way ahead of my time Is EMR progress?      Consider these two hypothetical   patient assessments.   The assessment is a critical section of the medical record where the physician shares his thinking on the patient’s condition.    The assessment answers the question, “What do you think is going on here and why?”   The Old Fashioned, Archaic, Fossilized and Sclerotic Assessment The quality and timing of the patient’s abdominal pain is strongly suggestive of mesenteric ischemia (lack of blood supply to the guts), as the pain consistently develops   45 minutes after meals.   The patient has numerous risk factors for...

Missouri, the ‘show me’ state, is showing the country an interesting and novel concept. Judges there will be apprised of the financial costs of various punitive options before issuing a sentence. For example, a judge would be informed that a convicted drug user could be sentenced to 5 years in prison for $50,000, or could do community service with a probationary period instead for a fraction of the cost. Blind justice? This new policy has generated spirited debate. Some welcome the reform, which aims to bring some measure of cost sanity to the justice system. Others oppose the effort arguing that justice must be meted out without regard to financial costs. Is this issue being driven by difficult economic realities? Some are hostile to incarceration for reasons independent of its exorbitant expense. These folks favor rehabilitation and treatment over confinement as a matter of policy. Is there any cost of justice that is too high? I viewed this report through the prism of a prac...

Our society thrives on tension and competition. GOP vs Democrats Civil Libertarians vs Eavesdroppers Ohio State vs Michigan Creationists vs Darwinists Ideas, like sports teams, compete to win. We are the referees of these contests. Many of these competitions in the public square are ongoing. Some of these duels are locked in a dead heat. Others are in overtime. Some are ‘challenge matches’ when a vanquished idea wants another shot to change the original outcome. Many of these controversies may never be resolved. In addition, the outcomes may change because we – the referees – have changed. What was considered to be a foul years ago may now be regarded as fair play. The medical profession is riddled with many internal conflicts that will not be easily resolved. Here are a few, and I’m sure readers could add generously to the list.  Primary Care vs Medical Specialists Physicians vs Insurance Companies Obstetricians vs Medical Malpractice Attorneys Fee-for-Service vs Sala...