I have already opined on my disapproval of a medical marijuana law recently passed in Ohio. Once of my points in that piece is that I did not want legislators making medical decisions for us. They can’t even do their own jobs.
I am not against medical marijuana; I am for science. The currency of determining the safety and efficacy of a medicine should be medical evidence, not faith, …
This doctor is against medical marijuana. Here’s why.
Years ago on Cape Cod, my kids and I stumbled across a man who had spent the day creating a sand sculpture of a mermaid. It was an impressive piece of art.
“How long did it take you to make it?” we asked. While I can’t recall his precise words, the response was something like “25 years and 7 hours.” I’m sure my astute readers will get his point.
We are transfixed …
If you think doctors make too much money, think about this
Even the most honest among us do not tell the truth all of the time. We are flawed human beings. We covet, we gossip, we steal, we lie, and we stand idly by. You don’t think you steal? Have you ever “borrowed” someone else’s idea and represented it as your own?
A few weeks before I penned this, I was presented with two opportunities to lie in order to save a …
When should physicians lie for patients?
“There are three kinds of lies: lies, damned lies, and statistics.”
There is much truth in this quotation of uncertain provenance. We see this phenomenon regularly in the medical profession. We see it in medical journals when statistics are presented in a manner that exaggerates the benefit of a treatment or a diagnostic test. Massaging numbers is raised to an art form by the pharmaceutical companies who will engage in numerical …
Patients are deceived by the slick presentation of statistics
Like nearly every gastroenterologist, we have an open access endoscopy system. This means that patients can be referred, or refer themselves, directly to our office for a a procedure without an office visit in advance.
Why do we do this? We offer it as a convenience, so patients do not need to make two visits to see us when it is clear that a procedure is necessary. For example, a referring …
Open access endoscopy raises potential ethical issues
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 …
The duel between documentation and doctoring is being won by the wrong side
Of course, patients are entitled to medical care around the clock. You would not expect to show up at 2 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 …
How can we take care of patients we have never seen?
There was a tragedy in France recently: 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 …
Are volunteer study patients making a free choice?
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 …
Fix high-deductible health insurance. But it won’t be easy.
Years ago, I was having dinner with two 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, …
Do physicians who go on long vacations lose their skills?
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 …
Don’t rely on Google for medical judgment
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 …
Is it the doctor’s fault if a patient doesn’t want to come in?
Over the years, I have heard families bemoan that their relative who was just readmitted to the hospital was sent home too early just a few days ago. Are they right?
First, let me say that in some instances they may be correct. It is certainly possible that the hospital, under increased pressure to kick folks out, may have pulled the discharge trigger too soon. The hospital is not always right …
Discharged too early? The decision is more complicated than you think.
Gluten is in the news again. Gluten and probiotics are among the two dietary issues that most consume my patients. I am asked for my opinion on them several times each week. Although my opinion is solicited, these patients have largely already made up their own minds as they are often avoiding gluten and swallowing zillions of “good bacteria” with zeal and enthusiasm.
Why do they do this in the absence …
Cheerios recalled for not being truly gluten free. An overreaction?
Patients are cool. I did a colonoscopy on a hospitalized man who was saddled with the ravages of obesity, diabetes, sleep apnea and respiratory disease. My partner had performed the initial consultation, and it was my task to bring light into a dark place by performing a colonoscopy. I engaged in some conversation prior to the procedure, not simply to acquire relevant medical facts, but also to establish some rapport …
The people who changed the world may surprise you
Doctors do not know everything. We make mistakes and mistakes in judgment. Sometimes we make the mistake of speaking when we should keep silent. At times, patients ask us questions that we can’t or shouldn’t answer; and yet we do. It shouldn’t be our objective to force certainly into an issue that is amorphous and murky.
Here’s a response that I recommend in situations where certainty is elusive.
“I don’t know.”
I saw …
What to say when medical certainty is elusive
Patients are entitled to receive medical advice 24 hours a day. If you call your doctor at 3 a.m., you will reach a physician who will advise you. Of course, it may not be your own personal physician as this individual cannot be expected to be available 365 days a year until he retires. Physicians partner with colleagues who share on-call responsibility …
You have access to a doctor 24 hours per day. When should you call one?
Every week, I am asked by patients if their heartburn medicine causes osteoporosis. The most effective heartburn medicines are called proton pump inhibitors, or PPIs. If you watch more than an hour of TV per week, then you have seen ads for some of them. Nexium, Prilosec, and Protonix are three examples of these medicines.
Many of them are now available over-the-counter at reduced dosages.
Patients today are incredibly informed, and sometimes …
Do heartburn drugs cause osteoporosis? A gastroenterologist answers.
Racism and prejudice are endemic in America. Many of us reflexively answer, No, if we are asked if we are prejudiced. I don’t. I say yes.
While I do my best to give everyone a fair shake, I grew up in a white suburban family in the latter decades of the last century. My friends, my parent’s friends and all those we …
Racism in physicians: It’s not a black or white issue
I was asked to consult on a 43-year old female with abnormal liver blood test results. It took but a few minutes to determine that she was an alcoholic, which was the likely explanation for her abnormal blood results. She drank several beers daily over several years.
My diagnosis was alcoholism, but did the patient concur?
“Do you feel that you are drinking …
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