MD Whistleblower

For most of my life, there has been a tipping disorder in this country.  Too many of us were undertipping those who served us and depended upon tips for their livelihoods.   At times, servers in restaurants would be fully stiffed, or received a paltry tip when they deserved more.  In general terms, increasing a tip from 15 to 20% means much more to the server than it does to the patron. Other occupations such has hotel workers, airport porters, cab drivers, tour guides, bartenders, valets and food deliverers – to name a few – depend upon the generosity of their customers.   Traditionally, a tip was a reward for good service.   Indeed, this provided an incentive for workers to perform well.   Better service led to better tips. We now have an entirely new strain of tip dysfunction in this country.   Tipping is no longer tied to service and has become an expected surcharge from classes of workers who heretofore would never have been eligible for a tip.   A few years ago, would a tip

I have not personally suffered an addiction and I have no expertise in addiction medicine.   But I have treated large numbers of individuals with gastrointestinal issues who also are in the midst of an addiction or are recovering from this illness.   I have tremendous admiration for a person who has – with the help of professionals – unshackled himself from the suffocating tentacles of addiction.   As I have not faced this challenge,   I cannot begin to contemplate the journey. This nation has not settled on a coherent strategy to battle this plague.   Is it a medical issue?   Is it a law enforcement issue?   Which treatments are evidence based?     Should insurance coverage for treatment be required as are other benefits such as preventive care?   Can treatment be compelled on an unwilling addict?   I read a poignant opinion piece recently in The New York Times by David Sheff whose son ultimately prevailed against his addiction.   The article refers to a study that concluded that

We live in an era now when workers have leverage over their employers.  Nearly every establishment is struggling to hire employees.  It’s mysterious, not only why so many folks have chosen not to return to work, but also how they are paying their living expenses.   Remote work, particularly for younger workers, has become a non-negotiable red line.  If you are an employer who expects full time in person presence, then good luck finding willing candidates.  Telemedicine has also permeated the medical profession.   Ten years ago, physicians would have howled that there could never be a replacement to the in person visit when doctors could read body language and engage in the age-old hands-on physical examination.   That was then.   Now, many physicians prefer to offer virtual care and many patients demand it. I’ve given up virtual visits, but not for the reasons that you may think. During the early months of the pandemic, when I first entered the virtual visit arena, I found the ex

Studies consistently show that more than half of American physicians are suffering symptoms of burnout.  Consider that astonishing statistic.  What if half the country or half of your own profession were suffering from a disease?  Wouldn’t you expect- or demand - that every available resource be devoted to crush it and rescue the afflicted? Is the medical profession and society at large attacking the physician burnout plague?   Not as I see it.   Indeed, the statistics are all trending in the wrong direction. Physicians and their families, their employers, other medical professionals, the government, and the public are all aware of this epidemic.   I often read expressions of deep concern for doctors’ plight, but the concern is not a treatment. We know the various forces and pressures that are pushing doctors toward the precipice.   There’s no mystery here.   Yet, why won’t anyone pull these doctors back from the edge? What are we waiting for?   A burnout pandemic? We have to put thi

I have never served in the armed forces, but I have enormous respect for our veterans and for those  who serve now.  My father served for 39 months during World War II.  Fortunately, he was not placed in harm's way.  During that era, nearly every young male served joining together in an existential conflict between good and evil.  This experience bound the entire nation together in a shared purpose with shared sacrifice.   Our nation so desperately needs an experience that will transcend our divisions to unite us as Americans.  Is there a moonshot out there that we could all rally behind?   Is there a leader in sight who can bring us together?  What if we could agree on our country's top 3 goals and then join forces to achieve them? Hey wait, I have an idea.  What if a deadly pandemic swept across the nation that could have the potential of causing over a million fatalities?  Facing this common enemy, we would surely become united against a deadly foe that was striking wildly w

We all have taken lessons from the pandemic. There were many things we got right, particularly the development and administration of safe and effective vaccines.  There was also much we got wrong including inaccurate and contradictory information from government agencies and keeping kids out of school long after the data supported a return to in person learning.  And while I am not a public health expert, I still wonder about the wisdom of having imposed restrictions and mitigating measures on all of us rather than focus more narrowly on at risk folks.  I realize that this is a controversial issue as there was the fear that low-risk individuals could transmit the virus to a vulnerable recipient.  The mortality and morbidity in elderly infected people were quite different from that of younger and sturdier individuals.  Public health experts argued that we needed a broad brush to protect more people. Coronavirus Caused Illness, Death, Anger and Division Protecting public health should

Sometimes, we read about a study result that is widely publicized, yet we are reluctant to accept its absurd conclusions.   I’m sure there are studies buried somewhere that conclude that seat belts and bicycle helmets are dangerous and that cigarettes prolong life.   If such studies do exist, they would face mountains of contrary scientific evidence.  In other examples, a medical study’s conclusions may be false or misleading because the data are improperly or inadequately interpreted.   Consider this hypothetical study.  One hundred patients with rheumatoid arthritis (RA) patients and 100 control patients are questioned about their exercise habits.  Ten percent of RA patients exercise regularly in comparison to 40% of the control group.   The authors than conclude that exercise might protect against the development of RA.  There are many scientific reasons why this conclusion is erroneous including the probability that RA patients don’t exercise as much because they have arthritis.