MD Whistleblower

One of the conundrums in medical practice is to determine if a medication is causing a side effect.  Sometimes, this issue is very straightforward.  A new medicine is prescribed.  Three days later, the patient develops a new symptom of constipation.  The medicine is stopped and the bowel pattern normalizes.  Most of us would agree that the evidence that the medicine was responsible for the bowel change is beyond a reasonable doubt. The above is a textbook example of a side effect, but alas, patients often have not read the textbook.   Consider a patient having diarrhea from colitis.   The gastroenterologist prescribes an appropriate medication.   Two weeks later, the patient contacts the doctor to report that his diarrhea has worsened.   Although diarrhea is among the long list of potential side effects of the medicine, might the increased diarrhea simply be from his underlying colitis? It's 'alimentary', my dear Watson! I have seen many examples of patients who come to

I have penned a few posts recently illustrating the difficulties in measuring medical quality.  Indeed there's a category on this blog entitled, Medical Quality, ready for your perusal. How do we measure something that is very difficult to measure?   Why is a painting hanging in a museum considered to be a masterpiece while others – which appear quite similar to most of us – are relegated to a much lower status?    And art experts may not agree on these designations! I have already performed approaching 50,000 colonoscopies in my career, and my colonoscopy counter notches more of these each week.   This is my gift to humanity.   Quite often, I am stopped in a store or on the street by a grateful recipient of one of my probing endeavors.   Clearly, patients regard the event as a bonding experience. Found this in a garage sale.  Worth anything? But how do they or anyone know if I am any good?   How do you assess the quality of a proceduralist? It sounds easy enough, except that

I have written how challenging it is for ordinary folks, let alone medical professionals, to assess the quality and competence of physicians. There are no easily measurable and reliable parameters.  Industries have emerged that specialize in assessing the competencies of practitioners and organizations in fields beyond medicine.  It is typical for those who are targeted for assessment to howl in protest claiming that the testing methods are irreparably flawed and should be abandoned.  Sometimes, these folks have a point. But other times, they are simply trying to avoid accountability. And just because an evaluation process hasn’t been perfected, doesn’t mean it offers no value.  For example, teachers have recoiled against using student test scores as an element in assessing their pedagogical skills.  I think that both the teachers and the testers have legitimate arguments. Professionals and tradesmen and their leadership advocates will reject processes that will disparage their members

The nation celebrates Labor Day on the morrow.  This holiday was created in the later part of the nineteenth century in response to immoral and abusive conditions for workers.  In that era, 12 hours shifts, 7 day workweeks and child labor were all routine.  Organized labor expanded over the ensuing decades leading to legislative and societal guardrails protecting workers from abuse and exploitation. Despite continued reforms of the workplace and fairer treatment of workers, tensions remain between management and labor.  At this very moment, the United Auto Workers has overwhelming authorized a strike in the event that union leaders decide that this is necessary. A typical Labor Day scene While this holiday has deep roots in organized labor, keep in mind that most American workers are non-union, and their work should be honored as well. Regrettably, but understandably, the true meaning of Labor Day and many other federal holidays is not top of mind for most Americans.  These commemorati

Years from now, the notion of simple telemedicine will seem quaint.  Keep in mind that as recently as a decade ago, most physicians would have denied that telemedicine could ever play a role in the medical profession. Physicians would have argued that this would dismantle the fundamental unit of medical care – the in-person office visit. Physicians would have rigidly maintained that they had to be face-to-face with their patients.   Doctors would need to observe their demeanor and body language and other non-verbal signals.   The physician would need to perform a physical examination to discover additional clues that might help to explain the patient’s symptoms.   Indeed, medical professionals and others have expressed that the act of touching itself served as a bonding experience between patients and their doctors.   The very definition of ‘bedside manners’ implies that the patient and physician are in the same location. Today, there are physicians who practice telemedicine exclus

When we are purchasing a product or a service, the marketplace offers us many choices.  Competing wares may have different quality and cost levels.  We experience this if we are renting a car, booking a hotel, hiring an attorney, selecting a restaurant or buying a musical instrument.  All guitars, for example, are not equal. When we decide to purchase at a certain quality and price point, we must accept the realities of this transaction.  We should not purchase a Chevy, for example, and expect a Cadillac experience.   I realize that price and quality may not follow a linear path.   Just because something costs more doesn’t mean it’s better.   There are wrinkles in the marketplace.   Budget hotels, for example, often provide guests with free breakfast free parking and free wifi while high end stodgy hotels gouge guests with resort fees (please explain to me what this is), insane parking charges and crazy minibar prices on top of their exorbitant room rates.   The task is to match

If we ever manage to tame Over-diagnosis and Over-treatment – the twin threats to medical reform - many players in the medical universe would find their status - and their livelihoods- downgraded to critical condition.   Let me offer a single sentence that points out the herculean challenge facing reformers. One man’s wasteful medical spending is another man’s income.  You Need the Strength of Hercules to Reform Health Care The system is riddled with conflicts of interest where various economic interests collide with our health interests. Here are three hypothetical examples to illustrate my point.    Political progressives clamor to sharply reduce drug prices to make them affordable for all Americans.   The pharmaceutical industry uses all means necessary to resist this.   Of course, making all drugs affordable would crush the drug companies economically.   They argue that such a draconian approach would stifle research, development, and innovation.   Why