Michael Kirsch, MD

Michael Kirsch is a gastroenterologist.

Patients sometimes have good reasons to refuse colonoscopies

Michael Kirsch, MD

Conditions

January 22, 2014

Many times over the years, I have witnessed the following scenario in my exam room.

Here’s the set up of this one act play.

Characters:

Elderly patient
Attentive daughter
The doctor

Scene 1

I’m seated at my desktop computer. The patient is seated before me. The patient’s daughter is seated next to her mother.

A patient comes to see me in the office with medical issues that strongly suggest that a colonoscopy should be performed. As an aside, …

What truly counts in medicine isn’t easy to measure

Michael Kirsch, MD

Physician

January 15, 2014

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 …

The consequences of zero tolerance: Why HIPAA is overkill

Michael Kirsch, MD

Physician

January 1, 2014

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.

Medical charts (remember when …
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The consequences of zero tolerance: Why HIPAA is overkill

How should a physician apologize after a medical error?

Michael Kirsch, MD

Physician

December 18, 2013

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 …

A quiet, contemplative man of inaction can be the true healer

Michael Kirsch, MD

Physician

November 26, 2013

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 …

Should Conrad Murray be allowed to practice medicine again?

Michael Kirsch, MD

Physician

November 1, 2013

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 …

Targeting gun owners is an easy target, but off the mark

Michael Kirsch, MD

Physician

October 11, 2013

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 …

Force feeding in Guantanamo: Why doctors shouldn’t participate

Michael Kirsch, MD

Physician

October 3, 2013

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 …

Would every profession consent to returning fees for mistakes?

Michael Kirsch, MD

Physician

September 20, 2013

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 …

A gastroenterologist dishes on unnecessary colonoscopies

Michael Kirsch, MD

Physician

September 9, 2013

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 …

Does your doctor know ACLS? Does it matter?

Michael Kirsch, MD

Physician

August 26, 2013

acls

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 …

Can prayer heal the sick?

Michael Kirsch, MD

Physician

August 8, 2013

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 …

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Can prayer heal the sick?

How no shows hurt private practice doctors

Michael Kirsch, MD

Physician

August 1, 2013

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 …

Should a patient’s financial concerns influence physician decisions?

Michael Kirsch, MD

Physician

July 17, 2013

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.

This absurdity is often …

Anyone can fall prey to addiction and substance abuse

Michael Kirsch, MD

Conditions

July 6, 2013

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 …

Here are some reasons why physicians lie

Michael Kirsch, MD

Physician

June 6, 2013

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 …

How the medical profession is being forced to game the system

Michael Kirsch, MD

Policy

May 29, 2013

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 …

Accepting reasonable expectations is a gamechanger for patients

Michael Kirsch, MD

Conditions

April 29, 2013

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 …

Are the days of screening colonoscopies numbered?

Michael Kirsch, MD

Physician

April 22, 2013

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.

When I …

Medicine and climate change have common elements

Michael Kirsch, MD

Physician

April 15, 2013

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. …