MD Whistleblower

One thing doctors like to do is to use fancy language.  Patients, however, want physicians to use simple terms.   Perhaps, using highfalutin language makes physicians feel more scholarly and important.  Of course, this bombast only confuses patients who may be too timid to respond that they don’t have a clue what we're saying.  If your doctor is speaking in tongues, then ask for a translator. He'll get the message. Icon of Pentecost when Apostles spoke in tongues Many professions have their own technical languages which is necessary for internal communications or scholarly work.  Beyond this, there is also a pomposity that drives this lexical elitism.  In the medical profession, medical terms seem to offer no advantage over colloquial alternatives.  Yet, physicians want to ‘speak like doctors’, whatever that means. Cool Medical Term            Lame Alternative Thrombus     ...

Folks must think than all doctors know all things medical.  I know this is true by the questions that I have been asked over the years.  While my expertise spans hemorrhoids to heartburn, I am routinely queried on medical issues well beyond the specialty of gastroenterology.  When I can’t answer questions about a new medicine for hypertension or if an MRI of the shoulder makes sense, folks look at me quizzically as if I must not be a real doctor. Today, more than ever, physicians are highly specialized with a very narrow medical niche.  There are ophthalmologists, for example, who only treat retinal disease.   Perhaps, there are even retinal specialists for the left eye only.   It wouldn’t surprise me.  My partners and I perform routine gastroenterology procedures in an ambulatory surgery center.   Patient safety is our priority and our staff and us are dedicated to this mission.  All of us are required to be certifie...

A few weeks back, a drug rep, aka a pharmaceutical representative, came to the office hawking a new constipation medicine.  These guys are in a tough racket.  They need to sell products that we physicians are often unable to prescribe.  It’s the Formulary, Stupid. The Best Disinfectant In the olden days, before I entered the hallowed halls of healing, pharm reps, or drug detailers, developed relationships with physicians who would then prescribe their drugs.  Physicians to this day deny the incontrovertible truth that we are influenced by pharmaceutical company marketing techniques, which still feature face time between sales folks and prescribing physicians.  These days, many of the sales tools used years ago have been properly prohibited.  Physicians cannot be flown to exotic locales and paid big bucks so they can serve as ‘expert consultants’ who will be subjected to push polling on the new pharmaceutical product.  (Why didn’t any compa...

I’ve posted a piece on this blog on the issue of faith and reason in healing. Indeed, the protagonist of that post is an inspirational figure, a selfless man who exudes grace and humility. I was honored that the post was shared with many Catholic clergy who appreciated my heartfelt words for one of their own. Faith and reason reentered my medical universe recently. A patient underwent surgery to resect a colon cancer. The tumor had metastasized to the lymph nodes, an unfavorable prognostic event. The surgeon entered the room and advised the patient that her survival is likely limited to 1-2 years. The patient and her husband were devastated. The distraught husband spent the next 24 hours sobbing in a painful and despondent state. He related the tragic news to his 3 children, ages 3, 5 and 8. Was this the appropriate time for the physician to relay such ominous news to a patient and family? Was it prudent for the overcome husband to share this traumatic news with his 3 young ch...

I’ve had two jobs since I completed a fellowship is gastroenterology over 20 years ago. For the first decade, I was a salaried physician. Afterwards, I promoted myself to private practice. Each model has its advantages and drawbacks , but for me the private practice model wins out. The climate in Cleveland is extremely inhospitable to private practice, because of two mega-medical institutions that incinerate private practices as their boiling lava flows across the region. So far, our practice is still viable, but the prospects for its long term health and welfare are questionable. One of the advantages of working for a straight salary is that income dies not depend upon productivity. (My employer maintained that we had a productivity bonus, but in reality there wasn’t much the physicians could do to adjust their salaries in either direction.) One of the disadvantages of private practice, particularly where I practice, is the need to hustle aggressively for patients, a task I neithe...

Electronic medical records (EMR) were supposed to rewire the medical grid.  It would increase efficiency, reduce redundancy, improve quality and reduce costs.  On  these measures I offer a grade of 0 for 4.  Ask any practicing doctor how EMR has impacted on his practice and be prepared for some remarks that differ from the government’s Kool Aid talking points.  EMR, thus far, hasn’t been ball bearings for the system.  More often, it gums up the works. The EMR Maze - Enjoy! The government spent billions of dollars with cash payments  to induce hospitals and doctors like me to jump on board the EMR express.  The Rand Corporation helped to fuel this euphoria in 2005 when it predicted exaggerated benefits of EMR.   By the way, this study was financed in part by EMR companies whom, I politely suggest, had a vested interest in the study’s conclusion.  Rand denies that they were unduly influenced by their backers, and I don’t c...

I saw an elderly patient a few months back for a gastrointestinal issue that fortunately led to a benign outcome.  He was a modest man who spoke softly and used few words.  As has been my custom for as long as I’ve sat across patients, I was interested to learn something of the man beyond the issue that brought him to see me.  Indeed, it is these vignettes that I regard as the gems of my practice.  Without them, I would be left only with the practice of medicine, and this would not be sufficient. He wore a military baseball style cap, emblazoned with a U.S.M.C. label.  To those who do not immediately recognize what these letters stand for, then I suggest that you apply to medical school, become a physician, see patients so you also will have the opportunity to learn stuff that really matters. I learned that he served in the Pacific theater in World War II and asked him about his service there.  While my father served in the war for 39 months, he r...