Readers know that I am a conservative practitioner. I rail against overdiagnosis and overtreatment. Less medicine results in more healing and protection. In an example, I have explained previously why I advise patients not to undergo total body scans, despite the lure that they offer a cancerophobic public.
I’ve never undergone a CXR in my life. I’ve never entered medicine’s tunnel of …
Don’t make waiting for the doctor a stress test
While I consider myself to be an ethical practitioner, I am not perfect, and neither is the medical profession. I will present a recurrent ethical dilemma to my fair and balanced readers and await their judgment.
Our gastroenterology practice, like all of our competitors, has an open access endoscopy option. This permits a physician to refer a patient to us for a colonoscopy, without the need for an initial office visit.
Patients …
The potential pitfalls of open access endoscopy
Practicing physicians like me rely on up scientific medical journals to keep us current on medical developments. We learn about new treatments for old diseases. New diagnostic tests are presented as alternatives to existing methods. Established treatments, which are regarded as dogma, may be shown to be less effective or less safe than originally believed. It’s a confusing intellectual morass to sort among complex and conflicting studies some of which …
When medical journals disagree: What’s a practicing physician to do?
Everyone likes to be recognized for a special achievement or accomplishment. Every career has special awards and commendations for everything. While there’s no reward that matches cold hard cash, many of these honorable mentions have no tangible value whatsoever. Pull into a fast food parking lot and you may see a parking space designated with a sign proclaiming, employee of the …
Getting congratulated on hand washing. Really?
Do you think that physicians’ advice should be based on their patients’ best interests? How about lawyers? Plumbers? Financial brokers?
An advisor who has what is termed a fiduciary duty is required to use the best interest standard with his client. For example, an attorney is prohibited from recommending that his client proceed to trial, which would be beneficial financially to the lawyer, if the attorney believes that a settlement serves …
Should physicians’ advice be based on patients’ best interests?
A female patient came to see me with some difficulty swallowing, a very routine issue for a gastroenterologist. I performed an scope examination of her esophagus and confronted a huge cancer occupying the lower portion of her esophagus.
I expected a benign explanation for her swallowing issue. She was relatively young and not particularly ill. She had seen my partner years in the past for a similar complaint, which he …
There’s nothing like discrimination — true or imagined — to keep our airwaves humming. Recently, Indiana and then Arkansas were media fodder for laws that were proposed to protect religious freedom. Yes, I know the other side of the argument, that these religious freedom protections were veiled attempts to discriminate against the LGBT community. Both states raced to revise their original laws, although the laws’ backers deny any discriminatory intent …
Does our mission to heal transcend personal beliefs?
I practice gastroenterology in Cleveland in the dark shadow of a large medical institution whose name contains the name of our city. They are a world class medical institution whose reputation is largely derived from its cardiovascular department. Presumably, these practitioners, like all doctors, advise patients who smoke that cigarettes have deleterious health effects. The entire campus is smoke-free, as …
Can hospitals tell workers not to smoke at home?
“Safety first” is a mantra of today’s hovering parents. It’s the default explanation that a parent invokes when an edict has been issued that cannot be challenged or reversed.
“Mommy, can I please have a water pistol?”
“I’m sorry, honey. You know how Daddy and I feel about guns. This is a safety issue. Now go and practice your violin and afterwards help yourself to some kale chips.”
The safety concept has crept …
Feeding tubes and the culture of patient safety
Many of my patients are taking herbal supplements, or so they think. This herbal and health supplements industry likely is envied by traditional pharmaceutical companies. The latter has to spend zillions of dollars proving safety and efficacy to the Food and Drug Administration (FDA). Many of these drugs are cast aside during the approval process or afterwards when serious side effects become known, or a new medicine is proved safer …
Herbal supplements: What are you really taking?
How many times each week do we hear the phrase, “If you’re not completely satisfied, we’ll refund the purchase price — no questions asked.”
This is more often a marketing ploy than a true money-back guarantee. I have a sense that trying to obtain a promised refund on an item that dissatisfied us is about as easy and carefree as changing an airline ticket reservation or reaching a live human when …
Should doctors offer a money-back guarantee?
I just deposited a check into my bank account by photographing the check with my iPhone and zapping it through cyberspace. I realize this is ho hum to the under 35 crowd. Soon, there won’t be any paper checks as the entire transaction will occur electronically. As a member of the over 35 crowd (plus 20 years), I am wowed by this process. I remember being astonished when my kids …
Mobile health: Just because we can do it doesn’t mean we should
I see patients with abdominal pain every day. Over my career, I’ve sat across the desk facing thousands of folks with every variety of stomach ache imaginable. I’ve listened to them, palpated them, scanned them, scoped them and at times referred them elsewhere for another opinion. With this level of experience, one would suspect that I have become a virtual sleuth at determining the obvious and stealth causes of abdominal …
How much testing should you do in chronic abdominal pain?
Most of us reject the rational argument that better medical quality costs more money. Conversely, I have argued that spending less money could improve medical outcomes. Developing incentives to reduce unnecessary medical tests and treatments should be our fundamental strategy. Not a day passes that I don’t confront excessive and unnecessary medical care — some of it mine — being foisted on patients.
At one point in my career, I would …
Should doctors consider costs when making medical decisions?
We’ve all heard or used the phrase, “Leave it to the professionals.” It certainly applies to me as the only tools that I can use with competence are the scopes that I pass through either end of the digestive tunnel. Yeah, I have a toolbox at home, but it is stocked similarly to the first aid kit that your new car …
Get help: Most physicians are not good at business
A few days before I wrote this, a patient had a complication in my office. I have discussed previously the distinction between a complication, which is a blameless event, and a negligent act. In my experience, most lawsuits are initiated against complications or adverse medical outcomes, neither of which are the result of medical negligence. This is the basis for my strong belief that the current medical malpractice system …
When physicians need backup during a routine procedure
One catch phrase in health care reform is cost-effectiveness. To paraphrase, this label means that a medical treatment is worth the price. For example, influenza vaccine, or flu shot, is effective in reducing the risk of influenza infection. If the price of each vaccine were $1,000, it would still be medically effective, but it would no longer be cost-effective considering that over 100 million Americans need the vaccine.
Society could not …
Treating hepatitis C with Sovaldi: Is it worth it?
Giving prescription refills is not quite as fun as it used to be. Years ago, we doctors would whip out our prescription pads — often sooner than we should have — and we’d scribble some coded language that pharmacists were trained to decipher. I’m surprised there were not more errors owing to doctors’ horrendous penmanship. On occasion, the Food and Drug Administration (FDA) would require a pharmaceutical company to change …
Why your doctor won’t refill prescriptions over the phone
A medical student recently asked my advice on her decision to pursue a career in dermatology. It was about 25 years ago when my own parents encouraged me to pursue this specialty. What was their deal? Perhaps, they anticipated future developments in the field and were hoping for free Botox treatments? As readers know, I rejected the rarefied world of pustules and itchy skin rashes for the glamor of hemorrhoids, …
Should medical students consider lifestyle when choosing a specialty?
If you are a physician like me who performs procedures, then rarely you will cause a medical complication. This is a reality of medical life. If perforation of the colon with colonoscopy occurs at a rate of 1 in 1,500, and you do 3,000 colonoscopies each year, then you can do the math.
Remember that a complication is a blameless event, in contrast to a negligent act when the physician is …
Complications are a reality of medical life
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