MD Whistleblower

I recall when urgent care offices proliferated and were often housed within pharmacy chains.  This latter arrangement was symbiotic in that the pharmacy provided a convenient venue for patients who then purchased their new prescriptions in the pharmacy.  And a patient entering the pharmacy for a medical visit is likely to make unrelated purchases while strolling the aisles. These sites are generally staffed by nurse practitioners (NPs).   I have worked with these excellent professionals for many years now,.  Beyond urgent care settings, NPs also work in hospitals and many other venues caring for patients with complex medical issues. When the urgent care option came onto the scene, there was stiff pushback from doctors who railed that the quality of care would be below par.   “Nurse practitioners are not doctors,” they warned.     My suspicion then was that doctors had unspoken concerns unrelated to medical quality.   The reason that NP-directe...

All of us have viewpoints on various issues and policies.   We have opinions on the criminal justice system,  immigration issues,  and eligibility for health care benefits, to name 3 examples. For many of us, our opinions evolve as we gain life experience and wisdom, which change how we view the world.  I regard this as personal growth which we should all welcome and aspire to.  I acknowledge that there are some bedrock principles that should remain stable. For instance, the tenet that physicians should serve their patients’ interests and not their own should persist.   With age, comes wisdom. We have also seen folks change their positions, sometimes rapidly, using a pathway different from the personal growth process I noted above.  Views can change rather suddenly when an issue affects someone or a loved one more directly.  For instance, a champion of strict law and order might feel that leniency is in order if his own son faces expulsion from a ...

Physicians, at least most of us, are not businessmen.  Yet, we are negotiators.  When I was in private practice, for instance, we were running an actual business.  There were negotiations with our landlord, with insurance companies, with vendors and with new hires.   Now, as an employed physicians, all of these issues – and many others – are out of sight and out of mind.  But I am still negotiating.  With whom, you wonder? I negotiate with my patients. I’m not suggesting that my doctor-patient relationships are cold, transactional events.   Hardly.   But every relationship, either business or personal, requires give and take.   Sometimes one party gives up some space to accommodate a compromise, and other times the partner behaves similarly.   Indeed, every successful relationship that I have participated in or witnessed is a breathing and flexible organism.   Negotiating with patients is less formal than is depicted here. ...

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...