MD Whistleblower

Last week, I posted on whether physicians should modify their medical advice in response to patients who cannot afford the recommended care.  A hypothetical patient was presented who had no medical insurance.  The clinical particulars suggested that a CAT scan of the abdomen was the ideal diagnostic test, but the patient would not be able to afford this.  I, therefore, offered readers several choices of medical advice, some of which was tailored to the patient’s financial situation.  Here’s my view.    While there is very little in medicine or the world which should be absolute, medical advice must remain pure.   It should depend only upon the physician’s best medical judgment regardless of the patient’s financial situation.    A millionaire and a pauper who present to the doctor with an identical medical issue should receive the same medical recommendation.   Yes, I realize that patients are not interchangeable and that there ...

I treat uninsured patients and insured folks who face high deductibles who are under financial strain because of the sagging economy and other personal pressures.   These folks need care that may be unaffordable.   Medical diagnostic testing is expensive.   Even routine laboratory testing can be very costly as those without insurance may be forced to pay the ‘retail cost’, which is quite different from insurance company discounted pricing.   This absurdity is often seen in the emergency room where an uninsured patient can be billed thousands of dollars compared to an insured person who has received identical medical care whose insurance company will pay a fraction of this amount.   Crazy. Because I am a human being, I try to be sensitive to my patients’ financial concerns.   Does the uninsured patient before me really need a CAT scan or a colonoscopy?  Couldn’t we just watch and wait for a week or two and spare him from the expense? ...

My personal paradox is that I have railed against the intrusion and dehumanization of technology, and yet I am tethered to my iPhone.   Do I feel differently when it’s my technology and not someone else’s?  I hope not or I might be forced to add hypocrisy to my list of flaws.  I’ll have to monitor myself in a fair and balanced manner.  Will I conclude that my phone call while at a restaurant is of monumental importance while another patron’s phone use is a selfish and unforgivable threat to world peace that should be prosecuted?  Purple Heart - Read on... This morning, I was halfway to work when I felt for the phone in the inside pocket of my jacket.  Not there.  I palpated other pockets none of which contained the desired item.  The car seat was bare.   I did not fear the most dreaded explanation, that being that the phone was mistakenly left in Starbucks and purloined by a Frappuccino felon.    A...

Over the course of a year, I have an alternating pattern of caffeinated coffee ingestion.   As readers should know, I will not swallow Starbucks ‘Joe’ as I do not think that I have sufficient stomach acid and other bodily defenses to successful prevail against this corrosive elixir. Of course, everything has a benefit if one is resourceful enough to discover it.  For instance, I have found their coffee to be quite useful as a paint remover or shark repellent.  The best coffee in Cleveland is found at Dunkin’ Donuts (DD).  Perhaps, one of the reasons their java is so smooth is that my order of coffee with cream is mixed at a 1 to 1 ratio.  Cream at DD is no half and half concoction; it’s the real thing. As I write this, there is an environmentally unfriendly Styrofoam cup beside me. I’ll down this coffee every day for weeks reaching a point where if I skip a day, I will enjoy the pleasure of an ice-pick, throbbing headache at 4 pm.  It’s a po...

It’s morning and I’m imbibing a beverage that has no nutritive value.  I only hope it won’t cause me harm, as it’s a beverage that slides down my gullet with regularity.  Of course, today’s poison may be tomorrow’s panacea.  This is one of the amusing ironies in the medical arena.  Every 10 years or so, it seems that what was felt to be medical dogma gets tossed out by a new set of studies, which will be reversed a decade later.    Remember when every peri-menopausal woman was advised in the strongest terms to take hormone replacement to protect her bones?  That was then... As to our diet, these recommendations are also subject periodic mutations.  Butter in.  Butter out. I am presently planted in what can safely be regarded as a fast food establishment, where in a single meal, one can exceed his daily caloric need.   With my fidelity to personal responsibility, I don’t blame the establishment for the free choices that ...

I have enormous respect for the military who have suffered the highest costs of protecting the freedoms that we often take for granted.  I have never served, but these men and women serve me and the rest of us every day. The Whistleblower blog is not an anonymous samizdat, such as was present in the former USSR.  I criticize the president openly under my own name.  Those who challenge governments in other countries risk imprisonment or worse. To those who protect our freedoms to write, speak, assemble, pray and criticize our leaders, please accept our collective endless gratitude, knowing that it will never be sufficient for what you have done and will do for us.

Yes.  Professions that heretofore enjoyed public admiration for pursuing noble work and reputedly insisting on the highest ethical standards have been exposed.  The Catholic Church could write a few blog posts on this.   Police officers, journalists and even teachers have also shown us that they are members of the human species and are subject to its weaknesses and frailties. George Washington Cannot Tell a Lie The fallacy is to expect certain professions and professionals to be more irreproachable than the rest of us.  We are all vulnerable to experiencing a fall from grace.  Staying straight and true is a struggle, at least for me.  Yes, physicians lie.  Sometimes, we rationalize a falsehood because it serves a patient’s interest.  We 'adjust' a diagnosis so that the medical test is covered by insurance.  Explain to me please why this is not stealing?  Is this different than shoplifting?   Why should the ...