MD Whistleblower

I advocate evidence based medicine.  We should restrict our medical recommendations to those that have a reasonable underlying scientific basis.   On the opposite end of this spectrum is quackery, when snake oil and other potions are hawked that either have no scientific support or have been shown scientifically to be ineffective. I do not offer snake oil here as a historical reference.  We have more snake oil and its congeners today than ever before.  People who are sick want to believe the man who promises them healing, particularly when conventional medicine has not succeeded.  This belief goes to the core of human nature, at least as I have observed over the past 3 decades.  Of course, in the medical world, we don’t have enough science yet for all of the medical issues that we physicians confront.   That means that we guess a lot.  How often does this occur?  Every single day.   Patients would be quite sur...

Sometimes, we play a little politics on this blog.  I am a student of current events and enjoy following the dysfunction and absurdities in American politics.  To paraphrase the legendary former British Prime Minister, ‘never has so little been done by so many to benefit so few’. Legendary Former British Prime Minister Which of the following recent events is the most politically charged? Speaker of the House John Boehner passed a clean extension of the debt limit without conditions. (Nothing like a colossal failure on this issue months ago to guide the speaker today.)  Obamacare received its 27 th extension, another ‘tweak’. A new study questions the value of mammography.  Readers know how skeptical I am about medical dogma.  When I was an intern a quarter century ago, I didn’t grasp why routine measurement of  Prostate Specific Antigen (PSA) was standard medical practice since it was true back then that more men were harmed than helpe...

In the medical world, when a physician, a scientist, a hospital, a drug company or a panel of experts issues a report, the games begin.  If one agrees with the statement or benefits from it, then the report is heralded as breakthrough brilliance.  If, however, the report suggests a new medical pathway that diminishes your relevance or reimbursement, then the report and its authors are regarded as misguided.  Yes, I am generalizing somewhat here, but you get the point. As readers of this blog know, I am a conservative medical practitioner.  I do not mean conservative as in supporting the NRA, prayer in public schools, self-deportation of illegal aliens (or should I say ‘undocumented residents?), ‘clean coal’ and lower taxes for millionaires and billionaires.  Conservative physicians describe those who are extremely judicious with regard to medical treatment and diagnostic testing.  We don’t lurch to treat or test unless a high threshold of necessity an...

Autonomy is a bedrock ethical principle in medicine that has supplanted medical paternalism.  Patients have a right to make their own medical decisions and are entitled to know the advantages and drawbacks of all reasonable options.  Clearly, informed consent cannot be given if the patient is only partially informed or has been given a slanted presentation by the physician. When a patient does not have the capacity to provide consent, then a surrogate is used.  This individual is charged to make the decision that the patient would have made if the patient were capable of doing so.  Some argue that the surrogate should decide on what he feels is in the patient’s best interest, which may be different than what the patient would have preferred. Can Christian Scientist parents deny lifesaving treatment to their children? The courts have properly ruled for the children in many of these cases.   These decisions may be traumatic for loving parents who fee...

I admit that I have a rudimentary knowledge of the business world, but I’m improving.  I now know, for example, that a C-suite does not refer to the procedure room where I do colonoscopies.  I am aware that executive coaching does not refer to advising top managers on their golf swing or tennis overhead.  I used to think that LLC stood for Long Live Colonoscopy, but now I know better.  CFO, Chief Flatulence Officer? While patients and physicians operate under oral agreements, business agreements are generally established in writing.  In these documents, terms are outlined including contingencies in the event that foreseeable obstacles or disputes develop.  Oftentimes, the two parties do not agree that a contractual term has been violated.  This is when the fun begins.   With a little luck, the legal profession enters the arena and can speedily resolve the disagreement in a matter of several years after impoverishing both sides. A co...

Many times over the years, I have witnessed the following scenario in my exam room.  Here’s the set up of this one act play. I’m seated at my desktop computer.  The patient is seated before me.  The patient’s daughter is seated next to her mother. Characters Elderly patient Attentive daughter The doctor Curtain's Up Scene I A patient comes to see me in the office with medical issues that strongly suggest that a colonoscopy should be performed.  As an aside, it is not my practice style to issue a colonoscopy edict, but rather to present the patient with available options, which should always include no testing as an alternative.  I may at that point strongly urge that the patient accept my colonoscopy recommendation, but at least the patient then knows the options with their respective advantages and drawbacks. [Reader aside: Examples of medical issues that lead most gastroenterologists and physicians to advise colonoscopy include: ...

                                                                                       Obamacare has promised to provide all of us with quality medical care that is affordable and accessible.  The very name of the law is the Affordable Care Act, which I have maintained will be short on both affordability and quality care.  Most of the country agrees with me.  The postponement for a year of the  corporate mandate to provide insurance in businesses with at least 50 full time employees was a great relief to these businesses and to Democrats ac...