MD Whistleblower

The nation celebrates Labor Day on the morrow.  This holiday was created in the later part of the nineteenth century in response to immoral and abusive conditions for workers.  In that era, 12 hours shifts, 7 day workweeks and child labor were all routine.  Organized labor expanded over the ensuing decades leading to legislative and societal guardrails protecting workers from abuse and exploitation. Despite continued reforms of the workplace and fairer treatment of workers, tensions remain between management and labor.  At this very moment, the United Auto Workers has overwhelming authorized a strike in the event that union leaders decide that this is necessary. A typical Labor Day scene While this holiday has deep roots in organized labor, keep in mind that most American workers are non-union, and their work should be honored as well. Regrettably, but understandably, the true meaning of Labor Day and many other federal holidays is not top of mind for most Americans.  These commemorati

Years from now, the notion of simple telemedicine will seem quaint.  Keep in mind that as recently as a decade ago, most physicians would have denied that telemedicine could ever play a role in the medical profession. Physicians would have argued that this would dismantle the fundamental unit of medical care – the in-person office visit. Physicians would have rigidly maintained that they had to be face-to-face with their patients.   Doctors would need to observe their demeanor and body language and other non-verbal signals.   The physician would need to perform a physical examination to discover additional clues that might help to explain the patient’s symptoms.   Indeed, medical professionals and others have expressed that the act of touching itself served as a bonding experience between patients and their doctors.   The very definition of ‘bedside manners’ implies that the patient and physician are in the same location. Today, there are physicians who practice telemedicine exclus

When we are purchasing a product or a service, the marketplace offers us many choices.  Competing wares may have different quality and cost levels.  We experience this if we are renting a car, booking a hotel, hiring an attorney, selecting a restaurant or buying a musical instrument.  All guitars, for example, are not equal. When we decide to purchase at a certain quality and price point, we must accept the realities of this transaction.  We should not purchase a Chevy, for example, and expect a Cadillac experience.   I realize that price and quality may not follow a linear path.   Just because something costs more doesn’t mean it’s better.   There are wrinkles in the marketplace.   Budget hotels, for example, often provide guests with free breakfast free parking and free wifi while high end stodgy hotels gouge guests with resort fees (please explain to me what this is), insane parking charges and crazy minibar prices on top of their exorbitant room rates.   The task is to match

If we ever manage to tame Over-diagnosis and Over-treatment – the twin threats to medical reform - many players in the medical universe would find their status - and their livelihoods- downgraded to critical condition.   Let me offer a single sentence that points out the herculean challenge facing reformers. One man’s wasteful medical spending is another man’s income.  You Need the Strength of Hercules to Reform Health Care The system is riddled with conflicts of interest where various economic interests collide with our health interests. Here are three hypothetical examples to illustrate my point.    Political progressives clamor to sharply reduce drug prices to make them affordable for all Americans.   The pharmaceutical industry uses all means necessary to resist this.   Of course, making all drugs affordable would crush the drug companies economically.   They argue that such a draconian approach would stifle research, development, and innovation.   Why

Over the past few months, I’ve written enough posts on Medical Burnout that I have created a new category to house them.  Readers will find there posts detailing the causes and consequences of burnout in the medical profession. The profession has been long on the causes but short on solutions.   What must be done to loosen the burnout shackles from medical professionals? It will be a huge undertaking for caregivers and society at large to turn this ocean liner around.  And it will take time.  The first step must be to obtain a commitment to the overall mission from as many constituents as possible.   Support will be needed from medical professionals, hospital leadership and administrators, physician employers, insurance companies and the public.   As with many reform efforts, many of the players must be willing to sacrifice some of their own interests in order to server the greater good – a worthy and rare event.   Without adequate buy-in from stakeholders, the effort will never ge

To succeed is to struggle.  Indeed, up to now, an accomplishment was the result of sweat, study, setbacks, discipline, collaboration and hopefully triumph.   Of course, the latter result is never guaranteed which makes this outcome so much more satisfying.  This process of struggling for success is well known to athletes, musicians, scientists, students, writers, chefs, farmers and many others.  All of us go through the same process in more mundane pursuits such as doing a crossword puzzle, learning a new language, testing out a new recipe or reaching a new goal in our exercise routine. I recall a very small personal struggle I engaged with during my internship and residency days decades ago.   Every patient that physicians-in-training cared for had x-ray studies done.   Checking the results was one of the myriad tasks that fell to interns and medical residents.   Not only was this important medical data, but we wanted to be prepared with the result just in case any of our superiors

Over the past several years, there has been an important change in how diverticulitis is treated.  This topic sentence may seem out of place on this blog which is largely a site for commentary.  This is not a site that discusses medical breakthroughs on the treatment of constipation or heartburn.  But diverticulitis does offer a commentary angle, if you will read further. Decades of teaching and dogma have informed the medical profession that diverticulitis is a localized infection of the colon.   Diverticula, or pouches, are weak points in the large bowel.   If a tiny puncture develops at one of these sites, some stool can leak out contaminating the sterile abdominal cavity.   A n infection develops which, of course, needs to be treated with antibiotics. Indeed, for most of my medical career, every case of diverticulitis I encountered was treated with antibiotics.   In most cases, these patients recovered fully.   This observation may be Truth #1.   Just because a patient recove