MD Whistleblower

I am a parsimonious practitioner.  While I can’t cite statistics, I strongly suspect that I order fewer laboratory studies, prescribe fewer drugs and order fewer diagnostic tests than do my peers.  Medical minimalism has always been my medical world view.  This can feel a bit lonely at times in a profession that is rife with over-diagnosis and over-treatment.  I am not suggesting that my approach is the only reasonable medical approach, only that it’s the style that I’m most comfortable with.  All of us should consider the philosophy of the professionals we engage.   And the professionals need to gauge the goals and risk tolerance of those they serve.   These relationships may need to enter into negotiations from time to time in order to agree on which pathway to pursue. Physicians, judges, law enforcement professionals, teachers and others are not homogenous philosophically.   While folks may (hopefully) agree on the facts, the interpretations may differ. Consider two different

Life can be vexing.   Life is not a math problem that has one indisputable correct answer.   We are constantly weighing options as we make decisions.  How much risk would we tolerate in order to hope to capture a reward?  Does an NBA star go for the three pointer or drive to the rim?  Does a defense attorney put his client on the stand or leave him mute hoping that the prosecution hasn’t met the required burden of proof?   Does a surgeon recommend an operation today or should the patient wait another 24 hours to see if his condition improves without surgery? All of us struggle where to draw the line.   Look at the ongoing debates in the public square regarding national security.   While some government officials deny this, most of us acknowledge that there is a tension between guarding our civil liberties and protecting our security.  Civil libertarians claim that we can do both, but I believe that trimming civil liberties would provide our intelligence community with more tools to

Pepto Bismol remains one of the most popular over-the-counter medicines that my patients swallow. They take it for all kinds of digestive distress.   Does it work?   Hard to say.   The elixir does have anti-bacterial and anti-diarrheal properties, but I suspect that there is a potent placebo effect at play also.   I personally think that these sales are largely the result of decades of brilliant marketing by the company.   We can all remember their television commercials in the days of yore when we would watch the pink liquid oozing down the esophagus and then gently coating the stomach creating a blanket of healing and protection.   What a graphic!   Many patients have internalized this marketing believing that this medicine is the fire extinguisher that can quiet their internal flames.    Right out of the doctor's 'black bag'. Patients are generally unaware of two important properties of this product. First, Pepto Bismol can turn the stool black.   Three or four times

Colonoscopy became ‘breaking news’ about a week ago.  The preeminent medical journal, The New England Journal of Medicine (NEJM) published a randomized trial assessing the effectiveness of screening colonoscopy in reducing the risk of contracting colon cancer and dying from it.  The results were lackluster. While there is accumulated evidence that colonoscopy can reduce colon cancer risk, the bulk of this data has not been the results of randomized controlled trials, the gold standard in medical research.    In the NEJM study, there was a group who was offered a screening colonoscopy and a separate control group who was not. Gastroenterologists, along with the medical community at large, have been preaching the lifesaving benefits of screening colonoscopy for decades.   The simple strategy is to remove ‘pre-cancerous’ polyps that are lurking silently in the colon and to remove them before they have an opportunity to transform into cancer.   What makes colonoscopy such an attractive

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