MD Whistleblower

I am a gastroenterologist.  Like most medical specialists, most of the patients I see are referred to me by other medical professionals.  In this role, I am serving as a consultant.  Similarly, when a specialist is asked to see a hospitalized patient by the attending physician, the requested doctor will be serving in a consultant role. Consultants are recruited when the medical team or an individual practitioner feels that additional knowledge and experience is necessary.   Consider three hypothetical scenarios. A patient has not responded to a standard course of antibiotics.   The attending physician asks an infectious disease physician to make recommendations. A primary care physician is uncertain if the abnormal chest x-ray is heart failure or pneumonia.   The doctor calls in a cardiologist to assist. A patient with colitis comes to an emergency room with worsening diarrhea after starting a new medicine.   The ER physician is uncertain if the patient’s diarrhea is a side-eff

Many of my patients are using medical or recreational marijuana to ease symptoms that do not respond well to conventional medical treatments. I understand this.  I have already opined on this blog that I believe that the medical evidence supporting the safety and efficacy of medical marijuana is rather thin, very different from the strict standards that the Food and Drug Administration (FDA) relies upon in assessing prescription drugs and medical devices.  Moreover, here in Ohio and elsewhere, our legislature is deeply involved in determining which medical conditions are eligible for medical marijuana treatment, a role that I believe should be handled exclusively by medical professionals and appropriate federal government agencies, such as the FDA.  Politicians should leave this to the professionals. How can you argue otherwise? I am employed by Cleveland’s largest health care organization which has national and international reach.   The organization will not permit any caregiver t

When I was training to become a gastroenterologist decades ago, the heartburn drug Prilosec (omeprazole) was released in the United States.  I prescribed it then to patients who had been suffering from heartburn for most of their lives.  After just days of treatment, their heartburn disappeared.  These folks couldn’t even remember what it felt like to live without heartburn.  And suddenly, they were cured with one small pill daily.  Now I know that heartburn is not exactly cancer, but this experience very early in my career showed me the potential for a pharmaceutical agent to improve lives.   I still relay this vignette to patients. Pharma is not the enemy. Think of all of the institutions and professions that we and our politicians demonize -   lawyers, oil companies, congress, corporate America, Big Tech and the pharmaceutical industry.   Recently, Ivy League universities have been promoted to a top ten ranking on this coveted list.   On a granular level, even individuals routin

One thing we have all learned about technology is that it cannot be restrained.  With the release of ChatGPT and various competitors, we are aware that an unfathomable technology will disrupt our lives in ways beyond our imagination.  In the coming years 2 nd and 3 rd generation AI will replace its forerunners. My guess is that this technology will dwarf the impact that the internet has had on all of us.  It will be able to create and cure and innovate and communicate and build and teach and protect and even drive your car.   As mentioned, future AI functions and capabilities are beyond the horizon and are out of view. Exciting?   What if your job would be an AI casualty?    It you drive a vehicle for a living, how will you and your family adapt when human drivers are no longer necessary?   Even jobs and occupations that we might believe are beyond AI’s grasp, may be in the crosshairs.   AI’s reach will be boundless.   It’s tentacles will reach through blue collar America and wil

Each work day, I enter the chamber of horrors also known as the electronic medical record (EMR).  I’ve endured several versions of this torture over the years, monstrosities that were designed more to appeal to the needs of billers and coders than physicians. Make sense? I will admit that my current EMR, called Epic, is more physician-friendly than prior competitors, but it remains a formidable adversary.  And it’s not a fair fight.  You might be a great chess player, but odds are that you will not vanquish a computer adversary armed with artificial intelligence. I have a competitive advantage over many other physician contestants in the battle of Man vs Machine.   I can type well and can do so while maintaining eye contact with the patient.   You must think I am a magician or a savant.   While this may be true, the birth of my advanced digital skills started decades ago.   (As an aside, digital competence is essential for gastroenterologists.) During college, I worked as a secretary

‘Twas the night before Christmas And all through the night, Biden's pet puppies Were ready to bite!   The Dems will run Biden GOP will have Trump While most of the nation Want both of them dumped!   Biden's their man. The race is but done, Yet most of his party Don’t want him to run. Biden is fit! His mind is so keen, Part of his charm? His gaffe-making machine!     Trump is in charge. His nomination can’t fail. But will he be running From a federal jail?     The country’s divided Will this be our fate? Who needs peace and love When we’re nourished by hate?   McCarthy was in. McCarthy was out. Santos was in. Now Santos is out!   With a few civil trials, And 91 counts Trump's polling goes up And his legal bills mount.   The best news for Trump That fits well with his style Was the political gift Of criminal trials!   GOP in the House In search of a speaker, Thumbs down on Jim Jordan

A fundamental skill that physicians rely on is calculating risk/benefit analyses when we advise patients.  My use of the word ‘calculating’ is a misnomer as there is no reliable scientific method to quantify risk and benefit.  Indeed, different physicians might ‘calculate’ such an analysis differently.  Similarly, different patients in the same medical circumstances might gauge the potential medical benefit differently.  This is not hard science.  Some folks might feel that a 5% risk of a major complication is acceptable, while others would balk at this statistic.   And on the benefit side, is it worth taking a medication that has some risk with the hope that it might shave 1 day off of a 7 day illness?   Despite that risk/benefit analyses are not easily quantified, physicians and patients must enter into a dialogue on this issue when a treatment or a test is being proposed.   The participants have to do their best to tease through the issues. If a 25-year-old athlete develops ac