MD Whistleblower

As a gastroenterologist -a trained specialist in digestive issues - I should have expertise in obesity, nutrition and weight loss strategies.  I really don’t.  While I have knowledge on these issues that likely exceeds that of most of my patients, I received inadequate formal training on these subjects during my gastroenterology training.   It is inarguable that digestive doctors – and indeed all physicians – should bring a high level of expertise on these medical issues into their exam rooms.  The impact of obesity reaches nearly every medical specialty.   Obesity is linked to heart disease, stroke, cancer, arthritis, diabetes, sleep apnea, high blood pressure and many other illnesses.  Most of my overweight patients tend to remain so.  Many of them are simply resigned to a shape and size that they feel they cannot alter.   Some are not motivated to engage in the hard work and long journey that can lead to a leaner dimension.  Some do not recognize that successful weight loss req

We’ve all heard about the blue wall of silence that describes a belief that law enforcement personnel will refrain from reporting misconduct of their colleagues to the proper authorities.  Physicians had similarly been accused of hiding behind a white coat wall of silence , as I have on this blog.   This describes the belief that physicians do not reliably turn in colleagues who are incompetent and impaired.  Personally, I have never knowingly participated in the care of a patient with an impaired colleague.   Competency is a murkier issue and is, of course, variable in the medical profession.  In addition, it’s not easy to define or to measure.  It is this very fact that has made me so hostile to the Pay-for-Performance schemes that claims to be a quality metric, but is truly used as a cost cutting tool. 'I Know Nothing' I am aware of physicians in my community who do not have a strong reputation of medical skill.  Yet, many of these physicians are beloved by their

I wish I could write that medical care today is an optimal, cost-effective and efficient system that consistently provides appropriate and sterling medical care.  I wish I could write that pharmaceutical companies, hospitals and extended care facilities all view patient care as their primary and overriding mission.  I wish I could write that physicians all share the highest ethos of patient advocacy. It is not possible to achieve these idealistic goals as the individual professionals, corporate entities and the government that comprise the medical profession are imperfect and face numerous conflicts of interests.  Indeed, this blog as devoted considerable space to highlighting these issues. Here’s a representative vignette from my world.  I was asked to see a hospitalized patient for an opinion on her low blood count, or anemia.  This is a common request for gastroenterologists as internal bleeding is a frequent explanation for anemia.  This is when we gastroenterologists

I am not going to offer an opinion if the Senate’s anticipated acquittal of the president in the impeachment proceeding will be correctly decided.    I have nothing to add to the millions of words that have already been said, written and dreamt on this issue.   And, even if I had divine inspiration to contribute a new thought, would it change anyone’s mind? Leaving aside the merits of the case, I do think the Democrats have committed a series of errors that contributed to the GOP’s victory and made it more palatable for senators to support the president. Flag of the U.S. Senate House members and others have been clamoring for the president’s impeachment since his inauguration.   Indeed, a resolution for impeachment was submitted to the Republican controlled House in December 2017.   This feeds the narrative that the Democrats were fixated on the impeachment outcome long before the Ukraine imbroglio developed. Democrats and others in print and the airwaves were warn

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