Michael Kirsch, MD

Michael Kirsch is a gastroenterologist.

Doctors are hammers. Don’t automatically be their nails.

Physician

September 20, 2014

Is your doctor a hammer and you’re a nail? Here’s some insider advice coaxing patients to be more wary and skeptical of medical advice. Should you trust your doctor? Absolutely. But you need to serve as a spirited advocate for your own health or bring one with you. Ask your physician for the evidence. Sometimes, his medical advice may result more from judgement and experience as there may not be …

Is much of the annual physical a waste of time?

Michael Kirsch, MD

Physician

September 2, 2014

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So much in medicine and in life is done out of habit. We do stuff simply because that’s the way we always did it. Repetition leads to the belief that we are doing the right thing.

In this country, we traditionally eat three meals each day. Why not four or two?

We prefer soft drinks to be served iced cold. I’ve never tried …

The consequences of prohibiting physicians’ free speech

Michael Kirsch, MD

Physician

August 26, 2014

I’m all for free speech and I’m very hostile to censorship. The response to ugly speech is not censorship, but is rebuttal speech. Of course, there’s a lot of speech out there that should never be uttered. Indecent and rude speech is constitutionally protected, but is usually a poor choice. We have the right to make speech that is wrong.

I relish my free speech in the office with patients. I …

Drug testing doctors: Will Californians see through the smoke?

Michael Kirsch, MD

Physician

August 16, 2014

California is contemplating requiring physicians to submit to alcohol and drug testing. Citizens there will be voting on this proposal this November. I do think that the public is entitled to be treated by physicians who are unimpaired. Physicians, as members of the human species, have the same vices and frailties as the rest of us.

I have no objection to this new requirement, if it passes. This will not be …

Are you a medical liberal or a conservative?

Michael Kirsch, MD

Meds

August 9, 2014

Our nation is highly polarized today, and often bitterly so. Democrats rail against the GOP. Pro-lifers face down pro-choicers. Fox News disses MSNBC. Isolationists push back against expansionists. Traditionalists disdain the politically correct. Free marketers duel against government advocates. Carnivores deride the gluten-free crowd. Martin Bashir trashes Sarah Palin, two proxies in a culture war.

There’s a philosophical divide among physicians also. Would you prefer a liberal physician or a conservative …

Law and medicine are more intertwined than they should be

Michael Kirsch, MD

Physician

August 1, 2014

I’m a law abiding blogger. Laws are meant to be obeyed. If an individual opposes a law in a free country, then he should operate within the system to modify it. I recognize that even in free societies, certain laws are so unjust and in violation of natural law that that the citizenry may be justified in relying upon other measures to affect necessary reform.

I’m not suggesting that an unwelcome …

Sometimes there is no substitute for a face to face visit with a doctor

Michael Kirsch, MD

Physician

July 24, 2014

A 32-year-old woman recently came to see me for an opinion on stomach pain. Why would I refuse to see her again? Abdominal pain is an everyday occurrence for a gastroenterologist. She was accompanied by her mother. I had never met this woman previously.

She had suffered abdominal pains for as long as she could remember. She recalled frequent visits with the school nurse when she was a young girl.

She has abdominal distress …

Medical judgment is paramount

Michael Kirsch, MD

Physician

July 16, 2014

The world is asunder. Iraq is sinking into a sectarian abyss. ISIS, a terrorist group, now controls a larger territory than many actual countries. Russia has swallowed Crimea and has her paw prints all over eastern Ukraine. China is claiming airspace and territories in Southeast Asia increasing tensions with Japan, Vietnam and the Philippines. The Israeli-Palestinian peace process is in another deep freeze. Terrorists in Sudan and Nigeria are kidnapping …

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Medical judgment is paramount

Guessing if medications are covered by a patient’s insurance company

Michael Kirsch, MD

Meds

July 7, 2014

One of the frustrating aspects of medical practice is trying to decide if the medication I am prescribing is covered by the patient’s insurance company. Even with the advent of electronic medical records, which should be able to determine this, we are often left to hope and pray.

Here’s how it works. Individual insurance companies have formularies — lists of approved drugs — that they encourage patients and their physicians to use. …

Pay-for-performance is all about cost control

Michael Kirsch, MD

Policy

June 19, 2014

If you read my articles, then you likely know about the scam known as pay-for-performance (P4P). This program not only fails to deliver on its stated mission to improve medical quality, but it actually diminishes it.

In short, P4P pays physicians (or hospitals) more if certain benchmarks are met. More accurately, those who do not achieve these benchmarks are penalized financially. I do not object to this concept. Folks who perform …

Why the ER admits too many patients

Michael Kirsch, MD

Physician

June 6, 2014

Every player in the medical arena has found itself challenged by conflicts where one’s self-interest competes can skew what should be pure advice. This issue is not restricted to the medical universe. Every one of us has to navigate through similar circumstances throughout the journey of life. If an attorney, for example, is paid by the hour, then there is an incentive for the legal task to take longer than …

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Why the ER admits too many patients

Maybe doctors should have disclaimers

Michael Kirsch, MD

Physician

May 27, 2014

Why does is seem that so much information given to us comes with disclaimers? The weight loss product ads on TV that promise more than they will deliver, are always accompanied by 5 nanosecond disclaimers in a font size that can’t be discerned by the human retina stating that the results are not typical.

It seems deceptive to be advertising a product by showcasing a performance that the vendor admits is …

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Maybe doctors should have disclaimers

Our broken medical malpractice system from a moral perspective

Michael Kirsch, MD

Physician

May 7, 2014

Remember personal responsibility? There actually was an era of responsibility when folks admitted when they screwed up and didn’t blame others for their own mistakes. I know this may seem incredible to the younger generation who simply assume that when something goes wrong today, it must be someone else’s fault. In today’s culture, this is not scapegoating, but the pursuit of justice. Welcome to the era of big victim.

In the …

Tort reform should not be controversial

Michael Kirsch, MD

Physician

April 23, 2014

I’ve been in the medical malpractice arena many times, and always walked away unharmed. If this system were presented in front of a fair minded and impartial jury, it would be dismantled. Sure, there are positive elements present, but they are dwarfed and suffocated by the drawbacks. The self-serving arguments supporting the current system are far outweighed by the financial and emotional costs that innocent physicians unfairly bear. Tort reform …

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Tort reform should not be controversial

When a pseudoscientific remedy makes a patient feel better

Michael Kirsch, MD

Conditions

March 26, 2014

Readers know that I am skeptical over the efficacy of complementary and alternative medicine. This is not merely a demonstration of my inborn skepticism, but doubt based on the fact the so much of their claims are untested, unproven and refuted.

I don’t regard the above comment as controversial. It is factual. I’ll let readers decide if it is but another example of the arrogance of conventional physicians who worship on …

Treating a symptom is not the same as treating a disease

Michael Kirsch, MD

Conditions

March 6, 2014

Physicians and patients collaborate to treat symptoms. This is not newsworthy and even sounds appropriate. Isn’t that what doctors are trained to do? It is but I’m not sure this should be a central focus of our healing mission. Treating a symptom is not the same as treating a disease.

For example, if an individual is having abdominal discomfort, pain medicine should not be the first responder, even if this would …

Save mammography or save women? Supporters face a quandary.

Michael Kirsch, MD

Conditions

February 25, 2014

Sometimes, we play a little politics on this blog. I am a student of current events and enjoy following the dysfunction and absurdities in American politics. To paraphrase the legendary former British prime minister, “never has so little been done by so many to benefit so few.”

Readers know how skeptical I am about medical dogma. When I was an intern a quarter century ago, I didn’t grasp why routine measurement …

A 2 question strategy to assess the worth of medical tests

Michael Kirsch, MD

Conditions

February 13, 2014

In the medical world, when a physician, a scientist, a hospital, a drug company or a panel of experts issues a report, the games begin. If one agrees with the statement or benefits from it, then the report is heralded as breakthrough brilliance.

If, however, the report suggests a new medical pathway that diminishes your relevance or reimbursement, then the report and its authors are regarded as misguided. Yes, I am …

Should this Jehovah’s Witness be transfused?

Michael Kirsch, MD

Conditions

February 5, 2014

Autonomy is a bedrock ethical principle in medicine that has supplanted medical paternalism. Patients have a right to make their own medical decisions and are entitled to know the advantages and drawbacks of all reasonable options. Clearly, informed consent cannot be given if the patient is only partially informed or has been given a slanted presentation by the physician.

When a patient does not have the capacity to provide consent, then …

When patients are late: Should doctors charge extra?

Michael Kirsch, MD

Physician

January 29, 2014

While patients and physicians operate under oral agreements, business agreements are generally established in writing. In these documents, terms are outlined including contingencies in the event that foreseeable obstacles or disputes develop. Oftentimes, the two parties do not agree that a contractual term has been violated. This is when the fun begins. With a little luck, the legal profession enters the arena and can speedily resolve the disagreement in a …

Michael Kirsch, MD

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