MD Whistleblower

Medical care has various tiers of service with differential quality levels.    Each level is designed to meet a specific level of need.  Physicians and patients do not always agree on what level of service is appropriate.  Sometimes a patient feels that a higher level of service is necessary and other times the physician has a similar view.  Consider the listing below of potential medical encounters.  Physician and patient dialogue through the Electronic Medical Record (EMR) portal Physician and patient phone call to discuss a medical issue. Telemedicine visit with audiovisual capability. Traditional office visit with a physician or medical professional. Emergency Room (ER) Visit. Each one of the above encounters has value, but clearly they are not equal experiences.   The objective is to match the level of the encounter with the medical need.   For example, if you are uncertain if your recently prescribed erythromycin should be taken with ...

Do you know what medicines you are taking?  Do you know the doses?  Do you know the purpose of each of the medications?  These seem like rather basic inquiries and yet you would be surprised how many patients cannot respond accurately to these 3 simple questions.   The medical profession needs to emphasize the importance of patients achieving an adequate level of medical literacy.   Knowing their medications is an important element of this mission.   It is much easier for doctors to care for informed patients. When a patient is unsure, for example, why he is on Lipitor, we can easily explain this.   It is more challenging, however, for doctors and other medical professionals when patients do not know the specific dose of a drug or if a drug was omitted from the medication list.   This happens all the time. Now here's a guy who knows how to make a list! Electronic medical records (EMR) have the current medication list available for the medical ...

An 85-year-old woman was referred to me because she was anemic.  She was accompanied by her son.  Anemia, meaning a decreased blood count, is a common reason that patients are sent to gastroenterologists.  The reason for this is that internal bleeding in the gastrointestinal tract – even silent bleeding – can cause anemia.  Gastroenterologists are always locked and loaded with our arsenal of scopes ready to probe into your digestive system in search of a bleeding lesion that would explain anemia.  While we are always hopeful that any discovery will be benign, at times the news is more serious.  Just after I entered the exam room, the patient offered this declaration. “I am not having a colonoscopy!” I had not yet even introduced myself to her and her son, but she was determined to set the ground rules.  Of course, it should be the patient who determines her own future, but generally this occurs after some dialogue with a medical professional....

Recently, a gastroenterologist in our group left our practice.  Of course, the remaining physicians must do our best to provide ongoing care as best we can for her patients.  Ongoing care does not mean seamless care even though some patients expect that a new covering physician will simply assume the reins without so much as a hiccough or a speed bump.  More realistically, there will be a transition period and some inconvenience to the patients and to the covering gastroenterologists.  I was assigned to cover her patients immediately after her departure when the volume of incoming laboratory and procedure results would be heaviest.  Even normal laboratory and radiology results require more work than usual for a covering medical professional.  We can’t simply shoot off a message ‘your biopsy result was benign’ and consider the case to be closed.  There may be many other lingering active medical issues to address.  A modest laboratory abnormality, w...

You sent my father home from the hospital too soon.   Three days later, he was worse than ever and needed surgery! I’ve heard similar lamentations from patients and their families over decades.   Every doctor and hospital nurse has also.   And I acknowledge that sometimes families are correct; folks were sent home too soon.   However, in my long experience, most patients are not sent to the street too soon despite some folks feeling otherwise, usually after the fact.    First, let’s all agree that the medical profession – like your own occupation – is a human endeavor which means that perfection is aspirational.   An imperfect outcome or a catastrophic development does not mean that medical carelessness or negligence has occurred.   Medical malpractice is a real issue, but that is distinct from adverse medical outcomes, which is what I am focusing on in this post Medicine is not mathematics.   There is no formula or set of proofs tha...

During the pandemic, I engaged in telemedicine with my patients out of necessity.  This platform was already destined to become part of the medical landscape even prior to the pandemic.  COVID-19 accelerated the process.  The appeal is obvious.  Patients can have medical visits from their own homes without driving to the office, parking, checking in, finding their way to the office, biding time in the waiting room and then driving out afterwards.  And patients could consult physicians from far distances, even across state lines.  Most of the time invested in traditional office visits occurs before and after the actual visits.  So much time wasted! Indeed, telemedicine has answered the prayers of time management enthusiasts. At first, I was also intoxicated treating patients via cyberspace, or telemedically, if I may invent a term.   I could comfortably sink into my own couch in sweatpants as I guided patients through the heartbreak of hemorrhoid...

Stomach acid must be Public Enemy #1 for gastroenterologists and primary care physicians.  Why else would more than 10 million Americans swallow proton pump inhibitor (PPI) medicines each day? These medicines are potent stomach acid blockers.  Common examples of these medicines include Prilosec (omeprazole), Nexium (esomeprazole) and Protonix (pantoprazole).  PPI medicines have generated tens of billions of dollars for pharmaceutical companies.  And several of these medicines are available over-the-counter (OTC), which permits the public to self-prescribe for a variety of ailments. Are ordinary folks selecting these medicines appropriately when they purchase OTC?   I have my doubts particularly since medical professionals often prescribe these agents very liberally going beyond the boundaries of medical evidence.   I have also been culpable of the transgression of PPI mission creep.   Indeed, studies have shown that physicians prescribe these acid bl...