MD Whistleblower

Folks must think than all doctors know all things medical.  I know this is true by the questions that I have been asked over the years.  While my expertise spans hemorrhoids to heartburn, I am routinely queried on medical issues well beyond the specialty of gastroenterology.  When I can’t answer questions about a new medicine for hypertension or if an MRI of the shoulder makes sense, folks look at me quizzically as if I must not be a real doctor. Today, more than ever, physicians are highly specialized with a very narrow medical niche.  There are ophthalmologists, for example, who only treat retinal disease.   Perhaps, there are even retinal specialists for the left eye only.   It wouldn’t surprise me.  My partners and I perform routine gastroenterology procedures in an ambulatory surgery center.   Patient safety is our priority and our staff and us are dedicated to this mission.  All of us are required to be certified in Advanced Cardiac Life Support in the unlikely event th

A few weeks back, a drug rep, aka a pharmaceutical representative, came to the office hawking a new constipation medicine.  These guys are in a tough racket.  They need to sell products that we physicians are often unable to prescribe.  It’s the Formulary, Stupid. The Best Disinfectant In the olden days, before I entered the hallowed halls of healing, pharm reps, or drug detailers, developed relationships with physicians who would then prescribe their drugs.  Physicians to this day deny the incontrovertible truth that we are influenced by pharmaceutical company marketing techniques, which still feature face time between sales folks and prescribing physicians.  These days, many of the sales tools used years ago have been properly prohibited.  Physicians cannot be flown to exotic locales and paid big bucks so they can serve as ‘expert consultants’ who will be subjected to push polling on the new pharmaceutical product.  (Why didn’t any company ever ask me to serve as an ‘exp

I’ve posted a piece on this blog on the issue of faith and reason in healing. Indeed, the protagonist of that post is an inspirational figure, a selfless man who exudes grace and humility. I was honored that the post was shared with many Catholic clergy who appreciated my heartfelt words for one of their own. Faith and reason reentered my medical universe recently. A patient underwent surgery to resect a colon cancer. The tumor had metastasized to the lymph nodes, an unfavorable prognostic event. The surgeon entered the room and advised the patient that her survival is likely limited to 1-2 years. The patient and her husband were devastated. The distraught husband spent the next 24 hours sobbing in a painful and despondent state. He related the tragic news to his 3 children, ages 3, 5 and 8. Was this the appropriate time for the physician to relay such ominous news to a patient and family? Was it prudent for the overcome husband to share this traumatic news with his 3 young ch

I’ve had two jobs since I completed a fellowship is gastroenterology over 20 years ago. For the first decade, I was a salaried physician. Afterwards, I promoted myself to private practice. Each model has its advantages and drawbacks , but for me the private practice model wins out. The climate in Cleveland is extremely inhospitable to private practice, because of two mega-medical institutions that incinerate private practices as their boiling lava flows across the region. So far, our practice is still viable, but the prospects for its long term health and welfare are questionable. One of the advantages of working for a straight salary is that income dies not depend upon productivity. (My employer maintained that we had a productivity bonus, but in reality there wasn’t much the physicians could do to adjust their salaries in either direction.) One of the disadvantages of private practice, particularly where I practice, is the need to hustle aggressively for patients, a task I neithe

Electronic medical records (EMR) were supposed to rewire the medical grid.  It would increase efficiency, reduce redundancy, improve quality and reduce costs.  On  these measures I offer a grade of 0 for 4.  Ask any practicing doctor how EMR has impacted on his practice and be prepared for some remarks that differ from the government’s Kool Aid talking points.  EMR, thus far, hasn’t been ball bearings for the system.  More often, it gums up the works. The EMR Maze - Enjoy! The government spent billions of dollars with cash payments  to induce hospitals and doctors like me to jump on board the EMR express.  The Rand Corporation helped to fuel this euphoria in 2005 when it predicted exaggerated benefits of EMR.   By the way, this study was financed in part by EMR companies whom, I politely suggest, had a vested interest in the study’s conclusion.  Rand denies that they were unduly influenced by their backers, and I don’t claim that they caved on their principles.  Nevertheles

I saw an elderly patient a few months back for a gastrointestinal issue that fortunately led to a benign outcome.  He was a modest man who spoke softly and used few words.  As has been my custom for as long as I’ve sat across patients, I was interested to learn something of the man beyond the issue that brought him to see me.  Indeed, it is these vignettes that I regard as the gems of my practice.  Without them, I would be left only with the practice of medicine, and this would not be sufficient. He wore a military baseball style cap, emblazoned with a U.S.M.C. label.  To those who do not immediately recognize what these letters stand for, then I suggest that you apply to medical school, become a physician, see patients so you also will have the opportunity to learn stuff that really matters. I learned that he served in the Pacific theater in World War II and asked him about his service there.  While my father served in the war for 39 months, he remained in the United States,

There is a steady push to change the way that physicians are paid.  No compensation model is ideal.  The fee-for-service (FFS) model has become Public Enemy #1 as it is felt to be responsible for overtreatment generating excessive costs and utilization.   Salaried physicians may be freed from the FFS conflict of interest, but it has other drawbacks including a diminished incentive to provide exemplary service to patients and to referring physicians.  Since physicians did not initiate compensation and health care reform decades ago when we should have, we are now being squeezed hard by external forces that will overcorrect on the system’s deficiencies.  It’s always better to fix your own house.  There should be a lesson here for other professions who are in need of some reform and repair.  Teachers, in my view, were dragged into the education reform arena, and will suffer because of it.  Attorneys have been smug and cavalier about the legal profession’s obscene excesses and I believe

Last week, I posted on whether physicians should modify their medical advice in response to patients who cannot afford the recommended care.  A hypothetical patient was presented who had no medical insurance.  The clinical particulars suggested that a CAT scan of the abdomen was the ideal diagnostic test, but the patient would not be able to afford this.  I, therefore, offered readers several choices of medical advice, some of which was tailored to the patient’s financial situation.  Here’s my view.    While there is very little in medicine or the world which should be absolute, medical advice must remain pure.   It should depend only upon the physician’s best medical judgment regardless of the patient’s financial situation.    A millionaire and a pauper who present to the doctor with an identical medical issue should receive the same medical recommendation.   Yes, I realize that patients are not interchangeable and that there are cultural, personality and religious differenc

I treat uninsured patients and insured folks who face high deductibles who are under financial strain because of the sagging economy and other personal pressures.   These folks need care that may be unaffordable.   Medical diagnostic testing is expensive.   Even routine laboratory testing can be very costly as those without insurance may be forced to pay the ‘retail cost’, which is quite different from insurance company discounted pricing.   This absurdity is often seen in the emergency room where an uninsured patient can be billed thousands of dollars compared to an insured person who has received identical medical care whose insurance company will pay a fraction of this amount.   Crazy. Because I am a human being, I try to be sensitive to my patients’ financial concerns.   Does the uninsured patient before me really need a CAT scan or a colonoscopy?  Couldn’t we just watch and wait for a week or two and spare him from the expense? Consider this scenario.   A 50-year-old

My personal paradox is that I have railed against the intrusion and dehumanization of technology, and yet I am tethered to my iPhone.   Do I feel differently when it’s my technology and not someone else’s?  I hope not or I might be forced to add hypocrisy to my list of flaws.  I’ll have to monitor myself in a fair and balanced manner.  Will I conclude that my phone call while at a restaurant is of monumental importance while another patron’s phone use is a selfish and unforgivable threat to world peace that should be prosecuted?  Purple Heart - Read on... This morning, I was halfway to work when I felt for the phone in the inside pocket of my jacket.  Not there.  I palpated other pockets none of which contained the desired item.  The car seat was bare.   I did not fear the most dreaded explanation, that being that the phone was mistakenly left in Starbucks and purloined by a Frappuccino felon.    As a U-turn seemed hazardous on the highway, I took the next exit and heade

Over the course of a year, I have an alternating pattern of caffeinated coffee ingestion.   As readers should know, I will not swallow Starbucks ‘Joe’ as I do not think that I have sufficient stomach acid and other bodily defenses to successful prevail against this corrosive elixir. Of course, everything has a benefit if one is resourceful enough to discover it.  For instance, I have found their coffee to be quite useful as a paint remover or shark repellent.  The best coffee in Cleveland is found at Dunkin’ Donuts (DD).  Perhaps, one of the reasons their java is so smooth is that my order of coffee with cream is mixed at a 1 to 1 ratio.  Cream at DD is no half and half concoction; it’s the real thing. As I write this, there is an environmentally unfriendly Styrofoam cup beside me. I’ll down this coffee every day for weeks reaching a point where if I skip a day, I will enjoy the pleasure of an ice-pick, throbbing headache at 4 pm.  It’s a pounder that stays with me for 3 hou

It’s morning and I’m imbibing a beverage that has no nutritive value.  I only hope it won’t cause me harm, as it’s a beverage that slides down my gullet with regularity.  Of course, today’s poison may be tomorrow’s panacea.  This is one of the amusing ironies in the medical arena.  Every 10 years or so, it seems that what was felt to be medical dogma gets tossed out by a new set of studies, which will be reversed a decade later.    Remember when every peri-menopausal woman was advised in the strongest terms to take hormone replacement to protect her bones?  That was then... As to our diet, these recommendations are also subject periodic mutations.  Butter in.  Butter out. I am presently planted in what can safely be regarded as a fast food establishment, where in a single meal, one can exceed his daily caloric need.   With my fidelity to personal responsibility, I don’t blame the establishment for the free choices that its patrons make.   Some years ago, Burger King (BK) w

I have enormous respect for the military who have suffered the highest costs of protecting the freedoms that we often take for granted.  I have never served, but these men and women serve me and the rest of us every day. The Whistleblower blog is not an anonymous samizdat, such as was present in the former USSR.  I criticize the president openly under my own name.  Those who challenge governments in other countries risk imprisonment or worse. To those who protect our freedoms to write, speak, assemble, pray and criticize our leaders, please accept our collective endless gratitude, knowing that it will never be sufficient for what you have done and will do for us.

Yes.  Professions that heretofore enjoyed public admiration for pursuing noble work and reputedly insisting on the highest ethical standards have been exposed.  The Catholic Church could write a few blog posts on this.   Police officers, journalists and even teachers have also shown us that they are members of the human species and are subject to its weaknesses and frailties. George Washington Cannot Tell a Lie The fallacy is to expect certain professions and professionals to be more irreproachable than the rest of us.  We are all vulnerable to experiencing a fall from grace.  Staying straight and true is a struggle, at least for me.  Yes, physicians lie.  Sometimes, we rationalize a falsehood because it serves a patient’s interest.  We 'adjust' a diagnosis so that the medical test is covered by insurance.  Explain to me please why this is not stealing?  Is this different than shoplifting?   Why should the offense change depending upon who the victim is?   Many

I’m all for enhancing patient safety.  Count me in on reducing medical errors.  I acknowledge that medical mistakes harm patients and many can be prevented.  The medical profession should promulgate and support any initiative that accomplishes these objectives. The public has become suspicious of the medical community who seem to circle the wagons when external scrutiny of its actions is threatened.  Yes, sunlight is the best disinfectant, but many of these shining lights are murky shadows that do not illuminate as intended. Murky Sunlight Copyright Christopher Down The government and insurance companies are now providing financial penalties if certain medical quality benchmarks are not met.  While this sounds attractive and overdue when it is expressed in a headline or a slogan, the true motivations and capability of these efforts have been questioned.  Is it really about safety?  I have tried to expose throughout this blog the fallacy that the medical malpractice syst

This past week, I had a once-in-a-career event.  Indeed, if I didn’t already author a blog, this episode would have been the catalyst to begin one.   As I write this, I am not certain which category label to assign to this post.  I will likely include it in General Whistleblowing rather than create a new category called Search and Rescue. Gastroenterologists are not just healers of the alimentary canal.  Yes, we are consumed with issues of mastication, salivation, rumination, trituration (GI power word), secretion, digestion, propulsion and elimination.  But, we are so much more than this.  We are poised to serve humanity in so many ways beyond medicine.    The colonoscope is mankind’s Holy Grail.  Please study the photograph below carefully.  When we were medical students peering at a chest x-ray while the attending physician hovered behind us, we were told that “the answer is on the film”.  Of course, we always missed the diagnosis.  We would focus on the heart and lung

I attended a medical staff meeting recently.  These are required meetings and attendance is taken, as was done when we were in kindergarten.   While some folks are interested in these meetings’ content, many are not and simply sign the attendance sheet and then slither out in a stealth fashion.   Sly doctors grab their pagers and then leave hurriedly pretending that they were summoned to an urgent medical situation, when they are actually heading for Starbucks.   One of the community hospitals I attend initiated a dastardly procedure when administrators would not post the attendance sign-in sheet until the conclusion of the medical staff meeting.   Under the threat of picketing, a massive walk out, letters to the local paper and other unspecified measures, the evil decree was rescinded. Who says that physicians have no power today? Sadly, most of these meetings have nothing to do with making us better doctors.  The agendas are full of medical coding and billing issues. Hospit

Ohio Stands With Boston I called my son, a Tufts sophomore, hours after the Boston bombs exploded.  I already knew that he was ok, but a horror in your own neighborhood reaches deep into your gut, as I learned when senseless evil descended upon the small town of Chardon, Ohio a few years ago. I couldn't reach him on his cell phone.  Later, he explained that cell phone coverage was blocked in order to prevent a phone from being used as a detonator.  This seemingly innocent comment demonstrates the shattering of innocence that has affected us all. Yes, our society knows fear and anger more than ever before.  We stare evil directly in the eye and wonder if it is lurking beyond our view.  But when it strikes, resilience, fortitude, selflessness, bravery and love have prevailed every time, as we saw in the great city of Boston last week.  While the pain of those who suffered directly is unimaginable, the actions of good people are as real as it gets. Hail to Boston.

Medical practices, particularly private businesses like mine, strive for efficiency. This has become more necessary as medical reimbursements inexorably decline while overhead and other expenses rise. This may be the point in this post when a reader will jump to the comment section below and carp how I and every other doctor are only in it for the money. Not so fast here. Yes, I would like to make a living and I believe that I deserve a decent one. In my case, I do not seek, and have never sought wealth. For small private medical groups, particularly in northeast Ohio, we are aiming to survive more than to thrive. These days wasted time during the work week can be the tipping point that buries a private practice. Where are the time sinkholes in medical practice? No show patients – This is the ‘Wonder Bread’ of medical practices. It torments doctors in 12 different ways. Younger readers may need to Google to get this reference. Late Patients – While these folks are

One of the points I offer in this blog and elsewhere is to be skeptical to assume that something is true because we think it should be. We’ve been brainwashed to believe that obesity is a killer, despite research performed this year concluding that a little more weight may add years to your life.  Many argue that an assault weapons ban will save lives despite the absence of social science research that supports this.  Fewer guns should save lives, right? When skeptics like me point to Chicago which boasts extremely strict gun control legislation while being a murder theme park, we are given excuses to reject the data that contradicts gun control dogma.  Isn’t the term assault weapon itself unfairly charged and loaded?  I have supported medical education reform advocating that medical residents and interns should not be worked to exhaustion and yet be expected to administer high quality and compassionate care to ill patients.  I had believed that somnambulating medical interns wer