MD Whistleblower

Some professionals and businesses get paid regardless of their outcome.   They are paid for their time and expertise.   For example, if you hire an attorney, unless you have a contingency fee arrangement, you will be billed regardless of the outcome.    If you sue a business because you allege a product you purchased is defective, but the business counters that you damaged it by using the wrong tools to assemble it, there is no guarantee that you will enjoy a legal victory.   However, if your lawyer has invested 20 hours of labor as your advocate, he or she will certainly enjoy a financial victory if an hourly rate is in place.   Similarly, if your financial advisor, who is paid on commission, advises that you invest in a certain product, and the investment declines 10%, only one of you will take a major hit.   Guess who? If you treat yourself to expensive theater tickets, but you find that the performance was dull and uninspiring, do you expec...

“He ate my dahlia!” exclaimed the lady of the house.   Our backyard is a menagerie.   We are often perched at the window gazing at birds hovering over our feeders, raccoons climbing tall trees, ground hogs, possum, wild turkey, deer, a red tail hawk, a seemingly misplaced spring peeper, stray cats and scampering squirrels and chipmunks. And, the lady was correct.   A chipmunk, who seems to know our property as well as a trained surveyor, hopped into the newly created dahlia flower pot and enjoyed a colorful repast.   As of this writing, there is one remaining, lone dahlia, which might be on his menu later for dinner or a midnight snack. Where Have All the Flowers Gone? I will take issue, ever so gently, that the resourceful rodent ate ‘our’ dahlia.   I suspect that readers have uttered or heard similar phrases, such as 'the deer ate our flowers!'   Let’s consider the issue from the animal's points of view.    The land t...

I have penned several posts on the pitfalls of the electronic medical record (EMR) system that we physicians must use.   Indeed, I challenge you to find a doctor who extols the EMR platform without qualification.   Sure, there are tremendous advantages, and the ease of use has improved substantially since it first came onto the scene.   But, keep in mind that these systems were not devised and implemented because physicians demanded them.   To the contrary, they were designed to simplify and automate billing and coding.   While this made their tasks considerably easier, it was at physicians' expense.   Features that helped billers and insurance companies didn’t help us take care of living and breathing human beings.    It made us focus on silly documentation requirements in order to be fairly reimbursed.   And, it offered very clumsy mechanisms to record a patient’s history – the story of your symptoms – which is our most valuable piece of ...

The colonists were not united in the mission to achieve independence from Great Britain. Indeed, there was tension between the Loyalists, who wanted to remain British, and the Patriots, who demanded separation.  Ultimately, the nation came together as the the great experiment in American democracy commenced.  This is embodied in the nation's original motto e pluribus unum , translated from Latin as 'out of many, one.  Have we remained true to this principle? Challenges and Choices Before Us in 2019 Divide or heal A cudgel or an olive branch Dialogue or lecture Accusation or apology Breaking or bending Sneering or smiling Entitlement or generosity Shouting or singing A polemic or poetry A fist or a handshake Saying no or saying yes 'You are wrong' or 'I am wrong In your view, dear readers, how are we doing?  Should we adopt a new motto, to unum de multis, out of one, many?

After 20 years, I have left private practice and joined with the Cleveland Clinic.   To those who know me and this blog, this development may seem surprising, if not shocking.   On many levels, I’m shocked at this unexpected denouement of my career.     Let me explain. First, these past two decades in private practice have been fabulous.   Our amazing staff and my partner worked hard every day to provide concierge level care to our patients.   We survived only because we provided a level of service that the surrounding competitors simply could not rival.   We provided customized and personal attention.   Our patients were happy and satisfied.   And, so were we.   So, why did we make a change? Over the past few years, my partner and I had become uneasy about our practice’s ongoing viability.   The economics of a 2-person private practice are increasingly challenging.   Consider the math.   There is ongoing downwar...

When I meet patients in the office, our conversations do not focus exclusively on the medical issue at hand.  Of course, if you come to see me with a stomach ache, at some point I will direct the dialogue toward your abdomen.  Often, our conversations are far removed from livers and pancreases, and deal with more personal vignettes and anecdotes.   Why does this happen?  First, I enjoy it; and secondly, it helps me to understand the patient better as a human being.  I won’t give this up, despite the many forces – Electronic Medical Records in particular – that conspire to dehumanize the medical experience.  I am a trained typist and had several secretarial jobs in my younger days.   The tool of the trade then was a contraption unknown to the generation whom are now soldered to their smart phones.  It was called a typewriter.  For those curious, you might actually be able to palpate one of these dust covered devices in your gran...

Readers know how strongly I feel that my profession is suffering from the twin chronic diseases of Overdiagnosis and Overtreatment.  Here's a primer on how physicians make medical recommendations to our patients. Take a look at this grid I prepared, which is worth a full year of medical school.                                     Low Benefit                    High Benefit Low Risk                                                        ...