MD Whistleblower

 There’s an adage known to every medical student, intern, resident, and practicing physician. When you hear hoofbeats behind you, don't expect to see a zebra. This quote has been paraphrased into several iterations, but the quote is credited to Dr. Thomas Woodward in 1940.   Dr. Woodward, a wise medical professor and Nobel Prize nominee, offered his advice to medical interns.   The aphorism has timeless value. The point is for physicians to exhaust common explanations when confronting medical clues before broadening the exercise to contemplate rare potential diagnoses.    It is more likely that hoofbeats are made by a common horse than a more exotic hoofed beast.   Get it? Let me offer a brilliant quote.   Common things occur commonly.   If a patient sees his physician to evaluate a fever, it’s unlikely that the doctor will entertain malaria as a diagnostic consideration, even though fever is a hallmark of malaria.   Seasoned clinicians will widen their diagnostic view when

Recently, I stated that probiotics are marketed and sold free from the strict scrutiny of Food and Drug Administration  (FDA) oversight that our prescription drugs routinely undergo.  And this is just how these companies want it.  Trust me, if probiotics had to endure the same vetting process that actual drugs go through, most of them would be snuffed out along the way. Here’s a simplified glimpse of how the system works. Yo ho, hey hey, keep away from the FDA! Many probiotics are classified by the FDA as dietary supplements, rather than drugs.   Indeed, it is this classification that allows the industry to thrive.   The FDA regulates supplements much more leniently than they do conventional prescription drugs that must endure years of intensive vetting and successive clinical trials.  The drug approval process is so rigorous that most drug candidates will not reach the finish line.  The FDA maintains high standards for safety and efficacy.  However, b ecause probiotics are not drugs

Usually, we doctors give you advice.   In this case, I’d like readers to offer an opinion on an issue that patients and I face regularly. First, let’s acknowledge the huge reservoir of frustration and anger directed against insurance companies concerning their coverage decisions.   I have willingly entered this arena to wage battles for patients.   Despite my vigorous prosecutions of these contests, the outcomes have been variable.   Indeed, these competitions are not for the causal physician participant.   The doctor must have the mettle, determination, skill and endurance of a Navy SEAL if there is to be any prospect of success. Some of my prior duels against Big Pharma and Big Insurance are chronicled in the Pharmaceutical Quality category on this blog.   Considering many insurance company coverage actions and decisions, it is understandable that patients do not believe that these companies prioritize the health of their members.   Although it is understandable to demonize t

Let me test my readers to gauge how skillful you have become in choosing wisely in the Byzantine medical universe.  You develop abdominal pain and, although you are not a trained medical professional, you fear that you have appendicitis.  There are two surgeons available and you want to engage in due diligence to ascertain which physician should be granted access to your abdomen.   A quick internet search uncovers the following data. Surgeon A:  Twenty patients had proven appendicitis.  This surgeon operated on all of the patients.  No case of appendicitis was missed.  Surgeon B: Twenty patients had proven appendicitis.  This surgeon chose to operate on 18 patients.  Two cases of appendicitis were missed.   Before reading on, think to yourself which surgeon would you choose? While this is not a trick question, I wonder how many readers were entrapped to select Surgeon A.  Who wouldn’t choose a surgeon with a 100% track record?  I wouldn’t.  I’d place my belly under the

Advertisers are masters at knowing how certain words and phrases will affect us.  Consider some of the seemingly innocent words and phrases below and how they have an emotional impact. IRS Big Tech Police officers Corporate profits Millennials Congress The Nursing Profession. Over time we have been conditioned to experience emotional responses to various phrases and labels.   For instance, there is nothing intrinsically evil in businesses earning money since this is an expected and desirable outcome.   Yet, ask us to react to the term corporate profits and I suspect that most of our reactions would trend negatively.   It’s unlikely that a political candidate would proclaim in an ad or a speech that he or she wants to be a Champion of Corporate Profits! Private Equity certainly merits inclusion in the above list.   Most folks have an unfavorable opinion of PE even if they don’t fully understand this business model.   And some of the actions committed by PE justify sus

As a gastroenterologist (GI), I am regarded by primary care physicians and other medical professional as having special expertise in digestive diseases.  Indeed, I have highly specialized training in digestive maladies and function.  I regard myself as a GI generalist, that is a practitioner who treats the full array of digestive conditions.  Over the past decades, I have treated patients with diseases of the small and large bowel, stomach, and esophagus issues and pancreatic liver and gallbladder disorders.  And I have had a full endoscopy practice – the tools of the GI trade.  One of the appeals of being a GI Gen is that I see a wide and diverse span of medical conditions.  In a single week, I may address heartburn and ulcers. Crohn’s disease, hepatitis, bowel changes, internal bleeding, nausea and vomiting, abdominal pain, and hemorrhoids.  I enjoy the variety.   GI Generalists Cover a Lot of Ground! During most of my career, I seldom referred patients to other gastroenterologists

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