Obamacare has promised to provide all of us with quality medical care that is affordable and accessible. The very name of the law is the Affordable Care Act, which I have maintained will be short on both affordability and quality care.
Most of the country agrees with me. The postponement for a year of the corporate mandate to provide insurance in businesses with at least 50 full time employees was a …
Everyone is familiar with the acronym HIPAA, which is the 1996 edict called the Health Insurance Portability and Accountability Act. Isn’t that a smooth and melodious name?
These are and regulations that are designed to protect your confidential protected medical information. I support the mission. I don’t think that your medical records should be deliberately or inadvertently shared with those who are not lawfully permitted to view them.
I had thought that apologizing was a straightforward act, but I now realize that it is a nuanced art form. We’ve all heard the “mistakes were made” version, usually issued by politicians who attempt to insert a layer of passive voice insulation between themselves and their screw-ups.
There is also the ever present conditional apology which by definition falls short of complete responsibility acceptance. The template here is: “I’m sorry for …
I’m sending a patient downtown to see a pancreatic expert. He’s a young man who didn’t fully appreciate the health risks of a former alcohol addiction. He’s been sober for well over a year, but alcohol toxicity can be unforgiving and permanent.
We don’t fully understand why some alcoholics develop cirrhosis and other complications while others seem to skate by without a scratch. While I want folks who have the strength …
Before Michael Jackson, most folks didn’t know what propofol was. Now, patients are asking me for it by name. It’s an awesome drug. It provides a beautiful sedation, is extremely safe and rapidly clears after the procedure. Under its effects, colonoscopy has become a sublime experience.
We administer it in a different manner than Conrad Murray did. For those who may have just awakened from a 5 year coma, Conrad Murray …
For most of us, we have never experienced the current pandemic of senseless violence that we read about and visualize every day. I challenge you to find a newspaper tomorrow morning, or listen to a news broadcast, that will not report on dark and pernicious inclinations and accomplishments of evil practitioners.
If that challenge is not sufficient, then find an American over the age of 70 to attest that the world …
Nearly every physician regards himself as an ethical practitioner. Nearly none of us are, at least not fully. There is no bright line that separates ethical from improper behavior. Indeed, it is because the boundary is fuzzy that ethicists and the rest of us wrestle with contentious controversies. It is, therefore, expected that ethicists are divided on many issues, much as the U.S. Supreme Court is often split in its …
Though I have been accused by various commenters as protecting my own specialty when I point out excesses, flaws and conflicts of interest in the medical profession, this accusation would be handily dismantled after a fair reading of prior posts. Indeed, my own specialty of gastroenterology and my own medical practice has felt the effects of the honed Whistleblower scalpel. If an individual or an institution will not willingly engage …
We gastroenterologists are regularly summoned to bring light into dark places. We are the enlightened ones who illuminate anatomical shadows. Sure, we have tunnel vision, but we like to believe that we can think broadly and creatively as well.
We are the scope doctors.
We are commonly consulted by primary care physicians and hospitalists to perform colonoscopies, upper endoscopies (EGDs) of the esophagus and stomach and other gastrointestinal delights. We deliver a …
Folks must think than all doctors know all things medical. I know this is true by the questions that I have been asked over the years. While my expertise spans hemorrhoids to heartburn, I am routinely queried on medical issues well beyond the specialty of gastroenterology. When I can’t answer questions about a new medicine for hypertension or if an MRI of …
Faith and reason entered my medical universe recently.
A patient underwent surgery to resect a colon cancer. The tumor had metastasized to the lymph nodes, an unfavorable prognostic event. The surgeon entered the room and advised the patient that her survival is likely limited to 1-2 years. The patient and her husband were devastated. The distraught husband spent the next 24 hours sobbing in a painful and despondent state. He related …
I’ve had two jobs since I completed a fellowship is gastroenterology over 20 years ago. For the first decade, I was a salaried physician. Afterwards, I promoted myself to private practice. Each model has its advantages and drawbacks, but for me the private practice model wins out. The climate in Cleveland is extremely inhospitable to private practice, because of two mega-medical institutions that incinerate private practices as their boiling …
I treat uninsured patients and insured folks who face high deductibles who are under financial strain because of the sagging economy and other personal pressures. These folks need care that may be unaffordable. Medical diagnostic testing is expensive. Even routine laboratory testing can be very costly as those without insurance may be forced to pay the ‘retail cost’, which is quite different from insurance company discounted pricing.
Over the course of a year, I have an alternating pattern of caffeinated coffee ingestion. As readers should know, I will not swallow Starbucks coffee as I do not think that I have sufficient stomach acid and other bodily defenses to successful prevail against this corrosive elixir. Of course, everything has a benefit if one is resourceful enough to discover it. For instance, I have found their coffee to be …
Professions that heretofore enjoyed public admiration for pursuing noble work and reputedly insisting on the highest ethical standards have been exposed. The Catholic church could write a few blog posts on this. Police officers, journalists and even teachers have also shown us that they are members of the human species and are subject to its weaknesses and frailties.
The fallacy is to expect certain professions and professionals to be more irreproachable …
I attended a medical staff meeting recently. These are required meetings and attendance is taken, as was done when we were in kindergarten. While some folks are interested in these meetings’ content, many are not and simply sign the attendance sheet and then slither out in a stealth fashion. Sly doctors grab their pagers and then leave hurriedly pretending that they were summoned to an urgent medical situation, when they …
One of the toughest parts of treating patients is managing their expectations. We wish that everyone could enjoy a perfect recovery with complete healing, but the medical profession is imperfect and life is unfair. Some folks cruise by decade after decade without a scratch, while others sag under the weight of chronic illnesses.
Accepting reasonable expectations can change the game for patients and their families. If the patient’s expectations exceed what …
The medical arena, like society at large, is permeated with self-interest. This reality makes me very skeptical that comparative effectiveness research, which I support, will get airborne. In medicine, every heath care reform, new medicine, new medical device or revised medical guideline is at some constituency’s expense. Recognizing and dismantling conflicts of interests is one of our greatest challenges and threats.
On the morning that I began this post, I read in our local newspaper that Tennessee is soon expected to have a law that would permit public school teachers to offer views on climate change and evolution that are counter to orthodox doctrine on these subjects.
No, I don’t think that creationism is science and it should not be disguised as such. Global warming, or climate change, however, is more nuanced. …
