MD Whistleblower

I recently booked a hotel in New York City where I hope to spend several delightful days this coming June.  During the booking process, the hotel’s representative read off a dizzyingly list of taxes and fees that I would be paying.  I don’t think I’ve ever been saddled with so many surcharges on any transaction in my entire life, except for the last time I booked a NYC hotel. I felt that I needed to call my accountant for guidance. Many hotels have become green with envy  (or should I say greed with envy?) over state and local taxing authorities who fleece hotel guests.  Why should hotels, who are highly trained fleecers, be left out? Fortunately for me, I won’t have a car.   Anyone familiar with NYC knows the insanity of bringing a car there.   Beyond the expense involved, and the seemingly impossibility of finding a parking space, there’s the sheer joy of taking a drive through midterm crawling through gridlock with horns bleating while receiving lovely gestures from fellow motoris

In 1990, Desert Storm was initiated by President George H.W. Bush, along with coalition partners to reverse Saddam Hussein’s aggression with respect to Kuwait.   As American and allied forces moved into Iraq, many hawks wanted these forces to advance to Baghdad, and drive out Saddam Hussein.   As we all know, President Bush pulled us out as he did not feel this objective was part of the mission.   He knew when to get out. Now, physicians are not military strategists, but there are parallels between military strategy and patient care, particularly when a patient is hospitalized.   Consider the following schema.   The Conflict:   A patient arrives in the emergency room with a cough and a fever.   The Mission: Disease eradication The Tactics:   Hospitalization Exit Strategy:   Getting the patient out. Physicians, just like the generals in the Situation Room in the White House, need a sound battle plan.   The plan must be flexible enough to adapt to changing contingencies an

I am regularly asked by patients and others at what age should colonoscopies end.  Some patients inquire hoping that they are one year beyond the limit! Other physicians face similar inquiries with regard to Pap smears, mammograms and other routine preventive tests.   Turning the tables, I have even read opinion pieces asking if there should be a retirement age for physicians.   Commercial pilots have an upper age limit of age 65.   Should an octogenarian surgeon be allowed to operate on patients?   Federal judges have lifetime appointments.   Is the public well served by this?    There are at least two sides to this lifetime appointment policy. Some argue for aging out folks in order to rejuvenate the ranks.   This makes sense.   Others argue that any individual who is competent should be permitted to continue working regardless of age.   Why should we jettison folks with decades of valuable experience just because a certain age has been reached?   The issue becomes sticky whe

Some time ago, I saw a woman who traveled across state lines to see me to receive yet another GI opinion. She had been having daily gastrointestinal symptoms for a decade despite an exhaustive and repeated series of tests arranged by multiple different gastroenterologists.  Her symptoms remained unexplained and I suspected that they were unexplainable. I have seen many patients like this who suffer from chronic abdominal pain, nausea, bloating, bowel issues and other digestive complaints who have been evaluated by prior competent gastrointestinal specialists.   It is terribly frustrating when there is no explanatory diagnosis to explain the misery.   Sometimes these patients ask, ‘Am I crazy’?   Of course, they are quite sane.   Many common digestive symptoms simply don’t light up on our diagnostic tests.   Bloating and nausea, for example, are unlikely to be explained by a scope exam or a CAT scan or other studies. So, what should these suffering individuals do? So, what did I t

For most of my career, I was in a small private practice.  Our staff were like family.  We prided ourselves on providing highly personalized attention to our patients which started at the moment that the patient was greeted by our receptionist.  For a patient to enjoy an optimal medical experience, every member of the team needs to perform at a high level.  The doctor is but one member of a larger team.  Indeed, I have heard personally of patients who have left medical practices who liked the doctors but not the staffs.  Everyone counts. We saw patients who were self-referred or sent to us by referring doctors or by family members.  I have always asked every new patient how they came to see me personally, and I still do.  It is always gratifying when a patient is recommended to us by a medical professional or a family member.   You took care of my grandmother and she raves about you!   This not only feels good to the doctor, but the patient arrives already having confidence about the

A patient came to see me recently for a second opinion on an abnormal blood test result.  He was accompanied by his parents.  They had driven a considerable distance for this visit.  The patient’s mother announced at the outset of the visit that she had been assured that all of the relevant records had been transferred.   My forthcoming comment will shock neither patients nor medical professionals.   Nary a single page of records was anywhere in sight. This vignette illustrates two incredibly frustrating and recurrent realities. Medical records that referring offices promise they have sent me often never arrive.  They are dangling somewhere within a extraterrestrial black hole.   On a regular basis, conscientious patients see me in the office assuring me that they were told that their records have been forwarded.   They may have been forwarded somewhere, but all I know is I don’t have them.   This drives patients to a state of apoplexy, and I don’t blame them.    There are variat

My employer,  a rather large and well known medical behemoth based in Cleveland, recently announced that patients may be charged for medical advice solicited on the patient electronic portal.  This has generated an array of opinions ranging from accusations of corporate greed to defending physicians’ right to be compensated for practicing medicine. Implementing this new program violates the following reality of human nature. Folks will not support losing an established benefit.   Consider how organized labor reacts when management aims to reduce worker benefits.   How would any of us feel if our employer cut back our vacation allowance?     How might homeowners feel if their mortgage interest is no longer tax deductible?   You get my point.   Over the past few decades, I have provided thousands of hours of free medical care on the phone and electronically.   I never felt that I was being ripped off since this was the only system I knew and I accepted it.   Similarly, patients n