MD Whistleblower

A day prior to this writing, a man well into his eighth decade came to see me for the first time.   He wanted advice from a gastroenterologist.   So far, this quotidian event is hardly newsworthy.    I asked him, as I ask every patient, if he had ever consulted with a gastroenterologist (GI) previously.   For me, this is a critical inquiry as it often opens a pathway to a reservoir of information.   For instance, if the patient responds that he saw a GI specialist 3 months ago for the same symptoms, but no cause was determined even after extensive testing, then I know that obtaining these records will be critical. Or, if a patient tells me that he loved his prior GI specialist, but he has to see me because his insurance has changed, then I know that I have be particularly mindful to establish good rapport. Sometimes, patients change physicians or specialists because they are dissatisfied.   Patients uncommonly volunteer the reason, but I ask them ...

If a patient wants a colonoscopy done, and it’s not medically indicated, should the doctor still do it? If the physician complies with this request, has he or she committed an ethical breach?   Should the medical board or some other disciplinary agency be notified to investigate? Of course, in a perfect world every medical procedure or prescription would be advised only if it is medically indicated.   But the world is not perfect and there are instances when good physicians may deviate from established medical dogma. We Inhabit an Imperfect World Consider these examples and whether you think that a disciplinary response is appropriate. A patient is due for his next screening colonoscopy in 2 years, which would be 10 years since his last exam.   He approaches his doctor with anxiety because his coworker was just diagnosed with colon cancer.   He asks that a colonoscopy be scheduled now.   The doctor agrees. A patient wants his colonoscopy performed in Dec...

Our favorite restaurant has closed. A child’s toy is left behind on a trip. Our dog ran away. We have all observed that the value of something in our lives becomes well known to us when it is missing.  The loss of a job, a friendship, financial security or one’s health are cold reminders of the worth of these items in our lives.  How important are the people in our lives?  We’ve all been taught this lesson the hard way.  Of course, it is human nature to take one’s advantages and blessings for granted.  I do my best to pause from time to time to meditate on the gifts that have fallen my way, many of which are undeserved.  I certainly need to do this more often. In fact, I don’t think one can do this often enough. Do Flowers Really Matter? I think most of us would agree that life is richer when we appreciate what we have while we still have it.   In the course of a long medical career, I have met so many inspiring individuals – happy and content ...

Labor Day became a federal holiday in 1894, during the presidency of the only chief executive who served two non-consecutive terms. (Have I tempted you to look up this piece of presidential trivia?)  This holiday emerged from an overheating crucible containing worker exploitation and worker unrest. All of this let to labor reform.  Change so often requires disruption, discomfort, protest and even violence.  Clearly, the antebellum conflict between the northern and southern states, for example, was not to be resolved peacefully. He served 2 non-consecutive terms. There are still, of course, unfair labor practices and worker exploitation.  Are Uber drivers employees or independent contractors?  Did Starbucks retaliate against employees who wanted to organize?   But to be fair, we must acknowledge that great progress has been made that is still ongoing.   Oftentimes, when a particular struggle has not yet achieved its full mission, folks point...

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....