MD Whistleblower

This blog has discussed conflicts of interests.  Indeed, every player in the medical arena has found itself challenged by conflicts where one’s self-interest competes can skew what should be pure advice.   This issue is not restricted to the medical universe.  Every one of us has to navigate through similar circumstances throughout the journey of life.  If an attorney, for example, is paid by the hour, then there is an incentive for the legal task to take longer than it might if the client were paying a flat fee.  The fee-for-service (FFS) payment system that had been the standard reimbursement model in medicine has been challenged and is being dismantled because of obvious conflicts that were present.  (This is not the only reason that FFS is under attack, but it is the principal reason offered by FFS antagonists.)  Physicians who were paid for each procedure they performed , performed more procedures.   This has been well documented.  Of course many other professions and trades stil

Why does is seem that so much information given to us comes with disclaimers?  The weight loss product ads on TV that promise more than they will deliver, are always accompanied by 5 nanosecond disclaimers in a font size that can’t be discerned by the human retina stating that the results are not typical. Watch the Pounds Melt Away! It seems deceptive to be advertising a product by showcasing a performance that the vendor admits is not typical. Let’s extend this philosophy to other professions and trades. Financial Planner:   Invest with us and earn 20% returns annually over 5 years. Results not typical. Attorney: When I catch your ambulance, I’ll make us both millionaires!  Results not typical. SAT Tutor:  My students have the dilemma of choosing between Harvard and Princeton.   Make your kids my kids. Results not typical. Airline Industry:  When our customers call us on the 800 line, a live human answers by the 3 rd ring. Results not typical. Politician:  I wi

I’m a physician and I’m against wellness.  Let me explain. Wellness is the new health mantra that has much more to do with marketing than with evidence-based medicine.  Wellness institutions and practitioners are omnipresent promising benefits that are often untested or rejected scientifically.   Hospitals that years ago would have shunned new age healing arts, now offer yoga, meditation, Reiki and massotherapy.  Do they do so because they have had a Damascus Road experience and now believe that these techniques are effective?  Guess again. Paul's Conversion on the Damascus Road Wellness is no longer restricted to medical campuses, costly weekend retreats for emotional and physical catharses and ubiquitous yoga storefronts.  Wellness is now championed by corporate America.   Business leaders argue that keeping employees well is not only a demonstration of good corporate citizenship, but is also good business.   Healthy employees, they claim, will reduce health care

Remember personal responsibility?  There actually was an Era of Responsibility when folks admitted when they screwed up and didn’t blame others for their own mistakes.  I know this may seem incredible to the younger generation who simply assume that when something goes wrong today, it must be someone else’s fault.   In today’s culture, this is not scapegoating, but the pursuit of justice.  Welcome to the Era of Big Victim. In the olden days, if someone slipped on ice and sustained injuries, he went to a doctor. Today, we could expect a court case where a jury would hear testimony from an Illumination Expert testifying that the wattage and angle of the sidewalk lighting was clearly deficient.   A Saline Expert would add that the salt that the proprietor applied to the sidewalk was not dispensed with a certified salt sprayer, thereby allowing dangerous ice crystals to survive.  Perhaps, an Ambulation Expert would instruct the jury that the soles of the fallen man’s shoes containe

I’m writing this aboard a United Airlines flight on route to Chicago.  I haven’t had this much leg room since I was inside my mother’s womb.   I am now in fear that if the gentleman in front of me reclines his seat, that it will disfigure me.  If this occurs, I wonder if United would be liable for my pain and suffering.   Now that I think about, throw that seat back, buddy! Stretch out and relax! I shouldn’t carp on United as I received an unexpected prize from the airline.  When I passed through the TSA checkpoint, I was told that I had been awarded a Pre-Check status, which conferred valuable privileges.  This meant that I did not have to remove my shoes or my jacket.  Somehow, the airline had determined that the Whistleblower posed no flight risk.  Luckily, the airline had not read some of my scathing Whistleblower posts on their pricing strategy and their deep commitment to customer service. Do you think that they profiled me to determine that my shoes likely contain

I’m a physician and I’m against wellness.  Let me explain. Wellness is the new health mantra that has much more to do with marketing than with evidence-based medicine.  Wellness institutions and practitioners are omnipresent promising benefits that are often untested or rejected scientifically.   Hospitals that years ago would have shunned new age healing arts, now offer yoga, meditation, Reiki and massotherapy.  Do they do so because they have had a Damascus Road experience and now believe that these techniques are effective?  Guess again. Ahead of His Wellness Time? 100 Years Ago Metchnikoff Suggests Probiotics  Wellness is no longer restricted to medical campuses, costly weekend retreats for emotional and physical catharses and ubiquitous yoga storefronts.  Wellness is now championed by corporate America.   Business leaders argue that keeping employees well is not only a demonstration of good corporate citizenship, but is also good business.   Healthy employees, the

Folks who have wandered through the Legal Quality category of this blog understand my views on our perverted and unfair medical malpractice system.  I've been in the arena many times, and always walked away unharmed.   If this system were presented in front of a fair minded and impartial jury, it would be dismantled.  Sure, there are positive elements present, but they are dwarfed and suffocated by the drawbacks. The self-serving arguments supporting the current system are far outweighed by the financial and emotional costs that innocent physicians unfairly bear.  Tort reform should not be controversial.  You may wish to peruse a few of my medical malpractice posts before spewing forth vitriol in the comments section. Beyond the medical arena, who wants to defend the crushing volume of litigation in the United States?   Let me be bold.  I think we have too much litigation and fear of litigation in this country.  Put that item up for a vote anywhere in the country exc

To those brave souls who have returned after digesting last week’s cheerleading on hospitalists, here is the Achilles’s heel of the system.  While the advantages are clear and substantial, there are serious vulnerabilities which have not yet been adequately remedied.  Achilles Held by the Heel Being Dipped into the River Styx Hospitalists cannot appreciate the medical nuances, personality, family dynamics, life events and prior experiences that may be well known by the out-patient physician.    There are serious communication lapses, all of which cannot be bridged.  The out-patient doc may know that the patient’s chest pain is his typical anxiety and that it is not necessary to repeat the cardiac evaluation that was done 2 years ago.  The hospitalist may take a different tack here.  Despite their best efforts, hospitalists know that they will not be seeing the patients after discharge.  As they are not permanently vested,  they may not address certain patient concerns, pu

Hospitalists are now firmly planted in the medical landscape.  These doctors have no office practices and earn their living exclusively by managing hospitalized patients.  These guys and gals are either hospital employees or are private groups who are under contract by hospitals.  The market and the profession were hungry for this new specialty, which has exploded across the country.   The advantages to patients and to practicing physicians are enormous.  Are there drawbacks?  Of course, but you’ll have to wait a week to read about them. Hospitalists Pro or Con?  Which side has more weight? When these hospital physicians first appeared on the hospital scene, there was buzz that patients would push back against these stranger-docs wanting their own office doctors to attend to them instead.   This never materialized.    Patients no longer had the expectation that their own doc would be available to them 7 days a week.  Indeed, medical physician groups and institutions had on-c

Readers know that I am skeptical over the efficacy of complementary and alternative medicine.  This is not merely a demonstration of my inborn skepticism, but doubt based on the fact the so much of their claims are untested, unproven or refuted. I don’t regard the above comment as controversial.  It is factual.   I’ll let readers decide if it is but another example of the arrogance of conventional physicians who worship on the altar of evidence based medicine.  Recently, I read a column in The New York Times by a university professor who was treated for a cold in China by drinking fresh turtle blood laced with grain alcohol.  In a day or two, he felt better.  Cause and effect?  It’s not easy to talk someone out of a view that a pseudoscientific remedy healed them.  Why should we do so?   If a patient tells me that his fatigue has finally lifted after giving up guacamole, do I serve him or the profession by pointing out the absence of any scientific basis for his renewed ener

From time to time, the Whistleblower will offer readers a quiz.  Physicians, similar to other professionals, have taken scores of standardized tests over the years.  Most physicians are skilled at these exercises which, in my view, are a poor measurements of skills necessary for becoming a capable and caring physician.  Yet, as we have learned from pay-for-performance and other ‘quality’ initiatives, we measure what can be easily measured even if it doesn’t really count.  The Kirsch progeny have been exposed to well over 100 quizzes during their formative years, when they competed for valuable prizes at the dinner table.  As we know at carnivals and county fairs, everyone wants to win that Teddy bear, no matter how much it costs to win it.   It’s the victory, not the prize. 1902 Washington Post Cartoon with Teddy Bear and TR True or False? A physician who owns a CAT scan machine is more likely to order scans than would another physician who does not own a scanner

Just read another article forecasting the demise of private practice, which is the model I practice in.  We certainly feel the squeeze here in Cleveland, where our small gastroenterology (GI) practice is suffering from some breathlessness as surrounding health care institutions suck up oxygen in the community. Now, being deprived of oxygen isn’t necessarily fatal.  Many patients suffer from diseases that result in low oxygen levels in their blood.  Folks who live at high altitudes don’t have the same concentration of oxygen available as do those who reside at sea level.  Yet, they live active lives. How do these folks survive?  Do they have lessons for my GI practice? Take a Deep Breath... Here are some options that help individuals with low oxygen levels breathe easier. Receive supplemental oxygen using an oxygen tank.  No analogous solution for my medical practice here.  For us, the ‘oxygen level’ can’t be artificially increased. Reduce activity level to m

Physicians and patients collaborate to treat symptoms.   This is not newsworthy and even sounds appropriate.  Isn’t that what doctors are trained to do?   It is but I’m not sure this should be a central focus of our healing mission.  Treating a symptom is not the same as treating a disease.  For example,  if an individual is having abdominal discomfort, pain medicine should not be the first responder, even if this would bring the patient relief.  Physicians try to understand the cause of the pain which would then guide our therapeutic response. The treatment would differ substantially if the cause of the pain were appendicitis or an ulcer or a kidney stone. Is Fever the Enemy? Often symptoms are regarded as diseases themselves that need to be treated.   Over the years, I have been called by nurses hundreds of times to prescribe medicine for patients who were nauseated.  Nurses are exceptional professionals, but they are not physicians.   They are preoccupied with the pa

I advocate evidence based medicine.  We should restrict our medical recommendations to those that have a reasonable underlying scientific basis.   On the opposite end of this spectrum is quackery, when snake oil and other potions are hawked that either have no scientific support or have been shown scientifically to be ineffective. I do not offer snake oil here as a historical reference.  We have more snake oil and its congeners today than ever before.  People who are sick want to believe the man who promises them healing, particularly when conventional medicine has not succeeded.  This belief goes to the core of human nature, at least as I have observed over the past 3 decades.  Of course, in the medical world, we don’t have enough science yet for all of the medical issues that we physicians confront.   That means that we guess a lot.  How often does this occur?  Every single day.   Patients would be quite surprised to learn that there is usually scant or conflicting medic

Sometimes, we play a little politics on this blog.  I am a student of current events and enjoy following the dysfunction and absurdities in American politics.  To paraphrase the legendary former British Prime Minister, ‘never has so little been done by so many to benefit so few’. Legendary Former British Prime Minister Which of the following recent events is the most politically charged? Speaker of the House John Boehner passed a clean extension of the debt limit without conditions. (Nothing like a colossal failure on this issue months ago to guide the speaker today.)  Obamacare received its 27 th extension, another ‘tweak’. A new study questions the value of mammography.  Readers know how skeptical I am about medical dogma.  When I was an intern a quarter century ago, I didn’t grasp why routine measurement of  Prostate Specific Antigen (PSA) was standard medical practice since it was true back then that more men were harmed than helped by its use. A recent stu