Michael Kirsch, MD

Michael Kirsch is a gastroenterologist.

Why this gastroenterologist decided to treat hepatitis C patients

Conditions

August 24, 2018

In a prior post, I shared my heretofore reluctance to prescribe medications for my hepatitis C (HCV) patients. In summary, after consideration of the risks and benefits of the available options, I could not persuade myself — or my patients — to pull the trigger. These patients were made aware of my conservative philosophy of medical practice. I offered every one of them an opportunity to consult with another …

The misguided expectation of eliminating pain

Michael Kirsch, MD

Physician

July 31, 2018

I am against all forms of bodily pain, both foreign and domestic. I wish the world were pain-free. When I am suffering from even a routine headache, I want immediate relief just like everyone else. The medical approach to pain control has changed dramatically even during my own career. When I started practicing a few decades ago, the strategy was pain reduction. We gave narcotics for very few indications such …

A health insurer’s true motives

Michael Kirsch, MD

Physician

July 17, 2018

A patient came to see me with lower abdominal pain. Was she interested in my medical opinion? Not really. She was advised to see me by her gynecologist who had advised that the patient undergo a hysterectomy. Was this physician seeking my medical advice? Not really. Was this patient coming to see me as her day was boring and she was bored and needed an activity? Not really. After the …

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A health insurer’s true motives

Which of these patients should get a liver transplant?

Michael Kirsch, MD

Conditions

July 7, 2018

People with liver failure and cirrhosis die every year because there are not enough livers available. Who should receive the treasured life-saving organ? There is an organ allocation system in place, which has evolved over time, which ranks patients who need liver transplants. Without such a system, there would be confusion and chaos. How can we fairly determine who should receive the next available liver? What criteria should move a …

Restricting opioid prescribing: Some error has to be tolerated

Michael Kirsch, MD

Conditions

June 27, 2018

I have written previously about the raging opioid epidemic in Ohio. Attacking and reversing this tidal wave will require many weapons, resources and time. Opioid addiction is a crafty and elusive adversary that will be difficult to vanquish. Our battle plan will have to be nimble and adjusted over time, much as military leaders must do in actual armed conflict.

Here in Ohio and elsewhere, physicians must abide by new …

It’s always easier to judge someone’s failures from higher ground

Michael Kirsch, MD

Policy

June 18, 2018

We’ve all heard the excuse or explanation that “it’s society’s fault,” to explain someone’s failure. We hear expressions like this often when an individual has committed a crime or simply failed to succeed. Personal accountability is diluted as we are told that this person came from an imperfect home, had no role models or ample education.

These arguments are often wielded by those who have been favored with society’s blessings and …

A surprising cause of rectal bleeding

Michael Kirsch, MD

Conditions

May 2, 2018

“I can’t stand the site of blood!”

We’ve all heard that adage. Blood can provoke emotional reactions from even steely muscle-bound bodybuilders. We gastroenterologists routinely receive fearful phone calls from patients who have observed even minor rectal bleeding. Fortunately, in most of these cases, there is a benign explanation for the sanguinary seepage.

If blood repels you, then gastroenterology should not be on your short, or even long list of professions under …

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A surprising cause of rectal bleeding

The intensity of EMR warnings: Who do they really help?

Michael Kirsch, MD

Tech

April 22, 2018

Eons ago, there was a television show where a non-human character would yell out, “Warning, warning,” when he sensed imminent danger. The series was called Lost in Space where we were entertained by a set of quirky characters on a cheesy set. We loved that stuff. It’s hard to imagine today’s millennials and younger folks being transfixed, as we were, with the deep television dramas of our day. Who could …

The follies of health insurance preauthorization

Michael Kirsch, MD

Physician

April 10, 2018

A few weeks ago, I saw a patient some gastro issues. So far, nothing newsworthy here since I am a gastroenterologist. I ordered a CT scan colonography, a special CT scan that is designed to view the colon in detail. It’s the CT scan version of a colonoscopy. Why didn’t I simply perform a colonoscopy, which, unlike a CT scan, would contribute to my retirement fund? That’s an easy one. …

Solving the problem of non-emergent care in the emergency department

Michael Kirsch, MD

Policy

March 22, 2018

I recently opined about a decision by Anthem to deny paying for emergency room (ER) care that it deemed to be non-emergent. My point was that insurance companies should not be obligated to pay for routine, non-emergent care, recognizing that we need a fair and reasonable method to define a medical emergency. In my view, payment should not be denied to a patient who reasonably believes he needs ER care, even …

Denying payment for emergency care: a physician defends insurers

Michael Kirsch, MD

Policy

March 14, 2018

We live in an era of demonization. Political adversaries are not opponents; they are villains. Commentary that contrasts with our views is labeled”fake news.” Presumption of innocence? R.I.P. Civil discourse has become a quaint memory. Why would one debate respectfully when today’s tactic is to talk over and demean your adversary?

On the morning that I prepared this post, I read an article reporting that one of Ohio’s largest insurance companies, Anthem, is denying payment for non-emergency …

Diagnosing the president disrespects those who truly have mental illnesses

Michael Kirsch, MD

Conditions

January 23, 2018

Many of my readers do not know who Barry Goldwater was, let alone of the Goldwater Rule established by the American Psychiatric Association in 1973. The rule advises against psychiatrists commenting on the mental health of public figures they have not examined. Obviously, a psychiatrist or any physician who has treated a public figure is prohibited to offer any public comment unless he has been authorized by the patient to …

Is autonomy really better for patients?

Michael Kirsch, MD

Physician

December 15, 2017

It used to be that doctors knew best. We told you what to do, and you obediently complied. The world has changed, and the paternalistic system of yore has given way to the shared decision model where patient autonomy is respected.

The old way: “Well, I’ll be setting you up for surgery soon.”

The new and improved way: “Let’s discuss all of the reasonable options with their respective advantages and drawbacks. Then, …

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Is autonomy really better for patients?

When EMRs crash: It’s time to push back

Michael Kirsch, MD

Tech

December 3, 2017

The computerized era has introduced all of us to a genre of errors that never existed during the archaic pen and paper era. The paper medical chart I used during most of my career never “crashed.” Now, when our electronic medical records (EMR) freezes, malfunctions, or simply goes on strike, our office is paralyzed. Although I appear to the patients as a breathing and willing medical practitioner, I might as …

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When EMRs crash: It’s time to push back

Who’s responsible for polypharmacy in the elderly?

Michael Kirsch, MD

Meds

November 20, 2017

There’s a common affliction that’s rampant in my practice, but it’s not a gastrointestinal condition. It’s called polypharmacy, and it refers to patients who are receiving a pile of prescription and other medications. I see this daily in the office and in the hospital. It’s common enough to see patients who are receiving 10 or more medications, usually from 3 or 4 medical specialists.

Of course, every doctor feels that he …

The rise of patient navigators is a sign that medical billing needs to be reformed

Michael Kirsch, MD

Physician

November 12, 2017

To accomplish certain tasks, we need a little help from our friends. No one can do it all, although many of us are more resourceful than others. Some folks are adventurous and dive into a new arena with excitement. They may be tinkerers who aren’t afraid to play with new gadgets. Sure, they might break some china, but they are apt to widen their skill set and enrich their lives. …

Most of the documentation physicians perform don’t help patients

Michael Kirsch, MD

Physician

November 3, 2017

Let me post a question that neither I nor readers can answer: How much of what I do during the course of a day directly benefits patients?

Perhaps, I don’t want to really know as I would be dismayed at how much of my effort benefits no one. Ask a nurse who works on a hospital ward, how much of his or her effort is directly applied to patient care. I would …

C. difficile: We are not winning the war against this cunning adversary

Michael Kirsch, MD

Conditions

October 27, 2017

If any reader has heard of C. difficile, affectionately known as C. diff, then I presume you have had closer contact with this germ than you would have liked. It’s an infection of the colon that can be serious, or even fatal. There isn’t a hospital in the country that isn’t battling against the infection.

We are not winning the war against this crafty and cunning adversary.

While the infection is not …

Why are you seeing the gastroenterologist?

Michael Kirsch, MD

Physician

October 18, 2017

Gastroenterologists, as specialists, are called upon by other doctors to address digestive issues in their patients. For example, our daily office schedule is filled with patients sent by primary care physicians who want our advice or our technical testing skills to evaluate individuals with abdominal pain, bowel issues, heartburn, rectal bleeding and various other symptoms. The same process occurs when we are called to see hospital patients. If a hospital …

The cost of drugs confounds this gastroenterologist

Michael Kirsch, MD

Meds

September 25, 2017

Most of us do not know the basics of economics, although we should. It impacts every one of us every day that we are alive. Yet, for most of us, once we get beyond the law of supply and demand, our knowledge of the subject starts to vaporize. I can’t explain fiscal or monetary policy. While I regard economics as a science, it seems that experts routinely interpret data differently, …

Michael Kirsch, MD

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