Michael Kirsch, MD

Michael Kirsch is a gastroenterologist.

Enter a clinical trial because it helps others, not necessarily yourself

Physician

October 2, 2019

From time to time, I am asked by someone about participating in a medical research study. These situations are usually when an individual, or someone close to them, has unmet medical needs. Understandably, a patient with a condition who is not improving on standard treatment, would be amenable to participating in a clinical trial to receive experimental treatment.

I find that most folks misunderstand and exaggerate the benefits they may receive …

Doctors have little clue about what actually goes on in their colleagues’ offices

Michael Kirsch, MD

Physician

August 30, 2019

When I meet patients in the office, our conversations do not focus exclusively on the medical issue at hand. Of course, if you come to see me with a stomach ache, at some point, I will direct the dialogue toward your abdomen. Often, our conversations are far removed from livers and pancreases, and deal with more personal vignettes and anecdotes. Why does this happen? First, I enjoy it; and secondly, …

How have EMRs changed the doctor-patient relationship?

Michael Kirsch, MD

Tech

August 5, 2019

I have penned several posts on the pitfalls of the electronic medical record (EMR) system that we physicians must use. Indeed, I challenge you to find a doctor who extols the EMR platform without qualification. Sure, there are tremendous advantages, and the ease of use has improved substantially since it first came onto the scene. But, keep in mind that these systems were not devised and implemented because physicians demanded them. To the contrary, …

When colon cancer is diagnosed, it’s also a difficult day for the gastroenterologist

Michael Kirsch, MD

Conditions

July 15, 2019

Exercising good judgment can mean the difference between life or death. Life can be unforgiving of the choices we make. As we all know, many life events are beyond our control and understanding. But, there is much we can do to shape our paths to a brighter destination.

Consider some of the choices listed below that many folks make every day. Are any of them familiar to you?

Texting while driving.

…

The problem of physicians and nurses connecting patients with hospital fundraisers

Michael Kirsch, MD

Physician

July 3, 2019

Many organizations solicit private donations from benefactors and philanthropists. Is there a stadium in the country that does not bear the name of a prominent donor? There are also anonymous donors who are not cursed with egos that require their names to be emblazoned in giant font on a building’s façade. But, most donors want recognition which is often used as an incentive when soliciting the donation.

Donors understandably receive perks …

Why this physician will no longer see nursing home patients

Michael Kirsch, MD

Physician

June 28, 2019

Our practice will no longer see nursing home patients in our office. If a nursing home patient is already established with us, then we will see him; but, we have decided not to accept new patients.

Of course, we believe that these individuals — like the rest of us — deserve medical care. This demographic not only deserves care, but has the greatest need for medical services. Our practice will see …

Medical judgment: Healing demands more than knowledge

Michael Kirsch, MD

Physician

May 28, 2019

I’ve delved into the issue of medical judgment more than once. I have argued that sound judgment is more important than medical knowledge. If one has a knowledge deficit, assuming he is aware of this, it is easily remedied. A judgment deficiency, per contra, is more difficult to fix.

For example, if a physician cannot recall if generalized itchiness can be a sign of serious liver disease, he can look this …

Even the most seasoned patients are no match for the Medical Insurance Industrial Complex

Michael Kirsch, MD

Physician

May 19, 2019

“Does my insurance cover this?”

I cannot calculate how often a patient poses this inquiry to me assuming wrongly that I have expertise in the insurance and reimbursement aspects of medicine. If I — a gastroenterologist — do not even know how much a colonoscopy costs, it is unlikely that I can speak with authority to a patient’s general insurance coverage issues.

Of course, patients assume that we physicians have an expansive …

What distinguishes good physicians from truly seasoned medical professionals?

Michael Kirsch, MD

Physician

April 17, 2019

One thing that gastroenterologists know about is stool. But, I’m not referring to that kind of stool in this post. Follow along.

When we do a colonoscopy, for example, we are relying upon stool, or more accurately a stool, as in a three-legged stool. This metaphor illustrates that the three legs must be equally strong or the stool will not stand. The three pillars of support that a colonoscopist needs include:

Health insurance company denials make no sense

Michael Kirsch, MD

Physician

April 10, 2019

We do most of our colonoscopies in our ambulatory surgery center (ASC), which is attached to our office. We are proud of the work that we and our staff do every day and are grateful for the outstanding feedback that we consistently receive from our patients.

Some insurance companies will not cover procedures in our ASC so these patients must get “scoped” at the hospital instead. For many of them, this …

Will blockchain become the coin of the medical realm?

Michael Kirsch, MD

Tech

March 18, 2019

First, there was Bitcoin, a cryptocurrency that utilizes blockchain, a decentralized system of data collection and transactions that we are told will defy hacking. (Wasn’t the Titanic said to be unsinkable?) We read that cryptocurrency and other blockchain functions will be a societal gamechanger, much like the internet was when Al Gore invented it some years ago.

My state of Ohio will now accept Bitcoin as payment for commercial taxes.

And, of …

Will the public be able to resist the pitch from 23andMe?

Michael Kirsch, MD

Conditions

February 19, 2019

Just because something is legal, doesn’t make it right. Just because we enjoy a right of free speech, doesn’t mean we should be verbally insulting people. Just because the Food and Drug Administration (FDA) approves a treatment or a test, doesn’t mean we should pursue it.

The FDA has given approval to 23andMe, a private company, to provide genetic testing directly to individuals. The results provide genetic risks of contracting several …

How should salespeople sell to doctors?

Michael Kirsch, MD

Physician

January 21, 2019

Two device salesmen recently came unannounced to our small private gastroenterology practice. They were hawking a product that could quickly and non-invasively determine how much scar tissue had formed in a patient’s liver, a useful tool for assessing patients with hepatitis and many other liver conditions.

We are physicians, not entrepreneurs. We do not regard the colonoscope as a capitalist tool. Yet, these two salesmen were barraging us with facts and …

Read more…

How should salespeople sell to doctors?

How carefully do most patients or doctors read medical forms?

Michael Kirsch, MD

Physician

January 14, 2019

Does any living, breathing human believe that there is not enough paperwork in our lives? While we are all burdened, I believe that the medical profession is uniquely deluged with an absurd volume of documentation requirements, most of which should be filed under “N” for nonsense. Ask any physician or nurse about this and have antacids on hand as you will soon see some sizzling smoke emerging from the medical …

Seasoned medical professionals prescribe new medicines sparingly

Michael Kirsch, MD

Meds

December 31, 2018

I prescribe heartburn medicines every day. There’s a gaggle of them now — Prilosec, Nexium, Prevacid, Protonix — to name a few. As far as experts know, their primary effect is to reduce the production of stomach acid. This is why they are so effective at putting out your heartburn fire. In simple terms: no acid, no heartburn.

I am quite sure that well-meaning physicians like myself do not understand or …

Before undergoing a test, ask whether it will make a difference in your care

Michael Kirsch, MD

Conditions

December 7, 2018

Recently, a physician asked my opinion if a patient needed a colonoscopy. My partner was already on the case and I was covering over the weekend. The facts suggested that a colonoscopy was warranted. The patient had a low blood count and had received blood transfusions. Certainly, a bleeding site in the colon, such as a cancer, might be responsible. We do colonoscopies to address similar circumstances on a regular …

The nuance behind an insurance company denial

Michael Kirsch, MD

Physician

November 20, 2018

I just read of a a jury award in excess of $25 million against an insurance company who denied a recommended cancer treatment to a patient who ultimately died. I do not wish to review here the particulars of this case, and admit that my knowledge is limited by one news report that I read. While I will not invoke the ubiquitous phrase “fake news,” I always bring some …

When diagnosing colon cancer isn’t in a patient’s best interest

Michael Kirsch, MD

Conditions

October 15, 2018

So much of life depends upon timing. Sure, we plan, but we know how much of our life’s events are unplanned and unexpected. So often, our jobs and our mates — two of our most defining accomplishments — are the result of a chance encounter or a random act. Life does not reliably proceed in an orderly manner.

This is often true in the medical profession. Here, physicians in our quest …

Do opioid contracts harm the doctor-patient relationship?

Michael Kirsch, MD

Conditions

October 10, 2018

A contract is an agreement stipulating the rights and obligations of the signatories. In most cases, a contract is consulted when a dispute arises. When all is proceeding swimmingly, the contract remains dormant in a file drawer or in a digital file. In general, decent people resolve differences in the old-fashioned way utilizing the twin arcane legal techniques of reasonableness and compromise. Remember them? Yes, it is possible to settle …

Will artificial intelligence ever replace doctors?

Michael Kirsch, MD

Tech

September 24, 2018

Increasingly, we see functions executed by machines that were formerly performed by living breathing human beings. Examples range from the mundane to the preternatural.