MD Whistleblower

To succeed is to struggle.  Indeed, up to now, an accomplishment was the result of sweat, study, setbacks, discipline, collaboration and hopefully triumph.   Of course, the latter result is never guaranteed which makes this outcome so much more satisfying.  This process of struggling for success is well known to athletes, musicians, scientists, students, writers, chefs, farmers and many others.  All of us go through the same process in more mundane pursuits such as doing a crossword puzzle, learning a new language, testing out a new recipe or reaching a new goal in our exercise routine. I recall a very small personal struggle I engaged with during my internship and residency days decades ago.   Every patient that physicians-in-training cared for had x-ray studies done.   Checking the results was one of the myriad tasks that fell to interns and medical residents.   Not only was this important medical data, but we wanted to be prepared with the re...

Over the past several years, there has been an important change in how diverticulitis is treated.  This topic sentence may seem out of place on this blog which is largely a site for commentary.  This is not a site that discusses medical breakthroughs on the treatment of constipation or heartburn.  But diverticulitis does offer a commentary angle, if you will read further. Decades of teaching and dogma have informed the medical profession that diverticulitis is a localized infection of the colon.   Diverticula, or pouches, are weak points in the large bowel.   If a tiny puncture develops at one of these sites, some stool can leak out contaminating the sterile abdominal cavity.   A n infection develops which, of course, needs to be treated with antibiotics. Indeed, for most of my medical career, every case of diverticulitis I encountered was treated with antibiotics.   In most cases, these patients recovered fully.   This observation may be Trut...

Increasingly, physicians today are employed and most of them willingly so.  The advantages of this employment model, which I will highlight below, appeal to the current and emerging generations of physicians and medical professionals.  In addition, the alternatives to direct employment are scarce, although they do exist.  Private practice gastroenterology practices in Cleveland, for example, are increasingly rare sightings.  Another practice model is gaining ground rapidly on the medical landscape.   Private equity (PE) firms have   been purchasing medical practices who are in need of capital and management oversight.   PE can provide services efficiently as they may be serving multiple practices and have economies of scale.   While these physicians technically have authority over all medical decisions, the PE partners can exert behavioral influences on physicians which can be ethically problematic. For example, if the PE folks reduce non-medica...

As promised in a prior post , here’s a sampling of issues that are grinding down doctors.  Physician burnout is no mystery illness; we know the causes.   Electronic Medical Records (EMR) .   This modernization of medical data recording has been a true gamechanger for billers and medical coders.   For doctors, it continues to be a source of great angst and frustration.   A few years ago, I was using 4 different EMR systems all at once.   Sound like fun?   It wasn’t.   EMR, despite its advantages, has been a potent force threatening doctor-patient relationships.   How do patients feel watching their doctors pecking away at keyboards throughout most of the visit with hardly any eye contact?   EMR also spews forth hours and hours of tasks and communications (previously known as paperwork)  which are hard for doctors to keep up with.   Readers are referred to the EMR Quality category on this blog for additional rants, I mean ...

We celebrate Independence Day this year at a time when the country is fracturing deeply along political, ideological, moral and religious lines.   The nation hasn’t been this divided since the turbulent 1960’s when we were rising in anger over the lies of Vietnam, the boiling over of the civil rights movement, the heated struggle for racial equality, the assassination of political and moral leaders and the women’s liberation movement.   But we managed to get through all of this even though many elements of these struggles are ongoing.   Important progress has been made and must be acknowledged.   Hate and anger today are omnipresent.   Yesterday’s heroes -police officers, judges, the FBI, public health leaders, news anchors, college professors – are now demonized.   How did we allow this to happen?   Are we supporting these darker forces or pushing back?   Is there a way out? I believe there is but enough of us will have to decide that co...

For most of my life, there has been a tipping disorder in this country.  Too many of us were undertipping those who served us and depended upon tips for their livelihoods.   At times, servers in restaurants would be stiffed receiving a paltry tip when they deserved more.  In general terms, increasing a tip from 15 to 20% means much more to the server than it does to the patron. Other occupations such has hotel workers, airport porters, cab drivers, tour guides, bartenders, valets and food deliverers – to name a few – depend upon the generosity of their customers.   Traditionally, a tip was a reward for good service.   Indeed, this provided an incentive for workers to perform well.   Better service led to better tips. We now have an entirely new strain of tip dysfunction in this country.   Tipping is no longer tied to service and has become an expected surcharge from classes of workers who heretofore would never have been eligible for a tip. ...

I have not personally suffered an addiction and I have no expertise in addiction medicine.   But I have treated large numbers of individuals with gastrointestinal issues who also are in the midst of an addiction or are recovering from this illness.   I have tremendous admiration for a person who has – with the help of professionals – unshackled himself from the suffocating tentacles of addiction.   As I have not faced this challenge,   I cannot begin to contemplate the journey. This nation has not settled on a coherent strategy to battle this plague.   Is it a medical issue?   Is it a law enforcement issue?   Which treatments are evidence based?     Should insurance coverage for treatment be required as are other benefits such as preventive care?   Can treatment be compelled on an unwilling addict?   I read a poignant opinion piece recently in The New York Times by David Sheff whose son ultimately prevailed against his addiction...