MD Whistleblower

Trust is the central element in our national motto.  Do you recall this 4-word phrase?  If you need a reminder of this iconic verbiage, just grab a coin or some paper money and you’ll find it there.  Perhaps, you can’t recall the motto.  Since we don’t study our money when making a transaction, our trustful motto may remain buried in the background – invisible while in plain sight.  I’ll bet that some curious readers are scanning a dollar bill right now!    As our trustful motto seems out of view, so has trust across society become much less visible.  When we do stumble across it, it can feel as if we have struck gold.  Years ago, for example, I wrote a post about a proprietor who showed me such a high level of trust that I memorialized the incident in this blog and will never forget the vignette.  The trust vacuum seems most evident in our political space.  The citizenry does not trust elective officials, particularly those of the opposing political party.  This phenomenon has sp

Since I started practicing medicine a few decades ago, I have been recertified every 2 years for Advanced Cardiac Life Support (ACLS).   Readers might not perceive any newsworthiness regarding this issue.  After all, I am a doctor and I should know how to respond to unexpected medical emergencies.  Except I have barely a clue. Yes, I pass the exam every other year.   The truth is that I do so because all of the institutions that I have worked for require this certification.   There must be a group of bureaucrats sequestered somewhere who decided that physicians should be ACLS certified, at least doctors like me.   But, as is so often true in life, mission creep sweeps in participants who should have been excluded in the effort.   The only moments that ACLS has my attention are those 2 hours every other year when I recertify. In between these episodes, I don’t read about it, dream about it and certainly never do it. Advanced life support is not simply a certification status – it’s

 I will share with readers a recent occurrence between me and another doctor that was both rare and refreshing.  I was serving as the gastrointestinal consultant on one of the doctor’s patients.  I performed a scope examination of the stomach and obtained some routine biopsy specimens.  The pathology results were abnormal, but benign.  No urgent action was needed, but a full airing of the significance of the results would require a conversation between me and the patient in an office visit.  I notified the patient that there was no medical threat at all and we would unpack it all during his next visit. The referring physician wondered about this delay, which perhaps is a different style from other gastroenterologists (GI’s) who he works with.   (My guess is that other GI’s may opt to handle the issue with the patient on the phone or via the portal. I think, however, that there’s too much complexity to fully address this issue in this manner.) So, here’s what the referring doctor did.

Here is a reality of human behavior.  Folks behave differently when they know they are being watched.  Consider two examples that we have all seen.  We are sitting in the driver’s seat of our parked car.  The driver in the adjacent car sees us and then opens his door with particular care so as to avoid dinging us. We wonder what his car door action might have been had our own car been empty.  Similarly, in most business scenarios, I suspect that the staff perform at a higher level when the boss is around. This phenomenon is referred to as the Hawthorne Effect, whose name derives from some industrial research done in the Hawthorne suburb of Chicago nearly a century ago. Do you behave the same way when someone's watching? And yes, this truth exists also in the medical profession. Consider the following proposed studies and if the results might be distorted by the Hawthorne Effect. The Chairman of the Department of Surgery announces an initiative to improve patient satisfactio

 Now that I am employed by a colossal medical center whose reach extends internationally, many patients land on my schedule seeking a 2 nd , 3 rd or even a 4 th opinion on recalcitrant and unexplained digestive issues. Many of these patients travel from neighboring states coming with the hope that yet another gastroenterologist will crack the code of their illness.  Obviously, any patient who seeks another medical opinion is already dissatisfied, hence the reason for seeking additional advice..  Here is a sampling of some reasons why patients solicit or are sent for new medical opinions. Persistent symptoms Search for an explanatory diagnosis for unexplained symptoms. Quality check to verify that the original doctor’s advice is correct. Encouragement of family or close friends to seek another opinion. Dissatisfaction with the doctor’s bedside manner. Friction with the office staff or the billing personnel. Office schedule of original doctor is booked out for months. Fear that a ser

One of the conundrums in medical practice is to determine if a medication is causing a side effect.  Sometimes, this issue is very straightforward.  A new medicine is prescribed.  Three days later, the patient develops a new symptom of constipation.  The medicine is stopped and the bowel pattern normalizes.  Most of us would agree that the evidence that the medicine was responsible for the bowel change is beyond a reasonable doubt. The above is a textbook example of a side effect, but alas, patients often have not read the textbook.   Consider a patient having diarrhea from colitis.   The gastroenterologist prescribes an appropriate medication.   Two weeks later, the patient contacts the doctor to report that his diarrhea has worsened.   Although diarrhea is among the long list of potential side effects of the medicine, might the increased diarrhea simply be from his underlying colitis? It's 'alimentary', my dear Watson! I have seen many examples of patients who come to

I have penned a few posts recently illustrating the difficulties in measuring medical quality.  Indeed there's a category on this blog entitled, Medical Quality, ready for your perusal. How do we measure something that is very difficult to measure?   Why is a painting hanging in a museum considered to be a masterpiece while others – which appear quite similar to most of us – are relegated to a much lower status?    And art experts may not agree on these designations! I have already performed approaching 50,000 colonoscopies in my career, and my colonoscopy counter notches more of these each week.   This is my gift to humanity.   Quite often, I am stopped in a store or on the street by a grateful recipient of one of my probing endeavors.   Clearly, patients regard the event as a bonding experience. Found this in a garage sale.  Worth anything? But how do they or anyone know if I am any good?   How do you assess the quality of a proceduralist? It sounds easy enough, except that