MD Whistleblower

A federal judge in Texas recently issued a ruling that would ban mifepristone by nullifying the Food and Drug Administration’s original approval of this medicine, which occurred 23 years ago. Mifepristone is one of two drugs that are used for medical abortions.  If this decision is ultimately upheld, it would ban this FDA approved drug throughout the country. Ironically, on the very same day, another federal judge in Washington state issued a contradictory ruling that would protect mifepristone’s status as an approved medicine.  An appellate court ruled a few days later that mifepristone's approved status remained valid, although prior restrictions on its use would be resumed.  This past Friday, the Supreme Court gave mifepristone a 5 day reprieve giving time for both sides to submit briefs days from now.   Will the Supreme Court deliver peace in the valley?   Not at all.   We have all painfully learned since the Roe v Wade decision of 1973 that a judicial determination may not

I have been a conservative medical practitioner since my training days decades ago.  As readers of this blog have read (?endured) repeatedly, I am very hostile to over-diagnosis and overtreatment.  While I don’t have data, my strong sense is that I order fewer scans, offer fewer prescriptions and order fewer lab studies than my peers.  I am not suggesting that my approach is the optimal pathway to medical quality, only that it has always defined my medical comfort zone.  My philosophy can be summarized as less is more . Patients have their own medical philosophies and over time tend to link up with medical professionals who share their approach.  Some patients laud physicians who test them liberally regarding these doctors to be very thorough and conscientious.  “My doctor is so thorough, on my first visit he ordered blood work, a CAT scan and is sending me to 2 specialists!”  Patients who prefer a more measured and conservative approach seek likeminded doctors.  When the patient an

There is an epidemic of burnout in this country.  Many professions are targeted.  Ask a teacher, a police officer, a politician or even your mailman about the increasing burdens that have been foisted upon them, and be prepared to hear frustrating and demoralizing responses.  The burnout malady has hit the medical profession hard and is reaching down the age ladder toward younger medical professionals. While my generation didn’t create burnout by intention, it does seem that we have permitted and even facilitated its proliferation.   Why have we done this?   What are the consequences?   How can we push back? Using a medical analogy, it’s often much easier to diagnosis an affliction than it is to treat it.   For instance, physicians routinely and reliably diagnose degenerative arthritis, but we can’t cure it and often our treatments are inadequate.   So, it is with burnout, particularly once it has become firmly established in our occupational landscape. The better strategy, of co

There are two ways to sedate patients for colonoscopy.  There is conscious sedation is when the gastroenterologist administers a ‘twilight sedation’, or moderate sedation when sedation is administered by an anesthesia professional, usually with propofol, a drug now known to most of us as  a contributor to the death of pop superstar Michael Jackson. Most Patients Prefer Propofol over the Twilight Zone Leaving issues of cost aside, most individuals involved in the colonoscopy experience prefers the propofol option.  Here’s why. The drug is extremely safe when administered by trained personnel, who in most cases are Certified Registered Nurse Anesthetists (CRNAs). Unlike with twilight anesthesia, the procedure is entirely painless.  Patients can expect to experience the same level of discomfort as they do with a haircut. Knowing that they face complete comfort during the procedure, patients are relieved of anxiety that often precedes the procedure for several da

My great pal Lewis, with whom I have shared a friendship for over half a century, have much in common professionally.   Is he also a gastroenterologist?    A physician?   A nurse?   Actually, he is a tax attorney.   So, where’s the commonality?   Could it be that my patients and his adversaries both feel that they are being ‘instrumented’?    While I suspect that this may be true, it is a different aspect of our respective professions that binds us. Lewis’s clients and my patients need to grapple with and accept uncertainty.   I find the parallels here to be striking and I’ll do my best to illustrate. Legal Uncertainty The client brings an issue to his attorney seeking a legal remedy or an opinion.    Let us assume a corporation wants to know if a particular expense can be legally considered a tax deduction.   The experienced tax attorney responds, after careful thought and deliberation (yes, the time clock is ticking!), that he is 75% certain that the proposed de

There are two ways to increase a quality rating of a process.  The old-fashioned way to work and study and practice and seek assistance and practice again and fail and regroup and ultimately objectively increase performance. Here are a few examples of this technique. A basketball player works with a coach and increases his foul shot success rate by 15%. A new medicine increases the cure rate of a disease by 40%. An engineering team invents a cell phone battery that has 5x the storage of current batteries. There is another way to increase quality ratings that has become quite common.  Lower the standards or game the system.  Here are some examples to illustrate. Lower academic standards in order to increase a high school's can graduation rate. Lower the income threshold of poverty so we can boast that there are fewer impoverished people in our communities. A surgeon's outcome stats rise markedly when he declines to accept very ill patients. So, if you are trying

Why are millions of Americans actively seeking out complementary medicine?   The lack of robust supportive evidence for many of these treatments has not diminished their appeal.   Indeed, demand for them is higher than ever and I anticipate continued growth.   Here in Ohio, the legislature has sanctioned medical marijuana for nearly 2 dozen maladies in the absence of persuasive and sound scientific evidence of efficacy.   For my rant on this, I will refer you to a prior post and I would welcome your response. Why then do intelligent and informed patients seek out alternative medical treatments that are unproven and are unlikely to be covered by their insurance companies?    In most cases, they do so because conventional medicine has failed and frustrated them.   Every medical specialist and general physician sees patients with recalcitrant medical issues that defy diagnosis and successful treatment.   Is it any wonder why such patients would seek other avenues for relief and under