MD Whistleblower

Most of us are familiar with the concept of medical guidelines.  These are sets of criteria that are supposed to ‘guide’ physicians facing certain medical circumstances. As physicians know, and often lament, guidelines over time morph to become mandates.  Even though by definition, a guideline is voluntary, many hospital oversight committees and insurance companies require physicians who deviate from guidelines to explain their actions. The U.S Preventive Services Task Force guideline states that folks 75 and older should not receive screening colonoscopies.  The  reason is that medical studies have demonstrated that the benefits of colon cancer screening in this age group is not justified by the risk and expense of the effort.  Of course, there is an age when colonoscopy does not make sense, but I’m just not sure what this magic number is. Too Old for a Colonoscopy? Consider these two hypothetical patients. (1)   A 78 year old man in excellent health has never had a scre

I began this past Thanksgiving Day seeing patients at two local hospitals.  Yes, I was working on Thanksgiving, as I have done on many holidays over the past 25 years.  Many folks have the luxury of jobs that offer every weekend and holiday off automatically.  Many don’t.   For example, on Thanksgiving, the hospitals were staffed by nurses, secretaries, security personnel, housekeepers and cafeteria workers.  And, of course, every patient was seen by his attending physician and various specialists.  If any of us contemplated complaining that we had to work, a quick glance at any of the patients confined to their hospital beds would have quickly set us right. It’s not only medical care that must be available every day of the year.  Law enforcement, firefighters, utility companies, and national security institutions simply can’t clock out on Friday afternoons.  If you call 911 on a Sunday, you will not be greeted by a recorded message.  The day is a national opportunity to expre

Physicians speak with patients every day on the phone for a variety of reasons.   Our practice now uses a portal system, giving patients access to some of their medical data and to us.  Although I was resistant to having e-mail communications with patients, I have come to appreciate the advantages. It relieves our ever congested phone lines It relieves patients from a state of suspended animation as they hope and pray that a living breathing human being will return to the line after being placed on hold It saves our staff time who no longer have to triage calls as the patient directly reaches the doctor While this streamlined cyber communication system is useful, it does have limitations.  It can’t solve every problem.  Indeed, some issues are not appropriate for either a phone call or an e-mail. Calling his doctor? Consider the following scenarios.  Which can be appropriately handled on the phone and which merit a face to face encounter with a physician? I was in the