Michael Kirsch, MD

Michael Kirsch is a gastroenterologist.

After a $417 million judgment: What should corporations do?

Physician

September 3, 2017

I have written about talcum powder previously. Indeed, I have not only opined on the slippery substance, but I am also a regular consumer of the product. Talcum powder has become magic legal dust that brings forth zillions of dollars to those who have been attacked by the poisonous toxin.

Just last year, I informed readers of $55 million and $72 million judgments to cancer victims who used powder against …

The risk that genetic engineering will be used to achieve non-medical results

Michael Kirsch, MD

Conditions

August 12, 2017

We cannot let the anecdote rule over us. We don’t make sound policy if we are swayed by isolated emotional vignettes. Of course, a vignette describes a living, breathing human being, but we must consider the greater good, the overall context and the risk of letting our hearts triumph over our heads when making general policy. Consider these examples.

If an expensive drug treatment program keeps five addicts clean for six …

When it comes to after-hours care, expectations need to be adjusted

Michael Kirsch, MD

Physician

July 31, 2017

Today’s patients must adjust to seeing many physicians, many of whom are strangers. If you need a doctor on the weekend, at night or just need a same day appointment, you may very well not be seen by your physician. This is not your father’s medical practice. The days of the physician house call have vanished. There are many reasons responsible for this evolution (or devolution) in medical care. Patients …

Why this physician doesn’t prescribe pain medications

Michael Kirsch, MD

Meds

July 18, 2017

It may seem strange that a gastroenterologist like me does not prescribe pain medicines.

Let me rephrase that. I don’t prescribe opioids or narcotics. I write prescriptions for so few controlled substances that I do not even know my own DEA number. You might think that a gastroenterologist who cares for thousands of patients with abdominal pains would have a heavy foot on the opioid accelerator. But, I don’t. Here’s why.

I …

When your doctor’s computer crashes

Michael Kirsch, MD

Tech

July 7, 2017

Earlier this week, as I write this, our office lost a skirmish against technology.

It was my procedure day, where lucky patients file in awaiting the pleasures of scope examinations of their alimentary canals. A few will swallow the scope (under anesthesia), but most will have back-end work done. We are a small private practice equipped with an outstanding staff. We do our best every day to provide them with the …

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When your doctor’s computer crashes

Is there a medication that can combat rigid and robotic thinking?

Michael Kirsch, MD

Meds

May 29, 2017

I had an interesting conversation with a patient in the office some time ago.

He was sent to me to evaluate abnormal liver blood tests, a common issue for gastroenterologists to unravel. I did not think that these laboratory abnormalities portended an unfavorable medical outcome. Beyond the medical issue, he confided to me a harrowing personal tribulation. Often, I find that a person’s personal story is more interesting and significant than …

This physician won’t tell his alcoholic patients to stop drinking. Here’s why.

Michael Kirsch, MD

Physician

May 19, 2017

When I am facing an alcoholic in the office, I do not advise him to stop drinking.

Other physicians may advocate a different approach. We live in a free society and individuals are free to make their own choices. I have decided, for example, not to own a firearm, ride a motorcycle or bungee jump as these activities are not only beyond my risk tolerance threshold, but are also activities that …

Physicians are under no professional obligation to provide care that is futile

Michael Kirsch, MD

Physician

May 12, 2017

I was covering for my partner over the weekend and saw his patient with end-stage liver disease, a consequence of decades of alcohol abuse.|

He was one of the most deeply jaundiced individuals I have ever seen. His mental status was still preserved. He could converse and responded appropriately to my routine inquiries, although he was somewhat sluggish in his thinking. It’s amazing that even after the majority of a liver …

The sad reality that medical consultants face

Michael Kirsch, MD

Physician

May 6, 2017

What should a medical consultant do when the referring physician wants a procedure that the consultant does not favor?

Of course, this sounds like a layup. The consultant, readers would surmise, should have a conversation with the referring colleague to explain why the procedure is not in the patient’s interest. The colleague then thanks the consultant for his thoughtful input, and for sparing the patient from the risks and expense of …

Your on-call doctor probably didn’t receive training in telephone medicine

Michael Kirsch, MD

Physician

May 3, 2017

Physicians spend a lot of time counseling patients on the phone. Often, these conversations occur at night with patients we have never met before. When I am on-call in the evenings or on the weekends, these are some typical phone calls I receive from patients I have never met.

I have a very bad stomach ache for the last hour.
I started having rectal bleeding an hour ago.
My wife tells …
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Your on-call doctor probably didn’t receive training in telephone medicine

Doctors have First Amendment rights too

Michael Kirsch, MD

Physician

April 28, 2017

Free speech is one of our bedrock constitutional rights. The battle over what constitutes lawful free speech is ongoing. But the issue is more complex than I can grasp with legal distinctions separating political speech, commercial speech and noncommercial speech. And, of course, the right of speech does not permit the free expression of obscenity or “fighting words” along with some other exclusions.

There is no right to free speech in …

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Doctors have First Amendment rights too

Before you join a clinical trial: Read this first

Michael Kirsch, MD

Physician

April 11, 2017

From time to time, friends, patients, and relatives ask my advice on participating in a medical experiment. My response has been no. More accurately, once I explain to them the realities of research, they don’t need to be persuaded. They back away.

Here’s the key point. When an individual volunteers to join a research project, the medical study is not designed to benefit the individual patient. This point is sorely misunderstood …

Drugs shouldn’t be this expensive

Michael Kirsch, MD

Meds

April 7, 2017

Why are the costs of prescription drugs so high? While I have prescribed thousands of them, I can’t offer an intelligent answer to this inquiry. Of course, all the players in this game — the pharmaceutical companies, pharmacy benefit managers, insurance companies, consumer activists and the government — offer their own bromides, where does the truth lie?

While I don’t fully understand it, and I don’t know how to fix it, …

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Drugs shouldn’t be this expensive

Doctors: Be careful, your words matter

Michael Kirsch, MD

Physician

March 14, 2017

Here’s a quote that readers will not readily recognize: “It is a pity that a doctor is precluded by his profession from being able sometimes to say what he really thinks.”

I’ll share the origin of the quote at the post’s conclusion. How’s that for a teaser? I’ll give you a hint below.

Physicians, by training and experience, are guarded with our words. To begin, we are never entirely sure of anything, …

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Doctors: Be careful, your words matter

Should patients order their own lab tests?

Michael Kirsch, MD

Physician

February 16, 2017

Knowledge is power. Increasingly, patients are demanding and receiving access to levers in the medical machine that would have been unthinkable a generation ago. The informed consent process, which I support, can overwhelm ordinary patients and families with conflicting and bewildering options.

Television and the airwaves routinely advertise prescription drugs directly to the public. Consider the strategy of direct-to-consumer drug marketing when millions of dollars are spent advertising a drug that …

Disclaimer! Caution: There’s too much information

Michael Kirsch, MD

Physician

January 2, 2017

Even though I am over 40 — by a long shot — I am familiar with the abbreviation TMI. Today, we are inundated with so much noise, chatter and static. I feel that we are bombarded with information that we must sift through and ultimately delete. The news cycle is 24 hours and hits us from so many electronic sources simultaneously. I am deluged each day with so many unwanted …

Why can’t we control outrageous health care costs?

Michael Kirsch, MD

Physician

December 14, 2016

Most of us are skeptical that insurance companies are devoted to our health. Answer the following question: Do you think your insurance company is more interested in your health or in controlling costs?

Pretty tough, huh?

There is a tension between medical quality and medical costs. If we had a system that offered perfect quality, it would be unaffordable. If we imposed rigid cost controls, then medical quality would be compromised. Where …

Are doctors the new drug dealers?

Michael Kirsch, MD

Meds

November 18, 2016

I have written about pain medicine, previously on this blog, and it generated some spirited responses. Let me be clear that I am completely against all forms of pain, whether foreign or domestic, physical, spiritual, psychic or even phantom. The medical profession has superb tools to combat and relieve pain, and physicians should utilize them, within the boundaries of appropriate use. We now have an actual specialty — …

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Are doctors the new drug dealers?

Flash sale: A $49 colonoscopy

Michael Kirsch, MD

Physician

November 10, 2016

Cleveland took a major economic hit a few years back when United Airlines cut most of its flights from our city. An airport is the heart of a metropolis. Lack of direct flights means that business meetings, leisure travel, conventions and trade shows will likely opt for more convenient locales. This was a business decision for United which I am sure was rational. Nevertheless, their gain was our loss.

As a …

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Flash sale: A $49 colonoscopy

We are not taking care of nurses. Who will heal the healers?

Michael Kirsch, MD

Physician

October 3, 2016

On the day that I penned this post, I rounded at our community hospital. My first patient was in the step-down unit, which houses patients who are too ill for the regular hospital floor. I spoke to the nurse in order to be briefed on my patient’s status. I learned that this nurse was assigned six patients to care for — an absurd patient volume for a step-down unit.

“Why so …

Michael Kirsch, MD

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