MD Whistleblower

Readers know of my hostility toward overdiagnosis and overtreatment.  I maintain that there is probably twice enough money as needed to reform the health care system if unnecessary medical care could be eliminated.  (Yes, I am including colonoscopies in this category!)   The challenge, of course, is that one person’s unnecessary medical care is another person’s income.   One institution that is routinely demonized are medical insurance companies.  They are described as Houses of Greed who put profits ahead of patients by design.  Every physician who is breathing can relate tales of woe describing frustrating obstacles that insurance companies place before us and our patients.  When one of my patients receives a ‘denial of service’ notification, I am always prepared to discuss the patient’s case with a physician at the insurance company, as this provides an opportunity for me to explain the nuances of the case to a colleague.  Ta...

I have written previously about the raging opioid epidemic here in Ohio.   Attacking and reversing this tidal wave will require many weapons, resources and time.   Opioid addiction is a crafty and elusive adversary that will be difficult to vanquish.   Our battle plan will have to be nimble and adjusted over time, much as military leaders must do in actual armed conflict. Here in Ohio and elsewhere, physicians must abide by new prescribing restrictions.   Prior to prescribing a controlled pain medicine, doctors are required to check the patients OARRS report on line, which catalogues the patient’s prescription history.   This would alert us if the patient was receiving controlled medicines from various pharmacies that the patient might not disclose to us.   Physicians and the public are encouraged to seek non-narcotic alternatives for pain relief.   If opioids are prescribed for acute pain, there is now a limit on the length of opioid treatment ...

We’ve all heard the excuse or explanation that ‘it’s society’s fault’, to explain someone’s failure.  We hear expressions like this often when an individual has committed a crime or simply failed to succeed.  Personal accountability is diluted as we are told that this person came from an imperfect home, had no role models or ample education. These arguments are often wielded by those who have been favored with society’s blessings and advantages. As readers here know, I am not politically liberal and regard myself as an independent who usually votes for Republican candidates.  I did vote for Senator Sherrod Brown, one of the most liberal members of the U.S. Senate, a fact that astonished friends and family, as I had concerns about the character of his opponent that I could not overcome.  I am proud of this vote.  Were you born next to a ladder? A 19-year-old female was sent to me to evaluate hepatitis C.  She was unemployed.  She had us...

Until last week, colon cancer screening for most folks started at age 50.  Why 50?   Why hadn’t the colonoscopy coming of age been set younger to prevent the tragedy of a 45-year-old, or an even younger person, developing colon cancer?   In the past 2 weeks, I had to give a young patient and his wife the sad and serious news that he had colon cancer.  Because of his young age, he never received a screening colon exam, as we routinely do with 50-year-old individuals.  Is it time to make an adjustment? Our colon cancer screening system is not perfect.   It is not designed to prevent every case.   There have been people in their 20’s who have been diagnosed with this disease, and there is simply no way to capture them in the system.   Experts in disease prevention must carefully analyze disease trends and behavior to find the sweet spot of when to begin screening.   And, money is part of this decision.   Let’s face it. ...

I never served in the military.  My father served for 39 months during World War II, but was never in harm's way.  He was in the navy, stationed in California.   Had President Truman not ended the war in Auguts 1945, I think it is likely that he would have been sent to join in an invasion of Japan. Because I have not served, and no one in my close circle is in the military, it is difficult for me to grasp the full depth and meaning of Memorial Day - a day that the nation honors and remembers its sons and daughters who have served, been wounded and have fallen. Arlington National Cemetary I try to connect with the experience as best as I can.   I watch, I read and I listen.  I recently watched Ken Burn's monumental documentary, The Vietnam War, trying to absorb its lessons.  But, I realize that I am still a spectator who will never comprehend the experience as the actual participants and their loved ones appreciate. I have been honore...

The day before I wrote this, I read about a ‘research’ fiasco where 3 individual were blinded after receiving stem cell injections into their eyes.  This ‘research’ was done in a physician’s office and cost each patient $5,000.   What a tragic outcome.  At least two of these patients discovered that this treatment was available by clicking on ClinicalTrials.gov, a name that suggests government approval, which is not true.  Clearly, the name of this website is deceptive.  Neither the Food and Drug Administration (FDA) or the National Institutes of Health had any endorsement or sponsorship role here.  Moreover, press reporting indicates that these patients had scant medical evaluation prior to and following the medical procedure. Note to readers: Legitimate clinical trials generally do not charge patients for participation. Legitimate clinical trials have intensive evaluation to screen patients for eligibility.  Many or most patients may ...

People with liver failure and cirrhosis die every year because there are not enough livers available.  Who should receive the treasured life-saving organ?  There is an organ allocation system in place, which has evolved over time, which ranks patients who need liver transplants.  Without such a system, there would be confusion and chaos.  How can we fairly determine who should receive the next available liver?  What criteria should move a candidate toward the head of the line?  Age?  Medical diagnoses? Insurance coverage? Employment status?  Worth to society?  Criminal record? An artist's rendering of the liver from the 19th century. Consider the following 6 hypothetical examples of patients who need a liver transplant to survive.   How would you rank them?  Would those toward the bottom of your list agree with your determination? A 50-yr-old unemployed poet is an alcoholic.  He has been sober for 1 ye...