MD Whistleblower

In a prior post , I shared my heretofore reluctance to prescribe medications to my Hepatitis C (HCV) patients.   In summary, after consideration of the risks and benefits of the available options, I could not persuade myself – or my patients – to pull the trigger.   These patients were made aware of my conservative philosophy of medical practice. I offered every one of them an opportunity to consult with another specialist who had a different view on the value of HCV treatment. I do believe that there is a medical industrial complex that is flowing across the country like hot steaming lava.   While I have evolved in many ways professionally over the years, I have remained steadfast that less medical care generally results in better outcomes.   A Scouting Patrol of the Medical Indutrial Complex There was an astonishing development in HCV treatment that caused me to reevaluate my calculus.   New treatment emerged that was extremely safe and amazingly effective.   Now, ne

Eons ago, there was a television show where a non-human character would yell out, ‘ Warning ’, Warning ’, when he sensed imminent danger.     The series was called Lost in Space where we were entertained by a set of quirky characters on a cheesy set.   We loved that stuff.   It’s hard to imagine today’s millennials and younger folks being transfixed, as we were, with the deep television dramas of our day.   Who could match the subtle allegory and nuance of shows such as Green Acres or Gomer Pyle?   Some superficial viewers regarded The Andy Griffith Show as a homespun, idyllic view of small town America.   In truth it was a biting satire on the excesses and abuses of law enforcement in the 1960’s. Robot and Dr. Smith I am overwhelmed with the warnings that I receive in my work and in my life.   It seems that warnings, caveats and disclaimers are so omnipresent that they have lost their impact.   As I write this, I am seated in McDonalds, sipping a cold beverage that doe

A few weeks ago, I saw a patient with some gastro issues.  So far, nothing newsworthy here since I am a gastroenterologist.  I ordered a CAT scan colonography, a special CAT scan that is designed to view the colon in detail.  It’s the CAT scan version of a colonoscopy.  Why didn’t I simply perform a colonoscopy, which, unlike a CAT scan, would contribute to the Whistleblower Retirement Fund?  That’s an easy one.  Care to take a guess? The patient refused to undergo a colonoscopy. The patient had no insurance and I don’t work for free. The patient is a ‘cat lady’ and loves all things CAT. The CAT scan was a better tool than colonoscopy to explain her symptoms. Playing Cat & Mouse with Insurance Companies I expect that my discerning readers can identify the correct choice.  I ordered the CAT scan because it was the best option for the patient, which the insurance company summarily denied.  I called the insurance company (always a fun and amusing exercise) and spoke

For a few decades, I did not treat patients with Hepatitis C (HCV) infection, despite aggressive marketing by the pharmaceutical companies and cheerleading by academics.   I was an iconoclast as most of my gastroenterology colleagues were HCV treatment enthusiasts. They argued that if the virus could be eradicated, that there was evidence that these patients could avoid some horrendous HCV complications, such as cirrhosis, liver failure and cancer of the liver. I’m certainly against cancer and liver destruction, but I have thought that the evidence that HCV patients who vanquished the virus would be saved from these fates was somewhat murky.   Treatment proponents would argue that the medical evidence for thes claims is solid, but I wonder to what extent their favorable bias toward treatment influenced their judgment.  We physicians know that a doctor or a drug company will seize on  particularly studies that supports their views.  Studies that challenge their beliefs may be crit

This past week high school students across the country walked out of school for 17 minutes to show solidarity with the 17 fallen Florida students and their families.   There is not a human being among us who disagrees with their mission, except for a few deranged and cowardly murderers.  These kids are crying out for more restrictive gun laws. Although I will offer a controversial view below on the walkout, let me say with clarity and sincerity that I am proud of these kids.  Since the horror in Florida, I watched them speak to us with passion, poise and eloquence.  While many of us may not agree on the best path forward, we can all agree that we have great kids in this country. These kids are right and have a right to demand to be safe. Schools have always been an oasis for our children, places where they are to be nurtured, educated and protected.   I know that there are many teachers who would serve as a shield for their students in any situation, as they have so nobly demons

Last week, I opined about a decision by Anthem to deny paying for Emergency Room (ER) care that it deemed to be non-emergent.   My point was that insurance companies should not be obligated to pay for routine, non-emergent care, recognizing that we need a fair and reasonable method to define a medical emergency.    In my view, payment should not be denied to a patient who reasonably believes he needs ER care, even if the symptoms are (hopefully) found to be innocent after a medical evaluation. For example, if a patient develops chest pain at 10 o’clock p.m., and is worried about an acute cardiac issue, he should call 911.   If the ER determines that chest pain is simple heartburn, it would not be reasonable for Anthem to deny payment for this ‘non-emergent’ condition.    We’re all a little smarter after the fact once we know the outcome. Some medical complaints, however, are never medical emergencies.   If you want ER care for a runny nose, a cough or a sore knee, and you proce

We live in an era of demonization.   Political adversaries are not opponents, they are villains.   Commentary that contrasts with our views is labeled ‘fake news’.    Presumption of innocence?   R.I.P.   Civil discourse has become a quaint memory.   Why would one debate respectfully when today’s tactic is to talk over and demean your adversary?   On the morning that I prepared this post, I read an article reporting that one of Ohio’s largest insurance companies, Anthem, is denying payment for non-emergency care provided at emergency rooms   (ERs).    In my view, this article was slanted, unfairly tilting away from the insurance company, an easy target to attack.    I think that a typical reader would conclude that the company was greedily trying to claw money away from sick customers.   An anecdote was offered describing a denial of payment for emergency care for abdominal pain that did seem improper, although there were no medical facts provided. I felt that the journalist did