MD Whistleblower

In last week's post, I promised an explanation why many screening and medical treatments offer so little benefit to individual patients.    If you invest the time to digest last week's post and the post before you now, then you will be equipped with new understanding that will enable you to make much better medical decisions.  In accordance with this blog's mission, this is truly a 'peek behind the curtain'.  I grant you that these 2 posts are a little wonky, but try to stay focused.   Here is the main reason that ordinary people – and even some medical personnel – become confused on this issue.   Studies that assess screening tests and medical treatments are often performed on very large groups of patients.   The reason for this is that smaller studies, for reasons I cannot fully explain here, are simply not felt to be sufficiently reliable.    This is why the Food and Drug Administration would never grant approval of a new medicine based on favorable resu

I find that the public often exaggerates the benefits of many preventive health measures.   I don’t blame the public for this.   There are several forces conspiring to deceive the average patient into accepting exaggerated claims of various medical tests and strategies.    Of course, the Medical Industrial Complex is a gluttonous beast that must be fed massive quantities of medical testing and treatment if it is to survive. Most of the public thinks that medical interventions, including mammography, lowering cholesterol levels, blood pressure reduction and even colonoscopy are downright lifesaving. Recognize that I am in favor of all of these measures, but that the actual benefit to the individual is much smaller than most folks believe.   In the case of mammography, there is uncertainty as to whether it saves lives at all, a view readers can easily find with a rudimentary internet search.   Mammography experts all agree that any benefit of this screening test to the individu

All work is honorable. Honor everyone's work. Work with honor.   The Whistleblower wishes all of you a meaningful Labor Day.

I have previously expressed how physicianss feel about treating patients that they do not know in a prior post , which readers are invited to review.  This post is the other side of the story.    Nowadays, patients are used to seeing physicians who are not their doctors.  Often, patients may be seeing a nurse practitioner, a highly trained professional for their medical care, instead of a physician.  A generation ago, patients nearly always saw their own physician, including if a patient was hospitalized. Imagine that, your own primary care doctor sees you in the hospital, an event that occurred when dinosaurs roamed freely. The medical universe has changed.  Hospitalists care for most hospitalized patients, which in my view, has vastly improved the quality of hospital medical care.  It is commonplace for patients who need to be seen right away in the office, to see a doctor who is available, who may not be the physician of record.  Pregnant women today often see many obstetric

It may seem odd that a gastroenterologist patronizes fast food establishments several times each week.  I’m in one right now as I write this.  I eschew the food items –though French fries will forever tempt me – and opt for a large sized beverage.  In truth, I am not primarily there for a thirst quenching experience, but more to ‘rent a table’ so I can bury myself in some reading.  Indeed, many thousands of New York Times issues have been devoured at these tables.  I saw a sign posted on the wall here that I had not seen before. Sorry, No Refunds Refunds?  How often can this happen in a place like this?  We all know that food items in these institutions are remarkably consistent, which is one of benefits that customers enjoy.  Your Big Mac or Whopper will taste the same in Pittsburgh as it does in Peoria.  I questioned the server on this new development and she explained that increasingly customers were demanding refunds for contrived reasons in an effort to bilk the restaur

From time to time, I am asked by someone about participating in a medical research study.  These situations are usually when an individual, or someone close to them, has unmet medical needs.  Understandably, a patient with a condition who is not improving on standard treatment, would be amenable to participating in a clinical trial to receive experimental treatment. I find that most folks misunderstand and exaggerate the benefits they may receive as a medical study participant.  Sometimes, I feel their ‘misunderstanding’ is fueled by study investigators who may overtly or unconsciously sanitize their presentation to patients and their families.  There is no malice here.  Investigators have biases and likely believe that their experimental treatment actually works.  Their optimism is likely evident in their communications. Here’s what an investigator might say to a patient. I thought you would be interested in a new clinical trial testing a new medicine for your disease.  P

Opaque:   adjective, not able to be seen through; not transparent Medical pricing is beyond opaque.   It’s a riddle wrapped in a mystery inside an enigma.   Many readers will recognize that this clever phrase is not my own. Throughout my career, I have been unable to provide an accurate answer to the perennial inquiry, how much does a colonoscopy cost?   Patients, of course, find this to be baffling.   This ignorance is certainly not restricted to my specialty of gastroenterology.   Does it make sense, for example, that the same medication may have wildly different pricing at different pharmacies or in different cities?    In contrast, we would expect to find a similar price for a gallon of milk among supermarkets.   My strong suspicion is that seemingly irrational, inflated and complex medical pricing is all by design to serve those on the billing end – hospitals, pharmaceutical companies and pharmacy benefit managers.   Before you accuse me leaving physicians off of thi