MD Whistleblower

I am a gastroenterologist who has been practicing for decades.  One would think that with my diagnostic cunning and length of service that I would be able to identify the cause of your stomach distress from across the room.  Alas, abdominal distress is often more cunning than the medical sleuths who aim to unmask its identity.  A reality of gastroenterology is that abdominal pain – an issue I confront every day  – is often unexplained and unexplainable, a frustrating reality for patients. Here’s another frustrating aspect of the experience that patients must often deal with. A patient with months or years of abdominal distress is seen in an emergency room.   In some instances, there have been more than one ER visit for the same issue.   Despite repeated laboratory data, a CAT scan or two, other imaging studies of the abdomen, a thorough review of the patient’s history and physical examinations which may be repeated over the course of hours in an ER, no diagnosis is made.    The pat

Over recent weeks, several times I have prescribed medications for patient that they could not afford. Insurance plans do not cover every benefit.  With respect to drug coverage, each insurance plans has a formulary - a listing of drugs that are covered.     As patients have learned well, covered medicines are categorized into different tiers, which determines to what extent the medication will be covered   The lower the tier number, the more money that the patient will have to surrender.   Some drugs are simply not on the formulary and can have eye-popping costs which might approach a patient’s monthly mortgage payment. Distraught woman hoping for a win so she can afford her colitis medicine. The two medicines that I had prescribed which were then stiff-armed for coverage were for colitis.   I had the patients research the costs and they and I were shocked by their findings.   At first, I thought they may have misplaced the decimal point, but the more expensive of the two was pric

A day prior to this writing, a man well into his eighth decade came to see me for the first time.   He wanted advice from a gastroenterologist.   So far, this quotidian event is hardly newsworthy.    I asked him, as I ask every patient, if he had ever consulted with a gastroenterologist (GI) previously.   For me, this is a critical inquiry as it often opens a pathway to a reservoir of information.   For instance, if the patient responds that he saw a GI specialist 3 months ago for the same symptoms, but no cause was determined even after extensive testing, then I know that obtaining these records will be critical. Or, if a patient tells me that he loved his prior GI specialist, but he has to see me because his insurance has changed, then I know that I have be particularly mindful to establish good rapport. Sometimes, patients change physicians or specialists because they are dissatisfied.   Patients uncommonly volunteer the reason, but I ask them directly why they have sought to m

If a patient wants a colonoscopy done, and it’s not medically indicated, should the doctor still do it? If the physician complies with this request, has he or she committed an ethical breach?   Should the medical board or some other disciplinary agency be notified to investigate? Of course, in a perfect world every medical procedure or prescription would be advised only if it is medically indicated.   But the world is not perfect and there are instances when good physicians may deviate from established medical dogma. We Inhabit an Imperfect World Consider these examples and whether you think that a disciplinary response is appropriate. A patient is due for his next screening colonoscopy in 2 years, which would be 10 years since his last exam.   He approaches his doctor with anxiety because his coworker was just diagnosed with colon cancer.   He asks that a colonoscopy be scheduled now.   The doctor agrees. A patient wants his colonoscopy performed in December, after his deducti

Our favorite restaurant has closed. A child’s toy is left behind on a trip. Our dog ran away. We have all observed that the value of something in our lives becomes well known to us when it is missing.  The loss of a job, a friendship, financial security or one’s health are cold reminders of the worth of these items in our lives.  How important are the people in our lives?  We’ve all been taught this lesson the hard way.  Of course, it is human nature to take one’s advantages and blessings for granted.  I do my best to pause from time to time to meditate on the gifts that have fallen my way, many of which are undeserved.  I certainly need to do this more often. In fact, I don’t think one can do this often enough. Do Flowers Really Matter? I think most of us would agree that life is richer when we appreciate what we have while we still have it.   In the course of a long medical career, I have met so many inspiring individuals – happy and content with their lot in life.   They are

Labor Day became a federal holiday in 1894, during the presidency of the only chief executive who served two non-consecutive terms. (Have I tempted you to look up this piece of presidential trivia?)  This holiday emerged from an overheating crucible containing worker exploitation and worker unrest. All of this let to labor reform.  Change so often requires disruption, discomfort, protest and even violence.  Clearly, the antebellum conflict between the northern and southern states, for example, was not to be resolved peacefully. He served 2 non-consecutive terms. There are still, of course, unfair labor practices and worker exploitation.  Are Uber drivers employees or independent contractors?  Did Starbucks retaliate against employees who wanted to organize?   But to be fair, we must acknowledge that great progress has been made that is still ongoing.   Oftentimes, when a particular struggle has not yet achieved its full mission, folks point out the distance remaining rather than the