MD Whistleblower

What’s all this chatter I hear about how hard it is to lose weight?   Relax.   Obesity has finally been conquered.   Those stubborn extra pounds that you’ve been stuck with will soon melt faster than a popsicle on a steamy summer day.   Although I am a practicing gastroenterologist who deals with nutritional issues routinely, I did not learn of this breakthrough in my medical journals or from experts in the field.   I learned it just by listening to the radio. I’m in the car several times a day, so I get my share of radio time.  Not a day passes that I don’t hear an ad for some kind of fat-busting pill or potion.  The products are different but the pitch is always the same. Obesity on the Run! Rapid weight loss No excercise No work or effort.  Pound magically disappear This seductive pitch is followed by testimonials from smiling ‘customers’ posing on the beach who corroborate the amazing result.  Their script usually includes: 'I've tried everything

Of course, patients are entitled to medical care around the clock.  You would not expect to show up at 2:00 a.m. at an emergency room to find a ‘Closed’ sign.  If you are having chest pain on a weekend, and you call your doctor’s office, you should expect a prompt response from a living and breathing medical doctor.  Patients are aware that when they call the doctor at night, that they are unlikely to reach their own doctor.  Similarly, when a patient is admitted to the hospital, they will likely be attended to by a hospitalist, not the primary care physician.  Such is the reality of medical practice today. No Patient Zone at Hospital Here are 3 types of after hour calls that merit mentioning. (1)One of my partner’s patients calls me because the diarrhea is still not better and it’s been more than 3 months.  While I completely understand the frustrated patient’s rationale for calling, there’s not much I can do in these circumstances.  It is generally not helpful to call a

Some issues do not need to be studied.   For example, would we expect the National Institutes of Health to fund a study to determine if drivers wearing blindfolds have better outcomes?   In the past few weeks, the National Football League (NFL) has conceded that head trauma is linked to chronic traumatic encephalopathy (CTE), a fancy term that means brain damage.  Of course, there have been multiple studies that have examined this question.  And, in a nod to the tobacco companies, the NFL for too long failed to admit what any school child could have deduced.  Smashing your head several hundreds of times against the ground or another helmeted gladiator does not promote good brain health.  Sometimes industries will cite their own ‘studies’ that astonishingly contradict what our intuition and common sense tell us should be true.  Would we accept the results, for example, of a movie industry  ‘study’ that extolled the health benefits of popcorn? Sometimes, in medicine, we need a s

Trump is roaring toward securing the GOP nomination in Cleveland this summer.  While I am excited that the convention will occur in my city, I expect chaos and gridlock downtown.  I won’t be visiting the Rock and Roll Hall of Fame, or any of our city’s other outstanding attractions, during that week. I think that Trump may garner the necessary 1237 delegates prior to the convention.  For self-serving reasons, the trailing 2 candidates are stating that no candidate will meet the required threshold and that the convention will select the nominee according to rules, yet to be decided.  My candidate Kasich – who has won only Ohio – crows that it’s now a 3 man race!  Sorry, John.  Wining 1 out of 32 states, while Cruz and Trump have won 9 and 19 states respectively, does not make this a 3-way tug of war. The New White House? The media is preoccupied to determine if the candidates and the GOP establishment will award Trump the nomination if he falls a few delegates shy and the

I am not a woman.  I cannot contemplate the physical and emotional experience of carrying a pregnancy and birthing a child.  I imagine that it is a singular experience that is as deep and awesome today as it has always been.  We have all seen the explosion in reproductive technology with in vitro fertilization, surrogate mothers, fertility agents and other emerging techniques.  This process, beyond the high costs, can create anguish for those who are on this journey. I have felt in many instances that the ethical ramifications of some of these techniques are minimized or dismissed.  Sadly, we often do stuff because we can, not because we should.  Do we really think we can stop human cloning? Recently, a woman in Cleveland had a cadaver uterus placed during an extremely demanding 9 hour operation on 2/24/16.  This was the first time this was performed in the United States.  Only a handful of these operations have been performed worldwide.  This woman, who has adopted children,

Proton pump inhibitors, or PPIs, are among the most common drugs prescribed in the United States.  They are extremely safe and highly effective for gastroesophageal reflux disease (GERD).  Are there potential side-effects?  Of course.  Look up the side effects of any of your medicines and you will soon need an anxiety medicine to relieve you of side-effect stress.  The side-effect lists of even our safest medicines are daunting.  PPIs are associated with a growing list of potential serious side-effects, at least according to the lay press.  A few clicks on your computer, and you will find that these medicines can cause pneumonia, C difficile colitis, malabsorption of nutrients, bone fractures and anemia.   The latest report to emerge links these drugs with dementia.  In the past two weeks, I’ve been questioned about this repeatedly by my patients.  One stopped her medication from fear that her heartburn medicine might be incinerating her neurons. Enemy of Heartburn Medicines

The nutrition police are at it again.  They demand that food products that use genetically modified organisms (GMOs) in their processing inform us of this on the product’s label.  They argue, not only that consumers have a right to know how their food is prepared, but also that manufacturers should be required to disclose when evil GMOs are utilized.  (Keep in mind that most of the food that we consume includes GMOs, a fact likely unknown by most of us.) Proposed Label For GMO Foods This labeling demand from the nutritionistas is a little hard for me to swallow.  I don’t want to hear about polling that demonstrates that most American favor mandatory labeling.  I guess we cite poll results when they support our views and dismiss them when we don’t.  Donald Trump is ahead in every poll.  See my point? There is no scientific evidence that GMOs harm our health.  Fear is not evidence.  Political correctness is not evidence.  Indeed, the Food and Drug Administration requir

There was a tragedy in France recently that did not involve offensive cartoons, radicalized jihadists or terrorists masquerading as refugees.  Innocent French citizens were taken down by a profession whose mission is to heal and comfort.  A medical clinical trial careened off the rails and crashed.  Were these volunteer study patients properly informed?  Are medical study patients here in the U.S. truly making a free choice? From time to time, friends, patients and relatives ask my advice if they should participate in a medical experiment.  While I am a doctor, I usually say no.  And, once I explain to them the realities of medical research, they usually say no also. While my colleagues may chastise me for not encouraging my patients to join clinical trials, my primary obligation is to advocate for the patient before me, not for society.  If physicians contemplate changing this ethical construct to consider the greater good when we advise patients, then we need to engage the

Massachusetts General Hospital (MGH), perhaps the most prestigious hospital in the United States, has just announced that it is joining the concierge medical universe.  Concierge medicine offers patients Rolls Royce care for an extra fee.  This model has gained popularity across the country and is attracting both patients and physicians.  Patients receive white glove treatment on demand and physicians have more time with each patient as they no longer are pressured to increase patient volume to pay bills.  I’m sure that some of these physicians have increased their incomes, but others may be paid the same, but enjoy seeing 6 patients per day instead of 20.  I was struck by $6,000 annual feel that MGH was charging concierge patients, the highest I had ever seen before.  The typical fee I had seen was in the $1,500 per year range.  Six grand per year will get Bay Staters personalized care whenever they want.  They will never wait for an appointment.  I imagine that the waiting rooms

I am known by my patients and friends for my calm, imperturbable manner.  Yes, I am equipped with the full range of human emotions, but few folks have ever seen me raise my voice or demonstrate bulging next veins.  I am not suggesting this is a virtue or a character flaw, but is just the way I am wired. Sure, I get irritated and frustrated with the absurdities of life, as we all do.   For those who cannot relate here, may I suggest calling any airline carrier to discuss changing your ticket reservation.  If that fails,  then have a go at reaching out for tech support when your home internet goes ‘poof’! Last week, I did become irritated when I was notified one evening about a patient’s abnormal blood test result.  I was on-call for our gastroenterology group, so I would be the designated physician to notify with concerning test results.  Why, then, was I miffed? Our community hospital uses a ‘new and improved’ system for notifying physicians after hours of significantly abn

May I whine for a few sentences please?  My staff and I have a high-deductible medical insurance plan.  As the costs of coverage increased each year, we had to find a product that we could afford for our small private practice.  As any small business owner knows, margins are tight, revenue is declining and expenses inexorably rise.  And physicians, unlike other retailers, cannot raise our fees.  Would you want to invest in a company with this business model?  If so, then contact me directly. High-deductibles health plans are painful for consumers.  The first several thousand dollars are borne by the individual.  While we have an HSA (Health Savings Account), which confers a tax advantage, it is still painful to fork over wads of one's wages to cover medical expenses.  Isn’t that what medical insurance is supposed to do? Would we expect fire insurance to cover only part of our house if it burned down? Will fire insurance cover a fire? But, I recognize that high-de

Years ago, I was having dinner with 2 members of The Cleveland Orchestra, one of the finest orchestras in the world.  I asked them, with my kids present, how much time they devoted to their craft.  As many parents know, getting kids to commit to practicing a musical instrument is about as easy as splitting the atom.  The musicians told us how much time they practiced, which was mind boggling.  Any artist or athlete or Green Beret or similar professional, has to demonstrate extraordinary commitment to maintain a superlative level of excellence and preparedness. every day. I asked one of the musicians, the violinist, how long he could stay away from playing his instrument before he noted some professional slippage.  Guess your answer.   At the end of this post, I will relate his reply. How long can you be away from your job before your performance ebbs? For most of us, we can take weeks or longer on holiday and return back to our positions seamlessly.  A few examples.

I am always always been irked when a hotel charges me for Wi-Fi use. This pick-pocketing is resented by hotel guests across the fruited plain.   This money grab is taken right out of the airlines’ playbook, who now charge us for carry-on bags, an aisle seat, a candy bar, a working flotation device ‘in the unlikely event of a water landing’ or a functioning oxygen mask.   Need to change your reservation?  Easily done for $150.  On what basis can this fee be deemed reasonable?  It constitutes consumer abuse of the first order.  Although airline profits are soaring, and fuel costs have tanked, there has been no trickle-down effect to travelers, who are left with little recourse except to pen cranky blog posts.  Airlines Heading Back to No Frills Hotels know that Wi-Fi is like oxygen.  Since we can’t live without it, why not extort a few dollars for it.  A paradox in this exploitative practice is that cheap hotels give their guests free Wi-Fi, while top tier hotels might charge $1

You see your gastroenterologist with long standing stomach pain.  You have undergone a reasonable evaluation and all the endoscopic bodily invasions and imaging studies of your abdomen have been normal.  Repeated lab work provides no clue explaining your distress.   You have been twice to the emergency room and were sent home with  prescriptions that didn’t work.  You are frustrated and so is your gastro guy.  You are convinced that there is a diagnosis that has been missed and you have the Google search to prove it. Every physician has had patients who come into the office with reams of paper from an internet search.  Usually, this approach uses a net that is just slightly over-sized for the task at hand.  It would be like using a butterfly net to catch a paramecium. Paramecia - Use a Small Net to Catch these Critters! Plug a few symptoms into a search engine, and then be prepared to take a year or so to review the results.  Pick a symptom, any symptom. Whistleblow

A patient came to the office and refused to see me, although I was quite willing to see him.  I’ll present the scenario followed by the patient’s reason he took an abrupt U-turn.   Then, if you are inclined, you may offer your own advice and comment. I performed a colonoscopy on this patient and found a large polyp in the upper part of the large intestine, or colon.  The upper part of the colon, or right side of the colon, has been receiving a lot of press in gastroenterology in recent years.  Medical studies have observed that cancers in this region are more easily missed for reasons that don’t need to be explained here.  For this reason, gastroenterologists are particularly vigilant when examining this region. The polyp was large and somewhat hidden behind a fold of tissue.  I suspected that this was a benign lesion.  I removed the polyp using one of the gadgets in our bag of tricks, but knew at the time that I had left some polyp tissue behind.  I was unable to remove the e

At the end of every year, the airwaves compete for our attention on programming that ‘looks back’ at the past year.  People we’ve lost in 2015. The 10 biggest news stories of 2015. The greatest gaffes of the past year. Stories that made us cry in 2015. Year-end magazine issues follow the same playbook. Whistleblower doesn’t look back.   Whistleblower Eschews Rear-view Mirror I suppose there is a public appetite for retrospectovision since, as we all know, the media’s mission is to serve up what we demand.  The newspaper adage, ‘if it bleeds, it leads’, is more a comment on us than it is on the journalism profession.  We are vampires who look to media for our next blood meal. Looking ahead is tougher since it’s quite a bit easier to chronicle known facts than it is to predict and guess.  But, isn’t this a more worthy task?  How do these story proposals grab you? People we’ll lose in 2016.  (Not serious, just want to assure you’re paying attention.)