MD Whistleblower

Future doctors will celebrate that they no longer prescribe the same drug at the same dosage for hypertension or pneumonia or arthritis or cancer or many other conditions.   Who knows even if drugs will be the mainstay of medical treatment.   Tomorrow’s treatments will be tailored to one’s age, gender, weight, race, overall medical condition, severity of the medical threat and genetic profile, among other variables.   We don't all wear the same sizes of socks and shoes, but yet medicine today has a one-size-fits-all treatment utility.  A new era, however, is upon us. What will be the fate of my beloved colonoscopies or heart catheterizations or blood draws or biopsies of tissues?    Fear not.   They will all be available to you, just as Van Gogh paintings or fossils of T-Rex are -  in museums.   The first exhibit will be a diorama of the physician’s office from yesteryear, adorned with some antique artifacts such as a stethoscope, an EKG machine and a reflex hammer.  

I have written, or more accurately ranted, about electronic medical records (EMR) systems throughout this blog.   While the systems have clearly improved since their mandatory introduction into the medical universe, they have still not delivered on many of their promises. Of course, EMR has brought tremendous advantages to the medical profession and we are all grateful for the technology.   But this progress has exacted a cost.   Many of them are clumsy to utilize.   When the technology breaks down or freezes, the office become paralyzed.   The systems are vulnerable to hackers who can exploit personal medical data or demand ransomware.   Many of the computerized notes   are so filled with pre-populated fluff carried over from prior visits, that it can be challenging to identify new medical information.   I often scroll through several pages in search of the physician’s thoughts and plans.   And a physician who is staring at a computer screen during an office visit will create a

As promised, here is the continuation of last week's post where I discussed the loss of physicians' diagnostic skills which have been largely replaced by technology. Of course, the medical community celebrates the miracles that technology has brought us.  Innovation has improved our lives and will continue to do.  On this issue, there is no debate. But, as with many advances, there is a cost.  Here's my take on the downsides of the technologization of the practice of medicine.   Could a CAT Scan Do Damage? Readers, Scan Below! Overreliance on technology has cost zillions of dollars. Much of the overdiagnosis and overtreatment in our health care system – which I have decried on this blog – is caused by medical technology. Technology has strained the doctor-patient relationship.  It is often easier to order a scan than to have a deeper conversation with patient who needs advice and counsel, particularly when physicians’ schedules are jammed. CAT scan

Does your doctor really know how to use a stethoscope or palpate your abdomen? Today’s physicians do not have the physical exam skills that our predecessors did.   We can argue if this truth has diminished medical quality – I’m not sure that it has.   But it has completely changed how medicine today is practiced.   The reason for declining physician exam skills is that technology has largely supplanted physicians’ hands, eyes and ears.   In the olden days, the stethoscope was the diagnostic tool for examining hearts.   I spent a month as a medical student with a legendary cardiologist who could make all kinds of cardiac diagnoses right at the bedside using 2 advanced medical instruments known as ears.   Surgeons and gastroenterologists in years past had to make   diagnoses of acute appendicitis and other abdominal emergencies based on feel and their ‘gut’.   Neurologists made accurate diagnoses of stroke just using their clinical skills. An Advanced Medical Instrument

Some time ago, I performed a colonoscopy on a patient who was having serious internal bleeding.   He had already received multiple transfusions since he was admitted to the hospital.   After obtaining informed consent for the procedure, I performed the colon exam.    I encountered blood throughout the entire colon, but saw no definite bleeding site, raising the possibility that the source of blood might be higher up than the colon, such as from the stomach.   I had not considered this possibility when I met the patient, but this was now plausible.   Can I proceed with the upper scope test, which the patient did not consent to, while the patient is still sedated from the colon exam? Could the Stomach be the Culprit? Seasoned gastroenterologists can usually predict the site of internal bleeding based on numerous medical facts, but there are times that we are surprised or misled.    Patients don’t always behave according to the textbook presentations we learned.   At t

‘Twas the night before Christmas, And all through the House, All the creatures were plotting, Claiming Trump was a….RAT! We have Schiff and Nadler And, of course, Madame Speaker, Who are as transparent, As the Anonymous leaker! Our Democracy might fail, Our Dem statesmen teach, So what choice do they have But to hold hands and impeach. When Mueller fell flat, They all felt the pain, But, the Lord heard their prayers And POOF – came Ukraine! With so many versions How could we know If Trump really offered A quid pro quo. The witnesses swore Trump’s plan was – Extort! Jim Jordan responded With a loud bleating snort. And with all of this static Some can’t be heard, When the candidates speak, We hear nary a word. So Warren and Bernie, (And Blitzen and Dasher) Have been squelched and muzzled. By the Candidate Crashers. When it all ends And the Senate says, No! No minds will change. I told you so!

There’s a phrase that every physician hears repeatedly from patients, that requires a nuanced response. Doctor, what would you do if you were me? There are variations on this inquiry, such as ‘what would you do if I were your father’, but they all are aiming at the same target.  The patient, or often the patient’s family, asks the doctor what advice the physician would choose if he were in the patient’s place.  For example, if the physician were the patient would he opt for: Surgery Chemotherapy Experimental treatment Watchful waiting A second opinion A third opinion Alternative medicine Acupuncture Hospice 'Doctor, what would you do? Patients erroneously believe that this form of inquiry is the magic bullet of finding out what the physician’s truly best advice is for a particular medical circumstance.  After all, if the doctor would recommend a treatment for his own mom, then surely this must be the best option. Except, it isn’t.  Here’s why. P