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Why Do Dentists Prescribe Prophylactic Antibiotics So Often?

Because they can. Why am I dissing my dental colleagues? Because I can. Perhaps, this is a simple case of Dental Envy, since their profession remains within secure borders far beyond the health care reform line of fire. Consider these dental incidentals: • Not a syllable in the ~2000 page health care reform law that affects dentists. Every filling is still worth its weight in gold. • Dentists recover every dime they bill. If their fee is a gazillion dollars, and your generous dental insurance, covers fifty bucks, guess what? There will be a very large cavity in your bank account. • No middle of the night runs to the emergency room, a drill that we physicians endure • No hospital work, which for many physicians has become an inefficient hassle which became the root of a new medical specialty • Dentists don’t need an attorney on retainer , or caps on non-economic damages, as their malpractice situation is calm. • We still call them, ‘doctor’. Dentists prescribe prophyla

How Do Physicians Choose Consultants? Looking ‘Under the Radar’

Professional sports has never been a dominant personal interest, although I admit that I become more engaged if my town’s teams reach the post season. Here in Cleveland, folks assign a priority level to sports that is just a notch below breathing. I do make it a point to know enough of what is happening within the various stadiums and arenas so that I am not ostracized or placed in a stockade in the public square to serve as a deterrent. If the Cleveland Cavaliers do not emerge as national champions this year, then northeast Ohio will sink into the Sea of Melancholy There is an aspect of professional sports that I greatly admire. This transcends the athleticism and skill of the athletes, the work ethic, coaching expertise, teamwork and the thrill of the game. This is one of the only institutions that is a pure meritocracy. The philosophy is simple and not blurred by arguments for diversity or massaging the qualifications for admission to serve another agenda. Coaches, managers and ow

Sir Isaac Newton and Health Care Reform

Whistleblower readers know of my deep skepticism that the promises of Obamacare will be realized. As time goes on, my skepticism sinks deeper. The health care reform (HCR) legislation that was passed with reconciliation guarantees more taxes, more access to care for the uninsured and more government control of health care. But it fails in its promise to bend the cost curve, or does it? Perhaps, I’m being unfair and need to adopt a more literal approach to the president’s promise of cost control. President Obama’s program does bend the curve, but does so in the wrong direction. He wouldn’t be the first Democratic president in recent memory to engage in a public demonstration of linguistical gymnastics. If health care costs continue to rise, can we expect to hear the president lecture us in 2012 during his reelection compaign with his finger wagging “I kept my promise to bend the cost curve, and I did.” This past month, a national and respected health care organization reported that

Comparative Effectiveness Research: Follow the Herd or Lead It?

I never took a psychology course in my life. Perhaps, I should have. How was I to know, or even suspect, that years beyond college, I would be the father of 5 kids? In retrospect, I should have been a psych major, so that I could have developed essential parenting skills in negotiating techniques, behavior modification, unflappable self control, brinkmanship, verbal dueling and mind reading. Without a solid psychological foundation, I have been fenced in and cornered by teenagers who know very well that I am shooting blanks. This has not been a fair fight. Two weeks ago, my daughter and I traveled to the east coast to visit 3 institutions of higher learning. This is the 3rd child that I have done college visits with. By now, I could give these ‘info sessions’ myself. They are verbal versions of Mad Libs, where the speaker simply plugs in terms specific to his institution. For example: “What really makes __________ University so unique, is our ( insert superlative adjective ) profes

Does Board Certification Really Matter?

My patients have the confidence of knowing that I am a board certified gastroenterologist (GI). I haven’t disclosed this to them personally, but somehow resourceful and curious patients can now find out facts about me that heretofore would have required a government warrant. (In fact, for my entire medical career, I have never displayed a diploma or any professional certificate in my office, which annoys my mom.) Now, with a few keystrokes, patients can read about my suspension from the fifth grade after making an unwelcome comment about another student. Being from the northeast, my initial reaction to this transgression was, “Will this be on my college record?” Assuming that I successfully recertify in gastroenterology in the coming year, I will enjoy this prestigious designation for another decade. I hope I that I am still practicing then, since the health care reformists have promised us a medical nirvana in in the coming years. It would be a shame if I retired just before the nirva

Cost-Effective Medicine: Cracking the Code

My friend, the Buckeye Surgeon , has resisted reforms in medical residency training programs, that have eased some of the inhumane exhaustion on young interns and residents. I have a different view on the subject. This issue generates spirited debate in the blogosphere and in teaching hospitals across the country. Not all medical education reforms, however, provoke controversy. I learned recently from an Ohio medical student that they are now being taught about the financial costs of medical tests and treatments. This makes so much sense that I am astonished it has taken so many decades to be incorporated into medical training. Indeed, even practicing physicians like me are often clueless about the costs of the tests we recommend. Perhaps, if we saw the price tags of the prescriptions and imaging tests we ordered, we might hesitate and reflect for a few nanoseconds A commentary in the current issue of The New England Journal of Medicine chastised medical educators and training p

Obama Passes on Colonoscopy: Oh, What Might Have Been!

Does anyone out there know why President Obama underwent a virtual  ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year? In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless special risk factors are present. Of course, maintaining the president’s health is in the national interest, so I understand why professional screening guidelines might not apply to him. For similar reasons, airline pilots are subjected to routine cardiac testing, not to protect the pilots' health, but to protect the passengers.  Stricter scrutiny of the president's health is proper. So, if the national interest required that the First Colon be studied prematurely, then why didn’t the president choose the screening test that nearly every physician opts for when we turn 50?  I’m baffled. It is inarguable that a colonoscopy is more accurate than VC and can remove polyps and obtain biopies at the time of the examination. In every i