MD Whistleblower

Bariatric surgery, including gastric bypass surgery, has become a popular remedy for obesity in this country.  Hospitals have weighed in on this issue and are marketing this service directly to the public who are ever willing customers of this slenderizing surgery.  I have many patients who have undergone the procedure and the results have been variable.   It’s too dismissive for me to refer to gastrointestinal bypass (GIB) as a ‘procedure’ as it is major surgery with major potential complications.  There are several types of bariatric surgery available today, but GIB is the standard surgery performed. It profoundly reroutes the guts and changes every day of your life.  This is not like undergoing a heart bypass surgery when after a period of recovery you resume your normal life.  After GIB, there is no normal life afterwards.  Your life is irrevocably altered.  Meals are such a significant and personal part of our lives.  Think of a...

The Deflategate investigation has concluded that it was more probable than not that Tom Brady had general awareness of the mysterious shrinking footballs.  Now the fun started.  Although t he investigator, Ted Wells, is highly regarded for his probity and objectivity, he was attacked by Brady supporters for what they argue were his tendentious findings.  As is so true today in our political world, when allegations are true and damaging, attack the messenger.  Physicists from prestigious universities brought us back to high school science class with theories suggesting how the squishy pigskins could have been the result of natural phenomena.  I think the science was a little squishy here.   It was, however, sentimental for me to relive the tender memories from high school physics about the exciting relationships between pressure and volume.  There’s nothing like a discussion of the ideal gas law to liven up a dull evening.  Would ...

Every week, I am asked by patients if their heartburn medicine causes osteoporosis.  The most effective heartburn medicines are called proton pump inhibitors, or PPIs.  If you watch more than an hour of TV per week, then you have seen ads for some of them.   Nexium, Prilosec and Protonix are 3 examples of these medicines. Many of them are now available over-the-counter at reduced dosages.  Patients today are incredibly informed, and sometimes misinformed, about their medical conditions and their treatments.  Most of their information is from the internet, and it’s easy for patients to become unwittingly trapped in the world wide web. The information dangling in cyberspace is entirely unregulated.  Information can be made to appear authoritative and objective when it actually is a paid advertisement.  Many blogs may appear to function to inform the public, when their true purpose is to serve the corporation that sponsors it.  If y...

Racism and prejudice are endemic in America.  Many of us reflexively answer, No , if we are asked if we are prejudiced.  I don’t.  I say yes. While I do my best to give everyone a fair shake, I grew up in a white suburban family in the latter decades of the last century.   My friends, my parent’s friends and all those we associated with were all the same color.  In elementary school, there was but a single black girl in our classroom. Is it possible for a white kid to grow up surrounded by all of the overt and covert prejudicial and stereotypical influences and somehow emerge pure?   I don’t think so.   Prejudice today among those of us who consider ourselves to be enlightened is more subtle and often hard to recognize. I don’t want to overplay this here.  I often feel that a charge of prejudice with regard to race, gender, age or religion is spurious and is launched to advance a personal or a political agenda.  We al...

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...