MD Whistleblower

There are two ways to sedate patients for colonoscopy.  There is conscious sedation is when the gastroenterologist administers a ‘twilight sedation’, or moderate sedation when sedation is administered by an anesthesia professional, usually with propofol, a drug now known to most of us as  a contributor to the death of pop superstar Michael Jackson. Most Patients Prefer Propofol over the Twilight Zone Leaving issues of cost aside, most individuals involved in the colonoscopy experience prefers the propofol option.  Here’s why. The drug is extremely safe when administered by trained personnel, who in most cases are Certified Registered Nurse Anesthetists (CRNAs). Unlike with twilight anesthesia, the procedure is entirely painless.  Patients can expect to experience the same level of discomfort as they do with a haircut. Knowing that they face complete comfort during the procedure, patients are relieved of anxiety that often precedes the proce...

My great pal Lewis, with whom I have shared a friendship for over half a century, have much in common professionally.   Is he also a gastroenterologist?    A physician?   A nurse?   Actually, he is a tax attorney.   So, where’s the commonality?   Could it be that my patients and his adversaries both feel that they are being ‘instrumented’?    While I suspect that this may be true, it is a different aspect of our respective professions that binds us. Lewis’s clients and my patients need to grapple with and accept uncertainty.   I find the parallels here to be striking and I’ll do my best to illustrate. Legal Uncertainty The client brings an issue to his attorney seeking a legal remedy or an opinion.    Let us assume a corporation wants to know if a particular expense can be legally considered a tax deduction.   The experienced tax attorney responds, after careful thought and deliberation (yes, the time...

There are two ways to raise the quality level.  The old-fashioned way to work and study and practice and seek assistance and practice again and fail and regroup and ultimately objectively increase performance. Here are a few examples of this technique. A basketball player works with a coach and increases his foul shot success rate by 15%. A new medicine increases the cure rate of a disease by 40%. An engineering team invents a cell phone battery that has 5x the storage of current batteries. There is another way to increase quality ratings that has become quite common.  Lower the standards or game the system.  Here are some examples to illustrate. Lower academic standards in order to increase a high school's can graduation rate. Lower the income threshold of poverty so we can boast that there are fewer impoverished people in our communities. A surgeon's outcome stats rise markedly when he declines to accept very ill patients. So, if you are trying to improv...

Why are millions of Americans actively seeking out complementary medicine?   The lack of robust supportive evidence for many of these treatments has not diminished their appeal.   Indeed, demand for them is higher than ever and I anticipate continued growth.   Here in Ohio, the legislature has sanctioned medical marijuana for nearly 2 dozen maladies in the absence of persuasive and sound scientific evidence of efficacy.   For my rant on this, I will refer you to a prior post and I would welcome your response. Why then do intelligent and informed patients seek out alternative medical treatments that are unproven and are unlikely to be covered by their insurance companies?    In most cases, they do so because conventional medicine has failed and frustrated them.   Every medical specialist and general physician sees patients with recalcitrant medical issues that defy diagnosis and successful treatment.   Is it any wonder why such patients would ...

I recently booked a hotel in New York City where I hope to spend several delightful days this coming June.  During the booking process, the hotel’s representative read off a dizzyingly list of taxes and fees that I would be paying.  I don’t think I’ve ever been saddled with so many surcharges on any transaction in my entire life, except for the last time I booked a NYC hotel. I felt that I needed to call my accountant for guidance. Many hotels have become green with envy  (or should I say greed with envy?) over state and local taxing authorities who fleece hotel guests.  Why should hotels, who are highly trained fleecers, be left out? Fortunately for me, I won’t have a car.   Anyone familiar with NYC knows the insanity of bringing a car there.   Beyond the expense involved, and the seemingly impossibility of finding a parking space, there’s the sheer joy of taking a drive through midterm crawling through gridlock with horns bleating while receiving lovely...

In 1990, Desert Storm was initiated by President George H.W. Bush, along with coalition partners to reverse Saddam Hussein’s aggression with respect to Kuwait.   As American and allied forces moved into Iraq, many hawks wanted these forces to advance to Baghdad, and drive out Saddam Hussein.   As we all know, President Bush pulled us out as he did not feel this objective was part of the mission.   He knew when to get out. Now, physicians are not military strategists, but there are parallels between military strategy and patient care, particularly when a patient is hospitalized.   Consider the following schema.   The Conflict:   A patient arrives in the emergency room with a cough and a fever.   The Mission: Disease eradication The Tactics:   Hospitalization Exit Strategy:   Getting the patient out. Physicians, just like the generals in the Situation Room in the White House, need a sound battle plan.   The plan must be...

I am regularly asked by patients and others at what age should colonoscopies end.  Some patients inquire hoping that they are one year beyond the limit! Other physicians face similar inquiries with regard to Pap smears, mammograms and other routine preventive tests.   Turning the tables, I have even read opinion pieces asking if there should be a retirement age for physicians.   Commercial pilots have an upper age limit of age 65.   Should an octogenarian surgeon be allowed to operate on patients?   Federal judges have lifetime appointments.   Is the public well served by this?    There are at least two sides to this lifetime appointment policy. Some argue for aging out folks in order to rejuvenate the ranks.   This makes sense.   Others argue that any individual who is competent should be permitted to continue working regardless of age.   Why should we jettison folks with decades of valuable experience just because a certain ...