MD Whistleblower

I see patients with abdominal pain every day.  Over my career, I’ve sat across the desk facing thousands of folks with every variety of stomach ache imaginable.   I’ve listened to them, palpated them, scanned them, scoped them and at times referred them elsewhere for another opinion.  With this level of experience, one would suspect that I have become a virtual sleuth at determining the obvious and stealth causes of abdominal distress.   I wish it were the case. Some Cases Defy Sleuthing The majority of cases of chronic abdominal pain that I – and every gastroenterologist – see will not be explained by a concrete diagnosis.   Sure, I’ve seen my share of sick gall bladders, stomach ulcers, diverticulitis, bowel obstructions, appendicitis and abdominal infections, but these represent a minority of my afflicted patients.  Patients with acute abdominal pain are more likely to receive a specific diagnosis, such as those listed a...

T’was the week before Christmas And all through the House, Boehner was stirring No longer a mouse The Senate as well In GOP hands Girding for battle With toothless demands. No government shutdown That never played well. Impeachment would surely Damn them to hell. Executive orders, No self-deport. Why diss the Congress? He does it for sport! In 2016, Are Repubs aware, That they need a candidate With Romney’s hair? GOP are no saints They carp and complain, Blaming Obama With dripping disdain. “He’s a king or a czar. It’s all been a ruse.” We know this is true It was on Fox News. So will there be progress? Will they join hands? Can we have hope? As we watch from the stands? Or can we expect, More of the same, Bickering, sniping And pointing the blame? Will Jeb give the nod? Can Hillary lose? Or Dancer or Prancer, Or maybe Ted Cruz? Sit back and relax, For the start of the show,...

Over the past decade, there has been renewed effort to increase the quality of colonoscopy. New data has demonstrated that colonoscopy quality is less than gastroenterologists had previously thought. Interestingly, colonoscopy is less effective in preventing colon cancers in the right side of the colon compared to the left side. Explanations include that some pre-cancerous polyps in the right side of the colon are more subtle to recognize and that the right side of the colon has many hidden areas that are difficult to visualize. New examination techniques and equipment are addressing these issues. The goal of colonoscopy is not to detect cancer; it is to remove benign polyps before they have an opportunity to become malignant. A new measure of medical ‘quality’ is to record how often gastroenterologists (GIs) remove polyps from their patients. For example, if a GI only detects polyps in 5% of patients, which is under the quality threshold, then someone will conclude that this physici...

This blog is devoted to an examination of medical quality.  Cost-effectiveness is woven into many of the posts as this is integral to quality.  Most of us reject the rational argument that better medical quality costs more money.   Conversely, I have argued that spending less money could improve medical outcomes.  Developing incentives to reduce unnecessary medical tests and treatments should be our fundamental strategy.  Not a day passes that I don’t confront excessive and unnecessary medical care – some of it mine - being foisted on patients.  At one point in my career, I would have argued that physicians and hospitals were motivated only to protect and preserve the health of their patients, but I now know differently.  Payment reform changes behavior. As an example, it is impossible for a patient with a stomach ache who is seen in an emergency room to escape a CAT scan, even if one was done for the same reason months ago.  I saw a p...

This is the only Thanksgiving holiday in my memory that I was not on call for hospital work.   Physicians, like many other folks, are not automatically off on holidays and weekends.  I’m not complaining here, but there are times that I am envious of individuals who are home on every weekend and holiday.  Americans need health care, law enforcement, and various emergency services even on days of national leisure.  When I am driving to the hospital on one of those days, I remind myself that the sick person I am headed to see has a much worse deal than I have. I have been bestowed with many blessings, and I am grateful for all of them.  Some of them, I may have earned, while others just fell my way.   Similarly, life’s travails can result from a bad decision or just bad luck.  Life isn’t fair. Spread Sunlight I admire folks who always spy a rainbow through a storm, and I want to be like them. Appreciating one’s lot in life, e...

We’ve all heard or used the phrase, ‘leave it to the professionals’.  It certainly applies to me as the only tools that I can use with competence are the scopes that I pass through either end of the digestive tunnel.  Yeah, I have a ‘toolbox’ at home, but it is stocked similar to the first-aid kit in your new car, which contains a few BandAids, adhesive tape and, hopefully, the phone number of local doctor.  My home tool box has an item that can practically fix anything – the phone number of a local handyman. Nothing for Hemorrhoids Here.      Photo credit It is essential to know one’s limitations, regardless of one’s profession.  Politicians shouldn’t speak authoritatively as if they are climatologists. Gastroenterologists should not prescribe chemotherapy, even though we are permitted to do so. Bloviating blowhards on cable news shows are likely not military experts. The guy who fixed your toilet might not be a top flight kitchen ...

A few days before I wrote this, a patient had a complication in my office.  I have discussed on this blog the distinction between a complication , which is a blameless event, and a negligent act.  In my experience, most lawsuits are initiated against complications or adverse medical outcomes, neither of which are the result of medical negligence.   This is the basis for my strong belief that the current medical malpractice system is unfair.  It ensnares the innocent much more often that it targets the negligent. I performed a scope examination through one of the two orifices that gastroenterologists routinely probe.  In this instance, the scope was destined to travel inside a patient’s esophagus on route to her stomach and into the first portion of the small intestine.  Sedation was expertly administered by our nurse anesthetist (CRNA).   The procedure was quickly and successfully performed.  The patient’s breathing became very impa...