MD Whistleblower

One of the perennial patient gripes I confront is why on some occasions I refuse to refill a patient’s medication that I have previously prescribed.  Usually, but not always, when I offer my explanation for this roadblock, the patient understands why I advise a face-to-face meeting. Here is a sampling of patient feedback I’ve received over the years. Why do I need to come in?  I’ve been on the same prescription for years? Why should I have to pay a copay when all I need is a refill? I live 45 minutes away. The doctor doesn’t have an appointment for 2 months and I only have 4 pills left! I don’t drive anymore and I can’t get a ride. This doesn’t happen with any of my other doctors. Here’s how I see it.  Of course, I understand the sentiments expressed above from the patients’ perspective.  Certainly, when a patient I know whom I have been in regular contact with asks for a refill, I send it right through.  If, however, I feel that too much time ha...

 I’ve never served in the armed forces.  Therefore, I can’t possibly grasp the depth of meaning that Memorial Day holds for families who know what service and sacrifice really mean. My father served for 39 months during World War II, but was fortunate to have been kept from harm’s way.   He was part of a generation, perhaps the greatest generation, that was not preoccupied with self.   The trite phrase, ‘we are all in this together’, was a touchstone of that time.   No more.   Back then we crossed oceans to serve not only our nation’s interests, but also to preserve world peace.   Now, we have become much more self-oriented, both as a nation and as individuals.   America First has captured the sensibilities of tens of millions of Americans, a phrase that harkens back to Charles Lindbergh who was a speaker and supporter for the America First Committee.   Lindbergh was an American hero who was also an anti-Semite who received the Service Cros...

It would seem self-evident that an applicant for a job should be scrupulously honest.   First, it is the right thing to do.   Secondly, in our digital era, one’s academic record can be accessed back to kindergarten.   Yet, many applicants will embellish their credentials or claim a skill level that may exceed reality.   Thirty years ago, I was applying for my first job in New Jersey after completing my 2 year gastroenterology (GI) fellowship.   I was not competent to perform ERCP, a complex scope examination that GI practices desperately still want to add to their practices' skill sets.   Yet, I was advised by a practicing GI physician to simply claim that I could do the procedure.   Otherwise, he said, they would simply pass me by.    I queried the practitioner on my proposed course of action after being hired if I were summoned to perform an ERCP.   Decades later, I do not recall his response.    I can imagine what my new e...

Recently, I read about a judge’s decision on a legal dispute.   The facts aren’t important here.   As I read my newspaper’s summary of the decision, it was clear to me that one side won and the other side lost.   Yet, both sides claimed victory.   This is commonplace in the public square where a clear loser boasts of a victory that even a casual observer recognizes to be magical thinking.   In the case above, the loser who claimed victory wasn’t a corporate PR spinner, but was the county prosecutor. Folks seem to have such a difficult time admitting error, poor judgment or failure.  Here’s a hypothetical.  A man sues a company alleging wrongful termination.  In addition to demanding that he be re-hired, he has asked for an apology, a public clearing of his name in boldface on the weekly company newsletter, back pay with benefits, and $5,000 to cover medical and psychological expenses incurred as a direct result of his firing. The judg...

  If we are lucky, then we have someone in our lives who loves us no matter what, who makes us feel a little smarter than we are, who sees a resemblance between us and some swashbuckling actor who looks nothing like us, who laughs at our jokes, who delights when we call or visit, who takes great pride in our accomplishments, who overlooks our flaws and who reassures us that the obstacle that has unexpectedly confronted us can be overcome.   Thanks, Mom! (And to moms everywhere.) Happy Mother's Day!

As my readers know, I have been a parsimonious practitioner during my entire career.   By this, I mean that I believe that less medical care leads to superior medical outcomes.   I have devoted several dozens of posts on this subject within this blog.   This is my medical philosophy.    Other physicians who see the world differently would challenge me suggesting that I deny patients necessary diagnostic tests and treatments.   Personally, I think that I have the better argument, but so do they. Interestingly, over time patients tend to select and stay with physicians who share similar philosophies.   For example, a patient who believes that regular diagnostic testing, frequent labs, a CAT scan now and then, prescriptions for various symptoms is unlikely to remain my patient because of a philosophical gulf between us.     If that individual, for example, expects antibiotics – as his former physician obediently provided – for what the ...

 I am not a public health expert.  But I have learned this past year that one need not have any public health knowledge in order issue advice and opinions.  How ‘bout some hydroxychloroquine with a bleach chaser? I trust our public health experts and have largely hewed to their advice, although I’m not sure that they have hit the bullseye every time.    As expected, they have modified their advice over time in response to new knowledge.   This is not a flip-flop – this is how science works. And millions of folks have completely rejected their advice for all kinds of reasons.   We’ve all seen photos of patrons who were piled into bars or kids on spring break who were recklessly partying on.   Masks optional. Others, in contrast, were pushing back on the Center for Disease Control and Prevention (CDC) arguing that the rules were not strict enough.   We’ve seen the teachers’ unions refuse to return to classrooms despite CDC guidance assuri...