MD Whistleblower

Would you rather be right, wrong or interesting?   When I was a medical student rotating on the OB-GYN rotation, the issue arose if female OB-GYNs were more sympathetic to patients than their male colleagues were.  Before reading on, what's your opinion here? There was a view that females in this medical specialty would have more empathy for patients as they may have experienced menstrual cramps, pelvic pain and childbirth.  No man can relate to these symptoms and they might be expected to be more dismissive or distant over these ‘minor hormonal disturbances’.  In other words, men just don't get it. A discrete GYN exam 200 years ago It is true that one who has ‘walked the walk’ may connect more closely with one who hasn't.  For example, since I have never suffered from an addiction, I can never counsel a drug addict or alcoholic with the same street cred as one who has triumphed over these afflictions. The chief of the OB-GYN department at my medical

I will digress from this blog’s medical quality theme to let off the gaseous form of H20, also known as steam.   I wouldn’t consider this to be a rant, a genre that I have offered previously.   But, it’s more than just venting to my readers.   So, it’s somewhere between a rant a and a vent.    In my world, I try hard to challenge myself and others.   It’s the way I’ve always been.   I love the debate, the argument and the rhetorical fencing.   I feel satisfied if I can change someone’s mind and I particularly relish when someone can change mine.   Let the better argument prevail.    Of course, contestants in this arena must be willing change their views and give an opposing argument a fair hearing.   There have been instances during these colloquies, and at other times, that I have inadvertently offended someone.  At times, this occurred because my words were clumsily selected.  On other occasions, the recipient may have been overly sensitive and had a low offense threshold

Behold the denizen who has bravely entered our property so close to Thanksgiving! Wishing all of you a great holiday.

At least a few times a year I am asked to prescribe antibiotics to people who are not my patients.  From my point of view, there is only one answer that makes sense here – no.   I have the same reaction when patients call me for a refill or advice when I have not seen them in a year or two.  The patient may feel that I will refill their heartburn medicine indefinitely without an office visit, but I won’t.  Once I hit the refill button, I am now totally responsible as the doctor.  Patient Gets Medication Refill in 14th Century The Patient’s Perspective I’ve been on the same medicine for 10 years and all I need is a refill.  I feel fine. I do not want to take time off work for an unnecessary appointment. Why should pay a copay when all I need is a refill?  Sounds like a rip off. The Physician’s Perspective No refill until I verify that there are no concerning symptoms. A routine ‘heartburn patient’ may have developed some swallowing difficulties which could signa

Doctors dispense medical advice.  That’s what we do.  Folks come to our office with various medical issues.  We talk to them.  We poke around some of their body parts.  Then, we exercise our medical judgement.  We might order a CAT scan.  We might prescribe stuff.  We might simply reassure them and send them on their way. This is a typical ‘day in the life’ of a health care provider, formerly known as a doctor.  From time to time, folks solicit my advice under different circumstances.  Despite my efforts to keep my medical specialty stealth, sometimes the secret seeps out when I am in a social setting. “Oh, you’re a gastro guy?  Would you mind if I asked you quick question about my husband?  He has a gas problem…” I get questions like this all the time, and I do my best to respond in way that sounds authoritative, yet dispenses no legitimate medical advice.  Here are some examples of how I might respond to the above inquiry on spousal flatulence. “Yeah, if I had a doll

I’ve delved into the issue of medical judgment more than once on this blog.  I have argued that sound judgment is more important than medical knowledge.  If one has a knowledge deficit, assuming he is aware of this, it is easily remedied.  A judgment deficiency, per contra, is more difficult to fix.  Who doesn’t think he has good judgment? For example, if a physician cannot recall if generalized itchiness can be a sign of serious liver disease, he can look this up.  If, however, a doctor is deciding if surgery for a patient is necessary, and when the operation should occur, this is not as easily determined.  Medical judgment is a murky issue and often creates controversies in patient care.  Competent physicians who are presented with the same set of medical facts may offer divergent recommendations because they judge the situation differently.  Each of their recommendations may be rationale and defensible, which can be bewildering for patients and their families.  This is one of t