MD Whistleblower

We live in an era where plastic surgery is routine.   Indeed, in many parts of the country, plastic surgery is an expected rite of passage.   Years ago, face lifts and ‘tummy tucks’ were done on those in middle age who were trying to experience a surgical time machine.  Now, folks in their 20’s are having all kinds of work done, not to recreate a prior image, but to create a new one. The traditional scalpel in only one of many tools used to perform body design work.  There is a smorgasbord of injectable fillers that plastic surgeons, dermatologists and other physicians provide to a public who is zealously combating every wrinkle.  Once a person is of the mindset that the only good wrinkle is a dead wrinkle, he will commit himself to a lifelong odyssey of cosmetic work.  These folks are generally never fully satisfied with how they look.  They are always finding imperfections that they target for correction. I enthusiastically recommend readers to read Nathaniel Hawthorne’s short

Medicine is for the birds, or it should be.  Hear me out. A day before I wrote this, I was on the trail in northwest Ohio, binoculars in hand, trying to tell one warbler from another.  This was the final weekend of The Biggest Week of birding in Magee Marsh on the shore of Lake Erie.  Birders converged here from neighboring states and even from foreign countries to participate in this ornithological adventure.  My companion and I were new to the game.  Indeed, my birdwatching prowess had consisted of being able to successfully identify a blue jay at the feeder on our deck.  I had now entered a different universe. There were serious birders afoot equipped with photographic and telegraphic equipment that looked like stuff that James Bond might have used.  Birds flitted about that heretofore would have generated no interest on my part.  When a rare warbler was spotted, the excitement raced through the birders like a brushfire, causing a crowd to gather to view the feathered pheno

From time to time, patients asks my advice on colonic hydrotherapy, vigorous sessions of enemas that aim to cleanse the body of toxins that are reputed to cause a variety of ailments.   The logic sounds plausible to interested patients.  Over time, toxins accumulate and leech into the body wreaking havoc.  Indeed, using the label ‘toxins’ already suggests that these are noxious agents.  If one accepts this premise, it is entirely logical that cleansing the body of these injurious agents would have a salutary effect. Not surprisingly, the health benefits of hydrotherapy usually target very stubborn and vague symptoms and conditions that conventional medicine do not treat adequately.  It makes sense that if your own physician is not making sense of your chronic fatigue, for example, that you would entertain other options.  I get this.  Who wouldn’t want to enjoy having more energy, better concentration, an enhanced immune system or delayed aging?  But, in medicine and in life, just

Is there stuff that you do just because that’s the way you’ve always done it?    I’ll answer for you – yes. In many circumstances, this makes sense.   For example, I stop my car at red lights just as I have always done.   I recommend that readers do the same as there is an underlying logic for this recommendation.   It is not simply a rote routine that has no rationale.    However, the particular order that we pour ingredients into a pot when making soup, may be more random than rational.    We follow the same order we always have, never pausing to wonder why or if there might be a better way. And, so it is with many practices and procedures in the medical profession. Let’s return to the medical condition of diverticulitis, which I presented on this blog recently.  Follow the link , if interested. For the last several decades, this disease has been treated in the same way – with antibiotics.   This means that physicians believe this to be an infectious disease – like st

I am a conservative practitioner in my specialty of gastroenterology.   Compared to peers, I order fewer scope examinations, prescriptions and CAT scans.   I’ve always believed that a more parsimonious practice of medicine would protect my patients better than would a more aggressive approach.   Sure, this also means that I spend fewer health care dollars on my patients, but this is not my primary motivator.   I practice in this manner because I am convinced that in the medical profession, less is more. I am somewhat of an iconoclast as many of my colleagues for various reasons practice differently.   They might feel that my medical nihilism is depriving my patients of necessary testing and treatment. Patients over time tend to find physicians who share their philosophy.    Patients who believe that more testing and more medication is the pathway to better health will not be comfortable with a doctor like me. But, change is afoot!   I predict that within the next several year

I have been treating diverticulitis for 30 years the same way.   When I suspect that a patient has this diagnosis, I prescribe antibiotics.   This has been the standard treatment for this disorder for decades. I have found that diverticulitis is a slippery entity that has two trap doors waiting for physicians to fall through.   It is an easy task to miss the diagnosis.   Every physician has done this. The diagnosis can be erroneously assigned to a patient.   Every physician has done this. Recognize that the phrase ‘every physician has done this’ includes me. The diagnosis can be elusive as there is no diagnostic test that secures the diagnosis.   The technology tsunami has covered the medical landscape, as it has run over so many other spheres in our society.   Doctors and patients increasingly rely upon ‘the numbers’.    Want proof?   Do you think there are many physicians today who can actually plug a stethoscope into their ears and hear, let aloneunderstand all of

In last week's post, I promised an explanation why many screening and medical treatments offer so little benefit to individual patients.    If you invest the time to digest last week's post and the post before you now, then you will be equipped with new understanding that will enable you to make much better medical decisions.  In accordance with this blog's mission, this is truly a 'peek behind the curtain'.  I grant you that these 2 posts are a little wonky, but try to stay focused.   Here is the main reason that ordinary people – and even some medical personnel – become confused on this issue.   Studies that assess screening tests and medical treatments are often performed on very large groups of patients.   The reason for this is that smaller studies, for reasons I cannot fully explain here, are simply not felt to be sufficiently reliable.    This is why the Food and Drug Administration would never grant approval of a new medicine based on favorable resu