MD Whistleblower

I have previously expressed how physicianss feel about treating patients that they do not know in a prior post , which readers are invited to review.  This post is the other side of the story.    Nowadays, patients are used to seeing physicians who are not their doctors.  Often, patients may be seeing a nurse practitioner, a highly trained professional for their medical care, instead of a physician.  A generation ago, patients nearly always saw their own physician, including if a patient was hospitalized. Imagine that, your own primary care doctor sees you in the hospital, an event that occurred when dinosaurs roamed freely. The medical universe has changed.  Hospitalists care for most hospitalized patients, which in my view, has vastly improved the quality of hospital medical care.  It is commonplace for patients who need to be seen right away in the office, to see a doctor who is available, who may not be the physician of record.  Pregna...

It may seem odd that a gastroenterologist patronizes fast food establishments several times each week.  I’m in one right now as I write this.  I eschew the food items –though French fries will forever tempt me – and opt for a large sized beverage.  In truth, I am not primarily there for a thirst quenching experience, but more to ‘rent a table’ so I can bury myself in some reading.  Indeed, many thousands of New York Times issues have been devoured at these tables.  I saw a sign posted on the wall here that I had not seen before. Sorry, No Refunds Refunds?  How often can this happen in a place like this?  We all know that food items in these institutions are remarkably consistent, which is one of benefits that customers enjoy.  Your Big Mac or Whopper will taste the same in Pittsburgh as it does in Peoria.  I questioned the server on this new development and she explained that increasingly customers were demanding refunds for contri...

From time to time, I am asked by someone about participating in a medical research study.  These situations are usually when an individual, or someone close to them, has unmet medical needs.  Understandably, a patient with a condition who is not improving on standard treatment, would be amenable to participating in a clinical trial to receive experimental treatment. I find that most folks misunderstand and exaggerate the benefits they may receive as a medical study participant.  Sometimes, I feel their ‘misunderstanding’ is fueled by study investigators who may overtly or unconsciously sanitize their presentation to patients and their families.  There is no malice here.  Investigators have biases and likely believe that their experimental treatment actually works.  Their optimism is likely evident in their communications. Here’s what an investigator might say to a patient. I thought you would be interested in a new clinical trial testing a new ...

Opaque:   adjective, not able to be seen through; not transparent Medical pricing is beyond opaque.   It’s a riddle wrapped in a mystery inside an enigma.   Many readers will recognize that this clever phrase is not my own. Throughout my career, I have been unable to provide an accurate answer to the perennial inquiry, how much does a colonoscopy cost?   Patients, of course, find this to be baffling.   This ignorance is certainly not restricted to my specialty of gastroenterology.   Does it make sense, for example, that the same medication may have wildly different pricing at different pharmacies or in different cities?    In contrast, we would expect to find a similar price for a gallon of milk among supermarkets.   My strong suspicion is that seemingly irrational, inflated and complex medical pricing is all by design to serve those on the billing end – hospitals, pharmaceutical companies and pharmacy benefit managers. ...

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 ...