MD Whistleblower

Many patients are confused by the difference between a screening and a diagnostic colonoscopy.  While the actual procedure is the same, the distinction between the two depends on why the colonoscopy is being done.  While you might think that I am wading into a sea of nonsense and absurdity, I am offering you a glimpse of the rational and reasonable world of medical insurance!  Try to follow along. Here’s a primer. A screening exam means that you have no symptoms or relevant laboratory or x-ray abnormalities that justify a colonoscopy.   Consider this to be a simple check-up for your colon.   You are being screened to determine if you have a hidden abnormality or lesion.   Get it?   A diagnostic exam means that the doctor is investigating an existing or suspected abnormality. A medical condition is under consideration and a colonoscopy is advised to investigate.     For example, if you have bowel symptoms, weight loss, blood in the stool, a personal history of colon polyps

Many issues have clear and obvious solutions.  Consider some illustrative examples.  If a light bulb has burned out, then most of us would agree that popping in a new bulb should be the enlightened response.  If a flower bed is dry, then we reach for a hose.  If our car’s fuel gauge is nearing empty…   I think you get the point here. Here's a slightly more complex scenario.    Let’s say that your car has a rattle.   The mechanic may not know the cause or the solution, at least initially, but we can all agree that there is a specific malfunction that can be remediated with a targeted intervention.   As with the dead light bulb example above, there is a specific, reparable defect present.  Unlike in the automotive world, other disciplines operate with a loose, flexible and proprietary framework.   Consider the financial industry.   One need only read a newspaper’s business section for a week to appreciate the divergence of opinions on financial and investment matters.   Experts c

Stomach Pain and Mind-Body Relationship This is a delicate issue and must be approached by medical professionals with care.  Of course, it is an established fact that psychic distress can be responsible for physical ailments.  Did you ever get a headache after having an argument?  Were you one of those students who experienced diarrhea before final exams? This past week, I saw 3 new patients in my practice with abdominal distress all of whom volunteered that they felt that emotional stress and anxiety were the culprit, or at least a major contributor to their gastro issues.   Obviously, when the patient has this level of insight and expresses it to the physician, it paves the way for a fruitful conversation. But, this is not always the case. When I see new patients with long histories of unexplained abdominal complaints, I do not initially raise the possibility of a psychic connection.   I think this is arrogant and has the potential to communicate the wrong message to the patient,

When a judge hears a case, neither party is 100% correct.  Each litigant may have a meritorious claim, but one of them will be found to have the better argument. If the dispute could be easily and amicably resolved, or one party was clearly wrong, then the matter would be unlikely to have reached a courtroom.  One litigant may be found to be 'more right' than the other Which litigant's right will prevail? Medical ethics has a similar construct.  Rarely, is an issue clearly and easily decided.  For example, with limited financial resources, tough decisions must be made on how to ethically allocate these funds.  Those who will not receive any funds may still have an ethical right to receive them, yet other groups may have a stronger right.  If our society decides that it will not pay for dialysis in moribund individuals, it does not mean that these individuals have no right to this treatment. These complex decisions create winners and losers.  Those who are ru

 After the Civil War, which had more casualties than in any other American conflict, Decoration Day was established to honor the war dead.  Over time, this sacred commemoration transitioned to Memorial Day, which became a federal holiday in 1971.  This day honors all who have fallen in the service of the nation’s armed forces.  Although our debt to them can never be satisfied, we can at least pause and reflect on the inestimable sacrifice that they and their families have offered this nation.   We salute you all. Gettysburg National Cemetery on the 50th Anniversary of the Battle. As we all see at this very moment in eastern Europe, freedom is never guaranteed.   It must be protected and defended from those who fear it and aim to destroy it.   Threats may emerge both from without and within.   It’s easy and understandable that we take our freedoms for granted – the freedom to criticize the government, the right to equal justice under law, the right to peaceably protest, the right

Would a doctor ever order a diagnostic test that was not medically necessary?  I’ll give you a hint to this ‘yes or no’ question; the answer has 3 letters. Of course, in a perfect medical world, every medication would perform flawlessly with no adverse reactions.   All medical tests would be justifiable and painless.   Physicians’ diagnoses would always be accurate.   Drugs would be affordable.  All patients would recover from whatever ails them. And doctors would never be late for their appointments! Sound like the medical world you know?   I doubt it.   The medical universe that I inhabit is riddled with flaws and imperfections.   It is, after all, a human endeavor which guarantees variable outcomes. Sometimes, the patient just doesn’t get better. So why would doctors like me at times order medical tests that are not necessary?  Wouldn't this violate my professional oath and code of conduct? Years ago, when the plaintiff’s bar was on fire suing doctors, many physicians or

The day before writing this, I had two unusual experiences in the office.  I am not referring to the patient whom I had not seen in years who gifted me yesterday with a full size New York style cheesecake.  I now must decide how I will apportion those 15,000 calories.  Perhaps, if I have 1 teaspoonful a day for a year that my BMI won’t be unduly affected.  The newsworthy events had nothing do with my medical skills.   I did not nail down a rare diagnosis or provide a cure that evaded other practitioners.   In fact, the events that I will highlight below occurred prior to my entering the exam room. When I enter an exam room to greet patients, they are generally engaged in the same activity – they are on their phones.   They are watching videos or playing games.   They are checking their e-mails.   They are pecking at the keyboard as they are issuing forth text messages of monumental importance.   Where did this come from?   How did we find ourselves in a world where no spare momen