MD Whistleblower

I spend more than half of my work week performing endoscopic procedures, the majority of which are colonoscopies.  Many of these colon exams are screening colonoscopies, meaning exams performed in the absence of any symptoms, an effort to reduce colon cancer risk.  This is in contrast to diagnostic colonoscopies which are performed to evaluate symptoms or abnormal lab values such as a low blood count or anemia.  Whether I am performing a screening or a diagnostic exam has no effect on the patient’s experience.  However, it may make a huge difference to the insurance company and your out-of-pocket financial obligations.   But I digress… Many of my procedure patients have previously seen me in the office for consultations.   In other words, they are my patients.   It’s likely that after their procedures that they will be advised to return to my office for continued conversations on their condition.   However, many procedure patients are unkno...

Is Medicaid on the chopping block?.   Will Social Security be trimmed back?  Are the knives out for Medicare? These are huge concerns for Americans who depend upon these entitlements for health care and survival.   Those who have enthusiastically championed massive cuts in the federal government are now reflecting on how critical the Medicaid program, for example, is for their constituents and local economies.   Imagine the harm done medically and economically when rural community hospitals would wither without these federal dollars. A large measure of public angst on these issues is derived from distrust in our politicians.   We have seen them engage in flip-flopping, backtracking, u-turning, ‘evolving’ and other iterations of political gymnastics.   Can we really be reassured by what they are saying today or when on the campaign trail?   (Hint:  W e can’t.)   When they reassure us that there will be no cuts in (insert government pr...

Last week, I presented some of the top frustrations that patients have with the medical profession.  As promised, here is a sampling of physician frustrations.  This is hardly a scientific survey but is taken from my own experience and conversations with colleagues over the years. The Electronic Medical Record (EMR) Industrial Complex.   Odds are very high that if you query your physician about the most frustrating aspect of their professional, that EMR will be in the top 3.   It continues to sap hours away from face-to-face time with patients.   A glitch in the computer system can paralyze the office.   And nothing strikes fear in medical providers more than a looming EMR upgrade. An upgrade means that whatever processes I have barely memorized will become null and void. The Electronic Portal.   This is the computer’s ‘in basket’ into which all communications, test results, patient inquiries, pharmacy issues, medication refill denials, notes from b...

What frustrates patients with the medical profession? What follows is not a scientific survey but merely my recollection of patient gripes over the years. Why is my doctor always late? Poor access to doctors and medical professionals.   This vexes patients more than the other challenges that they endure.   They simply cannot get in to see their doctors who are booked out for months.   What good is having a great physician if his or her schedule is locked down?   Sending these patients to an Urgent Care or an Emergency Room might be a convenient play by the doctors and staff, but this does not serve patents well. Rushed office visits.   I hear this all the time.   I’m sure that I’ve been culpable of this offense at times myself. The doctor is running behind and is under pressure to move the visit along efficiently.   But not all patients operate in this mechanized manner.   They need time to collect their thoughts, and we should permit them to ...

Here’s a great power word for readers to casually toss around with friends.  Iatrogenic . This refers to a medical condition or complication caused by a medical treatment.  For example, if a person undergoes a knee replacement and suffers blood clots afterwards, this complication is considered to be an iatrogenic illness – it is a direct result of a medical intervention. The volume of iatrogenic illness is enormous.   I am not suggesting that the medical profession is culpable, although adhering to strict safety guidelines and best practices can lower the case load.   Indeed, many such safety practices are in place today that were not present when I entered the profession.   Among the most common iatrogenic conditions are medication side effects.   On a regular basis, every physician and health care practitioner has wondered if a patient’s new or worsening symptom might be the result of a medication.   Sometimes this is an easy call.   For exa...

Next month my schedule will change.  I will henceforth be off on Fridays with my work week truncated to Monday through Thursday.   I am excited to be enjoying a long weekend every weekend.  And while the schedule change is relatively minor, this event does feel like an important career moment for me.  It is the first step on a journey that will ultimately lead beyond my professional career.  It is this recognition that makes this modest schedule modification more significant than one would think it deserves.  As some readers know,   my current employed position has been a dream job for me.   Prior to this, I was in a small private practice, which I loved, but was much more challenging professionally and personally.   My partner and I ran the business.   Working nights, weekends and holidays were routine for decades.   On an on-call night, if I slept  through until morning, I felt as if I had won the lottery.   And w...

Cologuard is a sophisticated stool test that checks for microscopic blood and altered DNA which can signal the presence of colon cancer or precancerous polyps.  Some patients are attracted to this non-invasive option rather than to traditional colonoscopy experience which includes the ever popular cathartic cocktail. This test was approved by the Food and Drug Administration (FDA) in 2014.    The test was initially quite popular as patients and physicians were enthusiastic about this new colon cancer screening option.   Often in medicine, what’s new becomes popular but initial enthusiasm tends to ebb over time.   (With time, the initial safety and efficacy reports for medicines and diagnostic tests may not be sustained.   This is why post-marketing surveillance after initial approval is so critical.) Patients were advised early on, as they are now, that a positive Cologuard test meant that a follow up colonoscopy was mandatory.   Certainly, when I or...