MD Whistleblower

I was asked to consult on a 43-year old female with abnormal liver blood test results.  It took but a few minutes to determine that she was an alcoholic, which was the likely explanation for her abnormal blood results.  She drank several beers daily over several years. My diagnosis was alcoholism, but did the patient concur? “Do you feel that you are drinking excessively or do you have it under control,” I asked. She replied, “I’ve got it under control.” That sad reply indicated that the probability of helping her to help herself was zero.  Ultimately, the addict must forge a pathway to healing.  Sure, we can help, coach and support the effort, and we should.  But, no addict ever reached the Promised Land by force or persuasion. Pouring One for the Road Sure, we’ll got this patient out of the hospital, back into the cauldron of inexorable self-destruction.  Did we help her?  I don’t think so.  This is not like treating a urina...

It’s Memorial Day tomorrow.  What is it exactly that we are charged to remember? Cole Slaw? Lighter Fluid? BBQ Sauce? My father was a member of the greatest generation, having served in the U.S. Navy for 39 months.  He was stationed in California and was never in combat, despite some apocryphal vignettes he regaled us with.  I’ve never served in the military and none of my friends have served.  If not for my job, I would have very scant exposure to military professionals.  I have numerous patients who have served in all branches of the military during the 1940's and 50's.  Many are true heroes who recall their service with understated modesty.  I have also cared for many Vietnam vets who still bear physical and psychological scars of a war we couldn’t win and should never have joined. Freedom is not free, a quote that moved me deeply when I first saw it on the Korean War Veterans Memorial in Washington, D.C.  I know that M...

While I consider myself to be an ethical practitioner, I am not perfect, and neither is the medical profession. I will present a recurrent ethical dilemma to my fair and balanced readers and await their judgment. Our gastroenterology practice, like all of our competitors, has an open access endoscopy option.  This permits a physician to refer a patient to us for a colonoscopy, without the need for an initial office visit. Ready, Aim, Fire! Patients can also schedule procedures themselves, such as a screening colonoscopy, without a physician referral, if allowed by their insurance carriers.  These patients enjoy the convenience of  bypassing an office visit.   We agree that an office consultation should not be required for routine screening procedures or to evaluate minor gastrointestinal symptoms. Of course, if a patient wants to see us in the office in advance – and some do – we are happy to do so.  I enjoy these pre-op visits which al...

Practicing physicians like me rely on scientific medical journals to keep us current on medical developments.  We learn about new treatments for old diseases.  New diagnostic tests are presented as alternatives to existing methods.   Established treatments, which are regarded as dogma, may be shown to be less effective or less safe than originally believed. It’s a confusing intellectual morass to sort among complex and conflicting studies some of which reach opposite conclusions in the same medical journal.  What’s a practicing physician to do? While the medical journals that physicians read are fundamental to our education, paradoxically most physicians have only rudimentary training in properly analyzing and assessing these studies.  For example, the quality of medical studies often depends upon statistical analysis, a mathematical field that is foreign to most practicing physicians.   Doctors like me hope that our peer-reviewed journal edit...

Everyone likes to be recognized for a special achievement or accomplishment.   Every career has special awards and commendations for everything.   While there’s no reward that matches cold hard cash, many of these honorable mentions have no tangible value whatsoever.  Pull into a fast food parking lot and you may see a parking space designated with a sign proclaiming, Employee of the Month!  Such an award conveys appreciation but does little to enhance the standard of living of the recipient. It seems that every other week there is some award show on television for the arts and entertainment industry.  99.44 Pure! I’d like an award, or at least a citation, for the work that I do as a gastroenterologist.   Fortunately, there are many awards and honors that I am eligible for.   Here are some of the prestigious honors that would illuminate any curriculum vitae. Fellow of the American College of Flatulence Honorary Doct...

Do you think that physicians’ advice should be based on their patients’ best interests? How about lawyers?  Plumbers?  Financial brokers? An advisor who has what is termed a fiduciary duty is required to use the best interest standard with his client.  For example, an attorney is prohibited from recommending that his client proceed to trial, which would be beneficial financially  to the lawyer, if the attorney believes that a settlement serves his client’s interest better.   While it may not always work this way in the real world, this is how it is supposed to happen. "Toilet's clogged, ma'am.  Better replace the whole thing." Shockingly, investment brokers, unlike certified financial planners, have no fiduciary responsibility when advising clients on thei r personal investments.  They are free to make financial recommendations that are ‘suitable’  for a client , even if this would not be in the clien t’s best interest.  The b...

I love teachers.  And, I love the teaching profession.  I remember years ago teaching one class to middle-schoolers on a subject that I thought exuded fascination and drama – the Civil War.  It was a long 50 minutes.  Even my daughter was doing her best to feign interest.  While the fault here may have been with the guest instructor, the lesson for me, which I have not forgotten, is how tough the teaching trade is. Teaching - Leave it to the Professionals I don’t have the same affection for the teachers’ unions as I do for the profession.  Their unions are advocacy groups to protect the interests of its members.  There is nothing wrong with this.  Many professions and occupations, including mine, have similar societies to whom constituents pay money in  exchange for various job protections. My issue with these groups is when they torture the truth to disguise the real reason for their positions.  Of course, even the most d...