MD Whistleblower

All work is honorable.     Sometimes, when I ask a patient what his occupation is, the response begins with, ‘I’m just a…”.   I’ll have none of it.   There is no ‘just’.    Most of the people who keep this country afloat are anonymous folks who put in an honest and decent day’s work.   Some use a keyboard and others use a hammer.   Some use a shovel and others use a colonoscope.   Some arise when we are still asleep and others start work after we have retired.   Some use their hands with skill and precision and others offer professional advice.    Some design a building and others build it.    Some create and others consume. But, why should these words matter here?   After all, I am just a blogger.

A man I had not met came to my office prepared for one of life’s most joyful pursuits – a screening colonoscopy.    Perhaps, this experience gives truth to the adage, ‘it’s better to give than receive’. This man was 70-years-old and was about to undergo his first screening study of the colon, an exam that experts and others advise take place at age 50.   Let me do the math for you; he was 20 years too late.   I performed my task with diligence and removed a large polyp.    While I believe that the lesion was still benign, we gastroenterologists prefer to discover your polyps when they are small.    Smaller lesions are nearly always benign and are safer to remove. Afterwards, I chatted with the patient and his wife and I expressed some surprise that there had been a two decade delay of his colonoscopy.    (Readers would be amazed and amused at the creative excuses I’ve been offered over the years explaining delayed colonoscopies.   A popular one is “I’ve been so busy!”, as i

A contract is an agreement stipulating the rights and obligations of the signatories.   In most cases, a contract is consulted when a dispute arises.   When all is proceeding swimmingly, the contract remains dormant in a file drawer or in a digital file.   In general, decent people resolve differences in the old fashioned way utilizing the twin arcane legal techniques of reasonableness and compromise.   Remember them?   Yes, it is possible to settle disputes without consulting an attorney. Settling a Dispute without a Lawyer I learned recently about the existence of Opioid Contracts, an 'agreement' between a patient and a physician regarding the use of opioids.    I have read through various OC templates and, although I have no law degree, they seem extremely lopsided in that one party seems coerced to accept numerous stipulations while the other – the doctor – serves as the enforcer.   Although many of these agreements require both the patient and the physician to

I read yesterday in Cleveland’s main newspaper about the tragic passing of a 14-year-old girl.   She had cancer.    Why would this tragedy have been reported on Page 1?    As sad as a loss of a child is from a medical condition, this is generally not of interest beyond the family, friends and loved one.   This case was different.   The parents refused the chemotherapy that her doctors advised.   They wanted their daughter treated with herbs and feared that standard medication would worsen their daughter’s already precarious condition.    The parents believed that chemotherapy would violate their religious beliefs. The parents sought another medical opinion from Cleveland’s other premier tertiary care center, which affirmed the original medical advice. About 2 weeks ago, the parents received a court order mandating that their daughter receive chemotherapy.   Shortly afterwards, the daughter, who was already on a ventilator,   developed serious medical complications and died.

Consider these behaviors.    A newborn calf nurses from his mother.    A robin places a worm into the gaping mouths of her offspring.    Cats know how to hunt. These behaviors are examples of instinct.   The creatures do not even understand why they engage in these acts.   They are inborn behaviors.   Animal Instinct Humans have instincts also.    Unlike most professional standards and qualifications, instincts cannot be easily quantified or tested.   But, under certain circumstances, they are invaluable assets.   We learned last week that the Transportation Security Administration (TSA) has been pursuing a program called Quiet Skies, when passengers who have met certain criteria are monitored for various behaviors that might suggest that closer scrutiny is warranted.    I am making no comment here on the merits of the program, but I am supportive of TSA using instincts of air marshals as a tool to evaluate threats.    Some have criticized this as an infringement

For a few decades, I have assisted tens of thousands of patients in making medical decisions.   While the stakes may be higher in making a medical decision, the process is the same as would be used in making any decision.    Gather the facts.   Weigh the options.   Consider the respective risks and benefits.   If applicable, consider additional issues that may tilt the decision, such as cost, family or professional impact, personal priorities or cultural norms.   Obviously, two individuals may share identical medical facts but decide differently – and both decisions may be sound and correct. Our politicians and government officials should use the same process when faced with a political decision or a vote.   But, they don’t.    Sure, they engage in a risk-benefit analysis, but in a rather twisted manner. Politician contemplating a vote:   “What is the risk to me if I vote for or against?” Same politician contemplating a vote:   “What is the benefit to me if I vote for

I am against all forms of bodily pain, both foreign and domestic.  I wish the world were pain free.  When I am suffering from even a routine headache, I want immediate relief just like everyone else.  The medical approach to pain control has changed dramatically even during my own career.  When I started practicing a few decades ago, the strategy was pain reduction.  We gave narcotics for very few indications such as kidney stones, heart attacks and severe abdominal pain after a surgeon evaluated the patient.  (The reason for this was so the surgeon could obtain an accurate assessment of the patient’s belly before pain medicine masked the findings.)  The new goal is pain elimination which I believe is one factor that has fueled the overconsumption of opioids, although there are other factors present.  I admit that I am opining on this as an individual who is blessed to be pain free.  I do not pretend or suggest that if I were afflicted with a painful condition, that I would not wa