MD Whistleblower

Our nation is highly polarized today, and often bitterly so.  Democrats rail against the GOP.  Pro-lifers face down pro-choicers.  FOX News disses MSNBC.  Isolationists push back against expansionists.  Traditionalists disdain the politically correct.  Free marketers duel against government advocates.  Carnivores deride the gluten-free crowd.  Martin Bashir trashes Sarah Palin, two proxies in a culture war.   There's a philosophical divide among physicians also.  Would you prefer a liberal physician or a conservative practitioner?  I'm not referring here to fiscal policy or legalizing recreational marijuana use.  Consider the following hypothetical scenario and the 2 physicians ’ approach from opposite sides of the medical philosophical spectrum. Which physician would you choose? Dueling Doctors The Patient:   She is a 50-year-old female with chronic fatigue syndrome (CFS).  She is only able to work part time because of her condition.  She has consulted with a

I’m a law abiding blogger.  Laws are meant to be obeyed.  If an individual opposes a law in a free country, then he should operate within the system to modify it.  I recognize that even in free societies, certain laws are so unjust and in violation of natural law that that the citizenry may be justified in relying upon other measures to affect necessary reform.  I’m not suggesting that an unwelcome federal tax on gasoline be greeted with pitchforks in the street.  However, our own democracy is a nation where slavery, ‘separate but equal’, exclusive male suffrage and Jim Crow discrimination were all legal.  In such cases, can we expect a legislature to strike down unjust laws that it enacted? Law and medicine are increasingly intertwined today, and more than they should be.   Physicians no longer practice unfettered from legal encroachments and regulations.  I am not referring here to the unfair medical malpractice system, a subject that has occupied a substantial portion of real e

A few days before this writing, a 32-year-old woman came to see me for an opinion on stomach pain.  Why would I refuse to see her again?  Abdominal pain is an everyday occurrence for a gastroenterologist.  She was accompanied by her mother.  I had never met this woman previously.  She had suffered abdominal pains for as long as she could remember.   She recalled frequent visits with the school nurse when she was a young girl. The Stomach - Usually Not the Source of 'Stomach Pain' She has abdominal distress of varying severity every single day. Despite this medical history, she was not ill and appeared well. Why did I refuse to take on her case?   She seemed like a very appropriate patient for my practice.  I have expertise in evaluating and treating abdominal pain.  The patient was pleasant and cooperative.   I believe she would have been comfortable with me as her gastroenterologist. I learned that the patient lived in another state and was only in Cle

Hobby Lobby, unfairly demonized in various corners of the public square, had their religious beliefs upheld in the highest court of the land in a 5-4 decision this week.   The company’s leaders are deeply believing Christians, which I believe is still a lawful practice in this country.  The company tithes to charity and pays its full time employees at least $14.00 hourly, both evidence of a culture of compassion and fair play. No, not these Supremes, the other ones. There is a din of shrill protestations that the company is against contraception and women, which is a complete falsehood.   Hobby Lobby is not the Catholic Church who objects to all forms of artificial birth control as fundamental religious dogma.  The company always intended to cover 16 different forms of contraception, including oral contraceptives, condoms and tubal ligation.  It objects to birth control methods that take action after an embryo has been created. I don’t grasp the notion that an institutio

The meaning of many holidays can be elusive.  On Memorial Day, are we contemplating our fallen heroes, or grilling burgers?  How many shopping days ‘til Christmas?  Labor Day?  Isn’t that the last weekend at the beach? The Fourth of July has just passed.   Hopefully, we paused at least for a few moments to meditate on what happened in Philadelphia in 1776.  I’ve seen the actual Declaration twice in my life.  The first time was when my mom took me to D.C. as a young child.  Later, I took the kids to the National Archives, where we waited in a long line to be rewarded with a few second gaze at the very faded ink that was sequestered behind thick glass. History is such a thrill.  It’s a dynamic discipline that breathes.  This past week, a scholar from Princeton, New Jersey claims that a punctuation mark – a period – does not appear on the original parchment, but was included in the official transcript of the Declaration authorized by the National Archives.  The omission

The world is asunder.  As I write this, Iraq is sinking into a sectarian abyss.  ISIS, a terrorist group, now controls a larger territory than many actual countries.  Russia has swallowed Crimea and has her paw prints all over eastern Ukraine.  China is claiming airspace and territories in Southeast Asia increasing tensions with Japan, Vietnam and the Philippines.  The Israeli-Palestinian peace process is in another deep freeze.  Terrorists in Sudan and Nigeria are kidnapping and murdering innocents with impunity.  The Syrian regime has resulted in 160,000 deaths and has displaced over 6 million people.   The Taliban continue to destabilize and terrorize in Afghanistan and Pakistan.  Disease and hunger claim millions of lives in the developing world while other world regions have a surplus of food and medicine.  We have an immigration crisis in this country that gets worse by the day.  Several million Americans are still out of work. Let’s not be distracted by these trifles.  A loo

A few weeks back, I posted a piece entitled, Are Emergency Rooms Admitting Too Many Patients?   The essay was cross posted on KevinMD’s site a week or so after it appeared on my blog.  I received buckshot style criticism from various corners of cyberspace on my post.  What provoked particular ire, was my implication that Emergency Department physicians faced financial conflicts of interest with regard to admitting patients into the hospital.   I’m open to criticism and debate in the blogosphere and in my own life.  My father was an attorney and my brother is a sitting judge.  I’ve raised my kids to question, argue and to seek out the other sides of issues despite that they may already feel that they grasp them sufficiently.  Now, that they are adults, I am often the target of these skills that I worked so hard to cultivate in them.  Numerous physicians were offended by my reimbursement implication.  In reading their responses, it was clear to me that I was not sufficiently inf

One of the frustrating aspects of medical practice is trying to divine if the medication I am prescribing is covered by the patient’s insurance company.  Even with the advent of electronic medical records, which should be able to determine this, we are often left to hope and pray. Here’s how it works.  Individual insurance companies have formularies – lists of approved drugs – that they encourage patients and their physicians to use.  Of course, this is all about the money.  There’s nothing evil about an insurance company making a deal with a particular drug company that gives them a price break.  The drug company will be delighted to offer the insurance company a discount in return for an anticipated high volume of prescriptions.   You can easily picture an insurance company negotiating with several different GERD medication representatives watching them each lowering their bid trying to get the contract.   Nexium Guy:   We’ll only charge you $.67 a pill Prevacid Gal:  We’l

Despite our professed values, everything has a price. We value life, but our society is unwilling to lower the highway speed limit to 40 mph, which would surely save lives.  The price of our collective inconvenience and economic impact is too high. Lower Speed Limit and Save Lives? We leave no soldier on the battlefield, but this military value cannot be viewed in isolation.  We are told this week by our commander-in-chief and his acolytes that rescuing a captured soldier is worthy regardless of the price.  We are told that negotiating with terrorists, breaking the law by not notifying congress and the release of 5 hardened Taliban detainees is a reasonable price for the return of a captured sergeant.    I feel that the price exacted was too high, although admittedly my view would be different if the sergeant were in my family.  For those who argue that no price is too high to rescue one of our own, should we have surrendered to the Nazis in World War II in return for so

If you read this blog, then you likely know about the scam known as Pay for Performance (P4P).  This program not only fails to deliver on its stated mission to improve medical quality, but it actually diminishes it.  For a fuller explanation on why this is true, simply insert ‘Pay for Performance’ into this blog’s search box, and grab some Rolaids.  In short, P4P pays physicians (or hospitals) more if certain benchmarks are met.  More accurately, those who do not achieve these benchmarks are penalized financially.   I do not object to this concept.  Folks who perform at a higher level should be rewarded accordingly.   My objection is that the benchmarks that have been selected are arbitrary and too far removed from true medical quality measurements.  Benchmarks have been chosen that are easy to measure even if these measurements don’t count for much.  In other words, what really counts in medicine, isn’t easy to count or measure. Medical Quality Measurement Instrument Co

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