MD Whistleblower

A few days before writing this, I had an ‘epic’ experience upon my arrival to work.   I had 17 procedures scheduled that day and the first few of these lucky folks were arriving.  After changing into scrubs, I sat before my computer and was prepared to swipe into the electronic medical record (EMR) system with my ID card.  On prior occasions, when I have successfully performed this swiping exercise during office visits, I have joked with the patient, ‘looks like they haven’t revoked my credentials!’ But not today.   After 3 swipes I had struck out.   No entry.   And my password wasn’t accepted.   Twelve hours ago, my credentials were solid and I was a physician in good standing.    Now it seemed I had become a physician non grata.   My morning welcome from my EMR system! What happened?   Was I being terminated without notice?   Were foreign hackers at work?   Was I to expect a ransom ware demand shortly? We use the electronic medical record system called Epic.   Our first call to

Five years ago, I left hospital wards and emergency rooms behind and entered a new & improved medical practice model, at least for me.  Since then, I only see patients for office consultations and procedures.  Office medicine is a very different trade than hospital practice each having very distinct skill sets.  If I were to return to the hospital now to see patients, it would be uncomfortable for me (and them) having not used these skills for years.  Similarly, hospital-based doctors might find transitioning to an office practice to be clumsy and uncomfortable. While it might seem that a gastroenterologist or any medical specialist should be able to see patients in any location, this is not the case for most of us.   Hospital medical issues are quite different from office medical complaints.   Physicians, as in so many other occupations, need repetition in order to maintain high competency levels.   There’s a reason, for example, that airline pilots need to maintain specified fl

I am regularly solicited for my opinion on the stool test Cologuard, a colon cancer screening option.  These queries generally come from folks who are angling to avoid the joy of the colonoscopy experience.  It’s hard to fathom why someone would want to avoid the pleasure of a supersized laxative followed by a day of fun on colonoscopy day!  Scientific investigators are working hard on colon cancer screening blood test options, but as I have pointed out , these are not quite ready for prime time. Finding alternatives to screening colonoscopy is a very high priority for the medical profession. There are two driving forces. Colonoscopy, while effective, is a laborious process which is a 2-day experience, requires a driver, frequent time away from work, is expensive and has risk.   If a stool or a blood test could achieve the same level of protection, it would be a game changer. The economic rewards for launching an effective stool or a blood colon cancer screening test would be a

Tomorrow is Labor Day, which became a federal law in 1894 after President Grover Cleveland signed a congressional act into law.  Originally, the holiday only applied to federal workers. Over time, all US states, territories and the District of Columbia observe the holiday. Similar to other national holidays, such as Independence Day, Memorial Day and Christmas, the original meaning of Labor Day is only dimly recalled or celebrated.  The following one-question quiz will test your knowledge.  The quiz is quite challenging and I wish competitors good luck.  Remember, although responses may appear reasonable, you are charged to choose the best answer. Which of the following best describes the meaning of Labor Day? (a) It's the last weekend on the beach marking the end of summer. (b) It's an opportunity to to show off backyard grilling techniques with hot dogs, chicken and ribs. (c) It's a time to honor workers in the 19th century, and those who followed, who fought for safer an

As readers know, the unifying theme of this blog is medical quality.  Indeed, the role of a whistleblower should be to raise the performance level of a profession or organization.  One need only scan this blog's category list for evidence of the blog's purpose.  Feel free to sample a post or two. The medical procedure that is fundamental to the practice of gastroenterology is colonoscopy.  I have performed north of 50,000 of these procedures on some very lucky inhabitants of northeast Ohio.  This will be my professional legacy, not quite a true gift to humanity such as music, art or literature.  I’ve been in practice long enough that there are patients whom I’ve performed more than 10 colonoscopies on.  Patients prefer to remain with a doctor whom they are comfortable with.  Long term relationships with patients is one of the joys of medicine. I also routinely perform colonoscopies on patients whom I have not met previously.  They are referred for the procedure by their pri

Over the years, I have treated various medical professionals from physicians to nurses to veterinarians to optometrists and to occasional medical residents in training. Are these folks different from other patients?  Are there specific challenges treating folks who have a deep knowledge of the medical profession?   Are their unique risks to be wary of when the patient is a medical professional? First, it’s still a running joke in the profession that if a medical student develops an ordinary symptom, then he worries that he has a horrible disease.  This is because the student’s experience in the hospital and the required reading are predominantly devoted to serious illnesses.  So, if the student develops some constipation, for example, he may fear that he has a bowel blockage, similar to one of his patients on the ward.. More experienced medical professionals may also bring above average anxiety to the office visit.  Physicians, after all, are members of the human species.  A pulmon

Last week, I presented the U.S Services Task Force’s (USPSTF)recent revision on its mammography guideline.  I agreed with the assertion that lives will be saved.  There is a little more to the story.  When a task force or an organization is devising a preventive medicine guideline, lives are not the only consideration.   First, mammography is a screening test – an exam performed on an individual without symptoms to prevent illness.   For clarification, a mammogram, unlike screening colonoscopies, is not designed to prevent cancer.   The objective is to detect breast cancer at an early phase which should result in a more favorable prognosis. Whenever a screening test’s target population is widened, as just occurred with USPSTF’s mammography revision, more lives will be saved.  For example, if we started performing screening colonoscopies at age 30, of course we would save lives since colon cancer can arise in folks in their 30’s.  However, what are the costs and risks of such an agg