MD Whistleblower

If losing weight were easy, we'd all be skinny.  If exercise were fun, we'd all be doing it.  If quitting cigarettes were effortless... What should our response be toward rising societal tonnage? A Weighty Issue Photo Credit Pass laws restricting access to the wrong type of food.  Former Mayor Bloomberg got stiff-armed on this approach by the courts.  It's also always fun to watch folks argue over the definition of a 'wrong food'.  The debate on which foods warrant prohibition at least brings some entertainment into the public square.  Imagine trying to achieve consensus over 20 or so food items that should be banned.  If this task were actually accomplished, cigarettes and alcohol would still be legal.  Make sense? Initiate a massive public education campaign to scare us skinny. Show ads of scary pictures with scary music reminiscent of an iconic anti-drug ad (This is your brain on drugs...) from a few decades ago.          "This is yo

Labor Day is here.  Like many of our National Holidays, we have forgotten the meaning of the day.  Is Memorial Day a time to reflect upon those who sacrificed so we would be free, or a time to grill burgers on the barbecue?   Same with the Fourth of July.  Martin Luther King Day is just a day off for many of us.  If greater participation and reflection on MLK is the objective, then why would this day be on a Monday when most of the country is at work?  Even Christmas, a holiday season that I enjoy but do not celebrate, has shed its deep religious significance having become a commercial enterprise.  This reality, I suspect, must sadden and disturb many believing Christians. Labor Day, when many of us will be laboring over charcoal-broiled ribs and chicken, was created to remember and honor this country’s labor unions.  Triangle Shirtwaist Factory Fire 1911 While I am hostile the politics of unions today, I readily acknowledge that they were a necessary response to egregio

So much in medicine and in life is done out of habit.   We do stuff simply because that’s the way we always did it.  Repetition leads to the belief that we are doing the right thing. In this country, we traditionally eat three meals each day.  Why not four or two?  We prefer soft drinks to be served iced cold.  I’ve never tried a steaming hot Coke.  Maybe this would be a gamechanger in the food industry? Life gets more interesting when folks question long standing beliefs and practices forcing us to ask ourselves if what we are doing makes any sense. In the medical profession, a yearly physical examination was dogma.  Now, even traditionalists have backed away from this ritual that had no underlying scientific data to support it.  Yet, patients would present themselves to this annual event believing that this ‘check-up’ was an important health preserver.  Here were some medical routines that were never questioned. Yearly ear drum examinations with the otoscope.   Alw

I’m all for free speech and I’m very hostile to censorship.  The response to ugly speech is not censorship, but is rebuttal speech.   Of course, there’s a lot of speech out there that should never be uttered.  Indecent and rude speech is constitutionally protected, but is usually a poor choice.    We have the right to make speech that is wrong. Does First Amendment Apply to Physicians? I relish my free speech in the office with patients.   I am interested in their interests and occupations and sometimes even find time to discuss their medical concerns.  I am cautious about having a political discussion with them, but patients often want my thoughts and advice on various aspects of medical politics, and I am willing to share my views with them.   I don’t think they fear that politics or any other issue under discussion will affect their care.  It won’t. A Federal Appeal Court recently decided in a Florida case that physicians could be sanctioned if they asked patients if the

I read recently that the left coast state of California is contemplating requiring physicians to submit to alcohol and drug testing.   Citizens there will be voting on this proposal this November.I do think that the public is entitled to be treated by physicians who are unimpaired.  Physicians, as members of the human species, have the same vices and frailties as the rest of us. Traveling leftward I have no objection to this new requirement, if it passes. This will not be a stand-alone proposal on the ballot, but is a part of the ballot initiative.   Why would trial lawyers in the Golden State want to include it?  The meat of their ballot effort is to reverse effective tort reform that had been in place there for several years.   Click on the Legal Quality category on this blog for a fuller explanation of why the medical malpractice system has been screaming for reform, and is slowing getting it.  Sure, there are always two or more sides to every issue.  But, when the different

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