MD Whistleblower

I was asked to consult on a 43-year old female with abnormal liver blood test results.  It took but a few minutes to determine that she was an alcoholic, which was the likely explanation for her abnormal blood results.  She drank several beers daily over several years. My diagnosis was alcoholism, but did the patient concur? “Do you feel that you are drinking excessively or do you have it under control,” I asked. She replied, “I’ve got it under control.” That sad reply indicated that the probability of helping her to help herself was zero.  Ultimately, the addict must forge a pathway to healing.  Sure, we can help, coach and support the effort, and we should.  But, no addict ever reached the Promised Land by force or persuasion. Pouring One for the Road Sure, we’ll got this patient out of the hospital, back into the cauldron of inexorable self-destruction.  Did we help her?  I don’t think so.  This is not like treating a urinary tract infection where healing requir

It’s Memorial Day tomorrow.  What is it exactly that we are charged to remember? Cole Slaw? Lighter Fluid? BBQ Sauce? My father was a member of the greatest generation, having served in the U.S. Navy for 39 months.  He was stationed in California and was never in combat, despite some apocryphal vignettes he regaled us with.  I’ve never served in the military and none of my friends have served.  If not for my job, I would have very scant exposure to military professionals.  I have numerous patients who have served in all branches of the military during the 1940's and 50's.  Many are true heroes who recall their service with understated modesty.  I have also cared for many Vietnam vets who still bear physical and psychological scars of a war we couldn’t win and should never have joined. Freedom is not free, a quote that moved me deeply when I first saw it on the Korean War Veterans Memorial in Washington, D.C.  I know that Memorial Day has deep meaning fo

While I consider myself to be an ethical practitioner, I am not perfect, and neither is the medical profession. I will present a recurrent ethical dilemma to my fair and balanced readers and await their judgment. Our gastroenterology practice, like all of our competitors, has an open access endoscopy option.  This permits a physician to refer a patient to us for a colonoscopy, without the need for an initial office visit. Ready, Aim, Fire! Patients can also schedule procedures themselves, such as a screening colonoscopy, without a physician referral, if allowed by their insurance carriers.  These patients enjoy the convenience of  bypassing an office visit.   We agree that an office consultation should not be required for routine screening procedures or to evaluate minor gastrointestinal symptoms. Of course, if a patient wants to see us in the office in advance – and some do – we are happy to do so.  I enjoy these pre-op visits which allows me to develop some measu

Practicing physicians like me rely on scientific medical journals to keep us current on medical developments.  We learn about new treatments for old diseases.  New diagnostic tests are presented as alternatives to existing methods.   Established treatments, which are regarded as dogma, may be shown to be less effective or less safe than originally believed. It’s a confusing intellectual morass to sort among complex and conflicting studies some of which reach opposite conclusions in the same medical journal.  What’s a practicing physician to do? While the medical journals that physicians read are fundamental to our education, paradoxically most physicians have only rudimentary training in properly analyzing and assessing these studies.  For example, the quality of medical studies often depends upon statistical analysis, a mathematical field that is foreign to most practicing physicians.   Doctors like me hope that our peer-reviewed journal editors have done their due diligence

Everyone likes to be recognized for a special achievement or accomplishment.   Every career has special awards and commendations for everything.   While there’s no reward that matches cold hard cash, many of these honorable mentions have no tangible value whatsoever.  Pull into a fast food parking lot and you may see a parking space designated with a sign proclaiming, Employee of the Month!  Such an award conveys appreciation but does little to enhance the standard of living of the recipient. It seems that every other week there is some award show on television for the arts and entertainment industry.  99.44 Pure! I’d like an award, or at least a citation, for the work that I do as a gastroenterologist.   Fortunately, there are many awards and honors that I am eligible for.   Here are some of the prestigious honors that would illuminate any curriculum vitae. Fellow of the American College of Flatulence Honorary Doctorate of Hemorrhoidology Election to the Sphincter Pr

Do you think that physicians’ advice should be based on their patients’ best interests? How about lawyers?  Plumbers?  Financial brokers? An advisor who has what is termed a fiduciary duty is required to use the best interest standard with his client.  For example, an attorney is prohibited from recommending that his client proceed to trial, which would be beneficial financially  to the lawyer, if the attorney believes that a settlement serves his client’s interest better.   While it may not always work this way in the real world, this is how it is supposed to happen. "Toilet's clogged, ma'am.  Better replace the whole thing." Shockingly, investment brokers, unlike certified financial planners, have no fiduciary responsibility when advising clients on thei r personal investments.  They are free to make financial recommendations that are ‘suitable’  for a client , even if this would not be in the clien t’s best interest.  The broker can consider his own

I love teachers.  And, I love the teaching profession.  I remember years ago teaching one class to middle-schoolers on a subject that I thought exuded fascination and drama – the Civil War.  It was a long 50 minutes.  Even my daughter was doing her best to feign interest.  While the fault here may have been with the guest instructor, the lesson for me, which I have not forgotten, is how tough the teaching trade is. Teaching - Leave it to the Professionals I don’t have the same affection for the teachers’ unions as I do for the profession.  Their unions are advocacy groups to protect the interests of its members.  There is nothing wrong with this.  Many professions and occupations, including mine, have similar societies to whom constituents pay money in  exchange for various job protections. My issue with these groups is when they torture the truth to disguise the real reason for their positions.  Of course, even the most disinterested spectator can see through this chara

A female patient came to see me with some difficulty swallowing, a very routine issue for a gastroenterologist.  I performed an scope examination of her esophagus and confronted a huge cancer occupying the lower portion of her esophagus. Life changes in an instant. I expected a benign explanation for her swallowing issue.   She was relatively young and not particularly ill.  She had seen my partner years in the past for a similar complaint, which he effectively treated by stretching her esophagus.  I expected that I my procedure would be a re-run.  I was wrong. Prior to the procedure, we chatted and I learned that she had recently undergone a CAT scan of the chest ordered in response to some respiratory symptoms, which were not severe.  After I had completed my scope examination of her,  I was amazed that no mention of this tumor was related to the patient, who had told me that only a hiatal hernia was seen. I requested a fax of the report which confirmed that the r

There’s nothing like discrimination – true or imagined – to keep our airwaves humming.  Earlier in the week, Indiana and then Arkansas were media fodder for laws that were proposed to protect religious freedom.   Yes, I know the other side of the argument, that these ‘religious freedom’ protections were veiled attempts to discriminate against the LGBT community.   Both states raced to revise their original laws, although the laws' backers deny any discriminatory intent or effect. It was likely that these governors feared an economic riposte from large companies who have expressed concern and disapproval over the perceived discriminatory effects of religious freedom laws.  I wonder how many of these companies do business with or remain silent about countries that use child labor, discriminate against women, have no freedom of speech or make homosexuality a crime.  Realize that the original RFRA proposals do not guarantee an outcome in any dispute, a point that I believe is

I practice gastroenterology in Cleveland in the dark shadow of a large medical institution whose name contains the name of our city.  They are a world class medical institution whose reputation is largely derived from its cardiovascular department.   Presumably, these practitioners, like all doctors, advise patients who smoke that cigarettes have deleterious health effects.    The entire campus is smoke-free, as are all hospitals today.   This is a relatively new development.  A few years ago, nurses and other hospital staff would huddle at the entrance puffing away.   No more.  Now, there is no smoking anywhere on the hospital property.  Hospital puffers now have to wait until quitting time, when they are behind the wheel and leaving the grounds before they light up.  I’m okay with all this.  The hospital should set an example to promote better health.  Patients and families who enter the hospital who must pass through a smoky fog might wonder about the hospital’s commitment to h

'Safety first' is a mantra of today's hovering parents.  It's the default explanation that a parent invokes when an edict has been issued that cannot be challenged or reversed. "Mommy, can I pleeeeeeze have a water pistol?" "I'm sorry, honey.  You know how Daddy and I feel about guns.  This is a safety issue.  Now go and practice your violin and afterwards help yourself to some kale chips." Caution! Water Pistol Zone Ahead The safety concept has crept into the medical arena.  In many cases, safety concerns about our patients are justified.  I see many of our elderly hospitalized patients approaching hospital discharge who face safety concerns at home with respect to falls, understanding complex and new medication lists and monitoring active medical issues.  Hospitals today have a staff of capable and compassionate professionals who do excellent work protecting patients poised for discharge.  This effort saves patients suffering and sav

I just deposited a check into my bank account by photographing the check with my iPhone and zapping it through cyberspace.  I realize this is a yawn to the under 35 crowd.  Soon, there won’t be any paper checks as the entire transaction will occur electronically.  As a member of the over 35 crowd (plus 20 years), I am wowed by this process.  I remember being astonished when my kids told me how they performed this same process a year ago.   It’s the same amazement I experienced when I first read about a new piece of technology called a ‘fax machine’. "You mean you slide a document into a machine and an exact copy emerges elsewhere?" In my younger days, depositing a check into a bank account meant waiting in line with my bank book in hand waiting for a living, breathing human to count and record my allowance and snow shoveling earnings.   The bank that my kids use today has no physical offices.  It is entirely in the Twilight Zone. Medicine will not be left behind her

I have a good memory, which has often been a great asset for me. Medical school in the 1980’s required massive memorization of arcane facts, formulas and anatomical structures. The philosophy then was that it was better to spend hours memorizing stuff every night then it would be to simply look them up when the information is needed.  My tone here conveys my view of this approach. I can remember the phone number in the house I lived in until I was 8 years old.  Impressive? Perhaps.Useful? I doubt it. Some folks have long memories, which is not always a gift.  There are events and painful moments that while they will always be stitched within our personal tapestries, they may be better placed beyond easy reach. Nations also have long memories.  I am writing now from Manila on the other side of the globe. Yesterday, I was snorkeling and witnessed a shipwrecked Japanese warship sunk in WW II by the Americans.  The war in the Pacific theater between the Japanese and the Americans was

This is a Whistleblower Holiday.  A few weeks before this posting, we are setting off to the Philippines.  After about 10 days there, we're off to Japan, where we expect to savor the full potential of sushi and other delicacies.  This will be the biggest trip of my life. I leave with enhanced immunity having received the influenza vaccine, a belated tetanus booster and the oral typhoid vaccine - veritable germ armor! No Traveler's Diarrhea! Why the Philippines?  My daughter, Elana, is spending a year there teaching at an international school.  We are going because she is there.We all know the advantage of maintaining low expectations.  Here are some of mine. Pull an all-nighter the night before departure to reduce the expected jet lag.  Manila is 13 hours ahead of Cleveland time. Don't miss the initial 7 a.m. flight out of Cleveland. No one on any of the 3 flights sitting in front of me reclines. The airport WiFi actually works. Our circulatory systems do n

It’s been amusing to watch Rand Paul, a doctor, trying to ‘clarify’ comments he made suggesting that vaccines for kids should be a matter of parental choice.  Conversely, Rick Perry some years ago had to walk back his aggressive pro-vaccine stance, when he championed mandating HPV vaccines for young girls.  This political clumsiness is not restricted to the GOP.  In 2008, both Barack Obama and Hillary Clinton argued that 'more research was needed on vaccines' potential side effects'. Presidential candidates, it seems, have not all been vaccinated against Panderitis.   Of course, I recognize an informed individual’s right to refuse treatment.  An adult with appendicitis has a right to refuse appendectomy, against the advice of the surgeon.  "You mean I didn't have to get sick?" Does a parent have a right to deny the measles vaccine for their kids?  I don’t think so.  Here’s why. Medical evidence provides overwhelming support for the vaccine’s