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Why My Patient Left the Office

A patient came to the office and refused to see me, although I was quite willing to see him.  I’ll present the scenario followed by the patient’s reason he took an abrupt U-turn.   Then, if you are inclined, you may offer your own advice and comment. I performed a colonoscopy on this patient and found a large polyp in the upper part of the large intestine, or colon.  The upper part of the colon, or right side of the colon, has been receiving a lot of press in gastroenterology in recent years.  Medical studies have observed that cancers in this region are more easily missed for reasons that don’t need to be explained here.  For this reason, gastroenterologists are particularly vigilant when examining this region. The polyp was large and somewhat hidden behind a fold of tissue.  I suspected that this was a benign lesion.  I removed the polyp using one of the gadgets in our bag of tricks, but knew at the time that I had left some polyp tissue behind.  I was unable to remove the e

Whistleblower Looks Ahead to 2016

At the end of every year, the airwaves compete for our attention on programming that ‘looks back’ at the past year.  People we’ve lost in 2015. The 10 biggest news stories of 2015. The greatest gaffes of the past year. Stories that made us cry in 2015. Year-end magazine issues follow the same playbook. Whistleblower doesn’t look back.   Whistleblower Eschews Rear-view Mirror I suppose there is a public appetite for retrospectovision since, as we all know, the media’s mission is to serve up what we demand.  The newspaper adage, ‘if it bleeds, it leads’, is more a comment on us than it is on the journalism profession.  We are vampires who look to media for our next blood meal. Looking ahead is tougher since it’s quite a bit easier to chronicle known facts than it is to predict and guess.  But, isn’t this a more worthy task?  How do these story proposals grab you? People we’ll lose in 2016.  (Not serious, just want to assure you’re paying attention.)

Why Trump is Running

What is politics without a conspiracy?  Here are two facts. Donald Trump is a very intelligent man. (Just ask Vladimir Putin.) Donald Trump says idiotic stuff. How does one reconcile these two facts? When a really smart person says really dumb stuff, then something is up. Why does he regularly issue forth insulting invective and false statements? Does he truly believe that John McCain is not a war hero?  Does he feel that schoolyard insults against fellow candidates gives him presidential luster?  Is his plan to slam the door on all Muslims a surefire way to make friends and make us safer?  Is mocking a disabled journalist politically savvy? Is describing Hillary Clinton’s urological delay at the recent debate as 'disgusting', a demonstration of his measured temperament?  Star Quality? It’s very tough to ascribe such views to an intelligent man, which he is, and often says so.  Who benefits from his volcanic eruptions of rhetorical venom?  Here are

Whistleblower Holiday Cheer 2015!

Jingle bells, jingle bells, Cruz is ridin’ high, Jeb is lagging way behind, But tells us he’s our guy.  Trump is here, Trump is there, Trump is everywhere, Promising we’ll be as great, As his golden hair.  Walker’s gone, Perry’s out, And Jindal, “Not my time”. Lindsey Graham is begging us, “Please send me a dime.” Carly has a pretty face, Christie’s slimming down. Pataki sports a comb over, Santorum wears a frown. Huckabee, with a smile Gives fire and brimstone ash, Carson says, “I stabbed a guy!” Kasich trolls for cash. Who among these flapping jaws, Will be the next to fall? Who can make the case for ‘Prez’? Pataki or Rand Paul? Hillary’s in the catbird seat. Bernie just can’t hit. The GOP in unison ‘Oh where, oh where is Mitt!’ Wishing you Joy and Peace!

Was Granny Sent Home from the Hospital Too Soon?

Over the years, I have heard families bemoan that their relative who was just readmitted to the hospital was sent home too early just a few days ago.   Are they right? Was Gramps Kicked Out Too Soon? First, let me say that in some instances they may be correct.  It is certainly possible that the hospital, under increased pressure to kick folks out, may have pulled the discharge trigger too soon.  The hospital is not always right even if their ‘discharge check list’ seemed to be in order.  Of course, patients are not adequately represented by a check list any more than physicians’ quality can be fairly measured in the check off, cook book method that the government and insurance companies are now championing. The hospital discharge check list may indicate that a patient with pneumonia can be safely discharged home as she has no fever or need for supplemental oxygen.  However, this patient may be 89 years old, riddled with arthritis and needs to attend to a spouse sufferin

Am I Too Old for a Colonoscopy?

Most of us are familiar with the concept of medical guidelines.  These are sets of criteria that are supposed to ‘guide’ physicians facing certain medical circumstances. As physicians know, and often lament, guidelines over time morph to become mandates.  Even though by definition, a guideline is voluntary, many hospital oversight committees and insurance companies require physicians who deviate from guidelines to explain their actions. The U.S Preventive Services Task Force guideline states that folks 75 and older should not receive screening colonoscopies.  The  reason is that medical studies have demonstrated that the benefits of colon cancer screening in this age group is not justified by the risk and expense of the effort.  Of course, there is an age when colonoscopy does not make sense, but I’m just not sure what this magic number is. Too Old for a Colonoscopy? Consider these two hypothetical patients. (1)   A 78 year old man in excellent health has never had a scre