MD Whistleblower

Freedom is not Free. Expressing profound gratitude to all those who served our nation and serve today, and to their families who share their sacrifice.

I had an interesting conversation with a patient in the office some time ago.  He was sent to me to evaluate abnormal liver blood tests, a common issue for gastroenterologists to unravel.  I did not think that these laboratory abnormalities portended an unfavorable medical outcome.  Beyond the medical issue he confided to me a harrowing personal tribulation.  Often, I find that a person’s personal story is more interesting and significant than the medical issue that led him to see me. I am taking care to de-identify him here, and I did secure his permission to chronicle this vignette.  He is active duty military and is suffering from attention deficit disorder (ADD).  He likes his job.  He was treated with several medications, which were either not effective or well tolerated.  Finally, he was prescribed Vyvanse, which was a wonder drug for him.  The ADD symptoms melted away.  This is when military madness kicked in.  He met wi...

When I am facing an alcoholic in the office, I do not advise him to stop drinking.  Other physicians may advocate a different approach.  We live in a free society and individuals are free to make their own choices.  I have decided, for example, not to own a firearm, ride a motorcycle or bungee jump as these activities are not only beyond my risk tolerance threshold, but are also activities that I have decided would not enrich my life.  Many smokers, though addicted, enjoy the experience and are aware of the risks of this activity.  Preparing One for the Road My responsibility as a physician is to inform and counsel, not to lecture or preach.  I tell alcoholics with clear candor the medical risks they face if they decide to maintain this lifestyle.  I advise them that if they wish to aspire to sobriety, that I will refer them to appropriate professionals for treatment.  I further inform them that in my decades of experience, very few alc...

I was covering for my partner over the weekend and saw his patient with end stage liver disease, a consequence of decades of alcohol abuse.  He was one of the most deeply jaundiced individuals I have ever seen.  His mental status was still preserved.  He could converse and responded appropriately to my routine inquiries, although he was somewhat sluggish in his thinking.  It’s amazing that even after the majority of a liver is dead, that a person can still live. The Liver - Alcohol's Enemy When I do my hospital rounds, it is rare that one of my patients is not suffering some complication of chronic alcoholism.  In the hospital, the disease is rampant.  In my office, this addiction is much more easily disguised.  I know that many of the high functioning alcoholics whom I see there have kept their addiction a secret.  Some lie and others deny.  There was a dispute with regard to the jaundiced patient referenced above.  The...

What should a medical consultant do when the referring physician wants a procedure that the consultant does not favor? Of course, this sounds like a lay up.  The consultant, readers would surmise, should have a conversation with the referring colleague to explain why the procedure is not in the patient’s interest.  The colleague then thanks the consultant for his thoughtful input, and for sparing the patient from the risks and expense of an unneeded medical procedure.  Then, a rainbow appears, songbirds tweet in harmony and the lion lies down with the lamb. When Physicians Dialogue, the Heavens Open and Music Plays! This is not how it works in real world of medical practice.  I wish it did.  Indeed, this issue has tormented me more than, perhaps, any other in my decades of work as a gastroenterologist.  Many referring physicians request procedures from us – not our opinions – and expect that their requests will be complied with.  This i...

Physicians spend a lot of time counseling patients on the phone.  Often, these conversations occur at night with patients we have never met before. When I am on-call in the evenings or on the weekends, these are some typical phone calls I receive from patients I have never met. I have a very bad stomach ache for the last hour. I started having rectal bleeding an hour ago. My wife tells me that my eyes are yellow. My chest is hurting.  It feels different from my usual heartburn. How do we manage patients with issues like those above?  We get hundreds of calls like this every year.  Do we send every patient to the emergency room just to play it safe?  Do we tell them to hang in there and to call their regular doctor when office hours open?   How can we be sure that a simple stomach ache isn’t the first warning of appendicitis or some other severe abdominal condition? My After Hours Medical Equipment Phone medicine relies on an entire...

Recently, I saw a young woman referred to me for an opinion on her hepatitis C infection. In the latter part of 2013 she made an unwise decision and started using intravenous drugs.  She also made a more unwise decision and shared needles.  She is fortunate that the only virus she contracted was hepatitis C, now curable.  I do not know the details of her life then which led her to lean over the edge of a cliff. It would seem to most spectators that her new lifestyle would portend an inexorable slide into an abyss.  Young addicts, for example, often cannot fund their addictions, and resort to criminal activities to generate necessary revenue.  Employment status and personal relationships become jeopardized.  The tapestry of a person’s life can rapidly unravel.  But, none of this happened.  About two years after the first shared needle pierced her vein, she quit and she’s been clean since. It was nearly a year later that she first saw me in t...