MD Whistleblower

I've never worn the uniform.  The military draft was long gone by the time I came of age.  My father served in the Navy for 39 months in World War II.  One of his brothers was a Marine and other served in the Army.  I regard them and millions of others as part of the greatest generation.  Defending America and its interests was inbred then.  There was unity of purpose.  What were the stakes?  Merely saving the world from domination and conquest.  They understood that this was a fight worth fighting. Had President Truman not ended the war in August 1945, my father, along with hundreds of thousands of others, may have been deployed to Japan.  Had that occurred, it is possible that these posts and it's author may never have existed.   What would America and Americans do today if free peoples on faraway shores were threatened?  Does our turning away from Ukraine as they defend against a ruthless and revanchist dictator guide o...

Some time ago, a patient was sent to me for a scope test.  This is hardly a newsworthy event since I do thousands of scope exams every year.  This patient had a known, benign narrowing at the lower portion of the esophagus, which is called a ring.  Years ago, another gastroenterologist stretched the ring which had been catching food on the way down.  My assigned task was to examine the ring and determine if a stretching was necessary.   This introduction of this case is the set up for the point I wish to make.   Too often, medical decisions are based on objective data without sufficient consideration of the patient.   Consider a few hypothetical examples. An MRI of the back shows disc protrusions in the lumbar spine.   A surgeon reviews the study with the patient and explains the rationale for surgery.   However, a detailed review of the patient’s symptoms suggests that the back pain may not be caused by disc protrusion at all.   I...

When is my next colonoscopy due?  Patient's ask me this all the time. While this inquiry would seem to lead to a straightforward response, it often doesn’t.   Why is this the case?   Isn’t there a simple chart instructing gastroenterologists when the next exam is due?     Yes, there are published guidelines, which were recently revised in 2019, but not everyone follows them.   Some physicians advise the same colonoscopy intervals that they have been recommending for many years.   Others rely upon their own judgement rather than consulting with professional guidelines.   More often than you might think, patients are the driving force such as when they request a colonoscopy sooner than is medically necessary.   I have heard many times patients relating vignettes such as ‘ my friend was just diagnosed with colon cancer.   I know I’m not due until next year but can we schedule it now?’   And keep in mind that when any new medical guid...

The week before writing this I saw a couple of patients for 2 nd opinions.  This can be very tricky terrain and I do my best to navigate skillfully.  A casual remark on my part could damage the relationship between the patient and the doctor of record. Here are examples of remarks that I believe are best left unsaid. “Your doctor did what ???” “We don’t recommend that surgery anymore.” “Sounds like you need a new doctor!” “Have you considered hiring an attorney?” “I agree with you that the doctor’s office was unprofessional.” You get the idea.   Other physicians who offer patients second opinions may have a different view on this.   They may believe it is their role to make highly detailed medical recommendations as best they can which may represent an acute therapeutic course change.   They may even offer to take on the patient formally, a suggestion that would be expected to be welcomed by the dissatisfied patient. Trapped in a Medical Labyrinth...

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...