MD Whistleblower

Several posts on this blog have been devoted to tort reform . More than any other subject, this topic generates more heat than light. Indeed, I describe these debates and commnets on this blog and elsewhere as duels, not discussions.  Many folks on various sides of this issue earnestly believe that they have the better argument. Other viewpoints are not purely held and are clearly contaminated by self-interest. I have written repeatedly that I believe that the current system is unfair and does not serve the public well. The public understands the issues and the controversies. In general, I don’t think most Americans believe that we have too few lawyers or lawsuits in this country. It is astonishing that people can defend a medical liability system that           Misses the vast majority of patients injured by medical negligence           Ensnares many more innocent physicians than ...

Smokers of the world unite! It’s strange for a physician to be sympathizing with the tobacco companies, purveyors of the opium of the people. Am I a stealth nicotine addict, an apologist for Big Tobacco who supplies me with my daily fix? This scurrilous allegation can be vaporized in a one-question quiz. Identify which two of the three individuals listed below are cigarette smokers. John Boehner, newly elected Speaker of the House , 3rd in line to the presidency Barack Obama, Commander-in-Chief and leader of the free world Michael Kirsch, Hemorrhoid examiner I’ve never smoked and I detest the habit. It kills people and separates lower income Americans from money that could likely be devoted to more worthwhile endeavors. I remember caring for folks with end stage emphysema as a medical resident and thinking that this disease was worse than cancer. I haven’t changed my mind. Yet, I have felt for years that Big Tobacco is demonized by the press and the government as Big Scapegoa...

Thank you, Obamacare. The GOP, demoralized and frustrated, as they endured the Obama liberal juggernaut that trampled across the country these past 2 years, has been resuscitated. It’s more fun to be in the majority, as Nancy Pelosi can recall. Democratic hubris and rising public disapproval provided not just a strong wind, but a tornado, behind the GOP’s backs. Obviously, there’s nothing revolutionary here, as midterm elections tend to favor the minority, with rare exceptions. What is noteworthy here is the depth of disapproval with the current administration’s policies, affecting every demographic. The gains that the Republicans achieved, particularly in the House, have left Democrats numb and glum. Whistleblower readers will not be shocked to learn that I did not vote for Obama in 2008, but I was inspired by him. I wanted to believe that he would be the transformational figure that his campaign promised and that the country desperately needed. In particular, I was moved by h...

I still marvel at the accomplishments of CAT scans and imaging studies.   These technologies have revolutionized the medical profession.   Imagine foretelling 50 years ago that a new technology would emerge that could perform ‘exploratory surgery’ without an incision.    This prediction would be greeted with disbelief, if not scoffing.   Of course, there would be similar reactions if decades ago other technological feats, such as fax machines, personal computers, emails and internet, were predicted. CAT scans save patients’ lives, prevent surgeries, make accurate diagnoses and refine treatment plans.   This is the good news.   However, as expressed repeatedly on this blog, there is a darker side of the story. Without doubt, too many CAT scans are performed. Accumulated medical radiation has health consequences. Resources expended on unnecessary CAT scans could be devoted to worthy health care endeavors Radiologists suffer from litigophobia and ide...

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...