MD Whistleblower

I am asked with some regularity whether I am aiming to retire in the near term.  Years ago, I never received such inquiries.  Why now?   Might it be because my coiffure and goatee – although finely-manicured – has long entered the gray area?  Could it be because many other even younger physicians have given up their stethoscopes for lives of leisure? (Hopefully, my inquiring patients are not suspecting me of professional performance lapses!) Interestingly, a nurse in my office recently approached me and asked me sotto voce that she heard I was retiring.    “Interesting,” I remarked.   Since I was unaware of this retirement news, I asked her when would be my last day at work.   I have no idea where this erroneous rumor originated from.   I requested that my nurse-friend contact her flawed intel source and set him or her straight.   Retirement might seem tempting to me as I have so many other interests.   Indeed, reading and studying, two longstanding personal pleasures, could be ext

Tomorrow is the last Monday in May, Memorial Day, now a federal holiday whose origins began in the postbellum era.  My father was among the Greatest Generation having served for 39 months during WWII.  Fortunately, he remained stateside. Presently, no one in our family is wearing the uniform.  We are not mourning a fallen soldier.  But many families are.  For many of them, every day is Memorial Day. I’ve been writing this blog for 15 years.   Several posts have criticized our government, politicians, various industries and even my own profession.   What might my fate be if I were blogging from some other nations? American Military Cemetery in Normandy Freedom is not free.   Authoritarianism seems to be on the rise, even here at home. To all those who are honoring the memory of a loved one who served, we can never thank you enough. May their memory be a blessing  

Patients have many legitimate gripes about the medical profession.  Medical professionals have our own list of pesky frustrations.  Overall, the profession is operating well, but there are well known deficiencies and flaws that are correctable and yet never seem to be addressed.  This is a frustrating reality, particularly for physicians who are wired to improve and correct what can be fixed.  Yes, the system is complex.  Yes, there are competing stakeholders who are angling to protect their power and economic interests.  Yes, despite an explosion of nurse practitioners and physicians’ assistants, patients still cannot obtain timely appointments.  Yes, many medicines are too expensive even for folks who have insurance.   Yes, medical bills are simpler than they used to be, but remain downright inscrutable for many of us.  Yes, electronic medical record (EMR) systems are omnipresent, but why isn’t there a universal EMR so that allows any physician to access all of a patient’s records?

Physicians handle thousands of questions annually. We respond to inquiries from patients, their families, insurance companies, nurses, professional colleagues, pharmacies, our staff and even strangers.  This is, of course, a part of our job, and it consumes a substantial amount of our time and energy. Questions come via homing pigeon Questions come via telegraph Was Alexander Graham Bell Calling his Doctor for a Question? And, responding to questions is not as easy as you may think.   Words matter and a clumsy word choice or an omission can wound instead of heal.   Here are some of the challenges we face when a medical inquiry is directed toward us. We may not know the answer. We may misunderstand the question and may misfire with our response. We may have incomplete data and need to calibrate our response accordingly. We may not be aware of the questioner’s true intent and anxiety.  For example, the question may seem innocent, e.g., “Is it normal

In two prior posts , I have offered my steep skepticism that probiotics deliver on the claims their manufacturers make.  By not being classified as actual drugs, these products leapfrog over traditional Food and Drug Administration scrutiny and are marketed directly to the public who seeks relief from various chronic diseases – conditions that conventional medicine doesn’t handle well. While I have lambasted the lack of medical evidence underlying probiotic treatment claims, in fairness, I will now offer an opinion that also has no supportive medical evidence.   So, probiotic enthusiasts may wish to call me out as well. I worry about unproven but plausible risks of long term probiotic use to the individual users and to society at large.   These products  are tampering with our own bacterial ecosystem that we don’t yet truly understand, always a dicey prospect.   And keep in mind that if you scan the labels of probiotics that fill several shelves in retail stores, they are all diffe

Ask most of us if we are honest and we will likely respond in the affirmative.   Who among us wants to admit publicly that we are a cheat or a liar? It would be more accurate to describe ourselves as mostly honest, since there are occasions when we do some fact massaging and truth shading.   And, sometimes, applying a little spin may be the better choice. Consider this hypothetical. Your mom has been working all afternoon to prepare meatloaf as a birthday treat for you.   While it appears appetizing with its golden-brown appearance, it is simply not palatable.   Your mom asks you directly how it is.    Choose among the following potential responses. Mom, did you mix in some dog food in by mistake? Hey, are you trying to poison me? I like the ground glass.  It give the meat a great crunch. Mom, this is great!  I hope there will be leftovers for tomorrow, if I can wait that long! 'Mom, the meatloaf was....indescribable!' While I do believe in the e

Is gluten really Public Enemy #1?   Many seem to regard it as a toxin. .   Restaurants and supermarkets offer a wide variety of gluten-free foods.   Years ago, physicians advised a gluten-free diet only for individuals who had celiac disease (CD), which is an autoimmune disease that largely affects the small intestine.    If a celiac patient wades back into Glutenland, his or her intestine will start an internal uprising.   I care for a few of these folks, but they are but a slim fraction of my patients who are shunning gluten.    Gluten are proteins contained in wheat and other grains.     Many adherents of a gluten-free diet believe that this is a more healthful dietary choice.   For most of them, there is no supportive evidence for this contention.    Why should it matter if an individual chooses to avoid gluten?   After all, there’s no risk here?   In fact, avoiding gluten can lead to vitamin deficiencies and increased exposure to arsenic and mercury.   I’m not suggesting that