MD Whistleblower

Which doctors practice defensive medicine? Only those who are breathing. The president, however, wasn’t convinced of this reality when he spoke to the nation on September 9th at a joint session of Congress. “I don’t believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs.” May be contributing? Mr. President, if I may , in the gray and nebulous world of medicine, one truth is certain; defensive medicine cost billions of health care dollars every year. Physicians hold this truth to be self evident. One month after the president’s speech, the non-partisan Congressional Budget Office (CBO) issued a report that reversed it’s own prior conclusions on the value of tort reform. It now states that tort reform could reduce “the use of diagnostic tests and other health care services when providers recommend those services principally to reduce their potential exposure to lawsuits.” The report als

The U.S. Supreme Court has opined that we cannot falsely scream Fire! in a crowded theater, despite our sacrosanct right of free speech. Even sacred rights have limits. When individual rights collide with societal rights, then each side’s arguments must be weighed to determine whose rights will prevail. This is not a clean or satisfying process as each claimant brings passion and legitimate arguments to the table. I have been involved in a cyber colloquy with Maggie Mahar at Health Beat discussing if health care is a right. Maggie is well known in health care circles and examines health care policy from a liberal perspective. She’s on the left and I’m not. I hesitate to define health care is an absolute right before considering some of the broader ethical ramifications. Is health care a human right? Is health care a constitutional right? Is health care a privilege? Is health care a commodity to be purchased at the discretion of the consumer? Is health care a responsibility? A laudabl

A new term has been introduced into the medical lexion - Never Events. This refers to medical misadventures that should never occur, such as removing the wrong limb or leaving a pair of pliers in a patient’s abdomen. These terms can be confusing for ordinary folks who are not medical policy wonks. Words and terminology matter here. 'Never events' are not medical complications, which are blameless events that occur in a small percentage of cases. Complications, as purely defined, are not medical malpractice events as no negligence has occurred. Here’s a primer. Medical Complication : A patient denies medication allergies. A physician prescribes penicillin and a rash develops. There is no culpability. Medical Malpractice : A physician prescribes penicillin without inquiring about drug allergies. The patient has a known penicillin allergy. Penicillin is prescribed and a serious allergic drug reaction ensues. This is medical negligence. The physician messed up. Never Event : A phys

This is a less controversial issue than patients ‘friending’ their doctors on Facebook, which I oppose. Although most physicians’ offices are not emailing with patients, perhaps they should. There are several obvious advantages. Decompress phone lines, which are suffocating nearly every medical practice in America. Relieve patients of the cruel and unusual punishment of languishing on ‘hold’ listening to elevator music or dead air. Allow office staff to efficiently respond to patients’ cyber inquiries at scheduled times. Eliminate the need for the ubiquitous phone menu system, a torture chamber that tests the mettle of even the most robust and seasoned patients Facilitate documention of patients’ inquiries, which is not reliably accomplished with phone calls. Permit staff and physicians to access patients’ emails from remote locations. Allow for emails to be forwarded to other staff and physicians with a keystroke. Available 24/7. Sure, email communications between physicians and pat

Every physician knows what a black box warning is. This is a special Food and Drug Administration (FDA) requirement to warn doctors about potentially severe drug reactions. Most medicines do not have any black box warnings. Wyeth, a pharmaceutical company, will have to place a black box warning for their drug Phenergan, a medication routinely given for nausea. Phenergan has been on the market for over 50 years. I’ve prescribed it for years with excellent results, and I have never witnessed an adverse reaction. The catalyst for the black box development was a tragic side-effect that a woman experienced in 2000 after receiving an injection of the drug. A physician’s assistant injected the medication improperly into her arm. As a result, she developed gangrene and her right forearm had to be amputated. She argued in court that she was not sufficiently informed about the drug’s risk and the jury awarded her $6.7 million. This past week, the U.S. Supreme Court rejected Wyeth’s appeal. What

When it comes to Facebook, I will offer full disclosure, a policy I’ve advocated in my medical ethics postings; I am neither a friend nor a fan of this godfather of social media. In my 7 member nuclear family, 6 of us use Facebook as a portal into their personal worlds. Once again, I am the outlier. I just don’t have the time to create and maintain another universe in my life. It would eliminate the scant discretionary time that is still available to me. Bloggers at the American College of Physicians and KevinMD and have mused about physicians using Facebook to communicate with patients. Earlier this year, Sachin Jain, M.D. wrote a commentary in The New England Journal of Medicine discussing his ambivalance to ‘friend’ a prior patient. While the public might be receptive to ‘friending’ doctors, most physicians won’t be in a hurry to use social media with their patients. Physician Facebookers would not want patients to have access to their vacation photos and personal vignettes, ma

This past week, the Montana Supreme Court heard a right-to-die case where the plaintiff argued that there is a constitutional right to physician-assisted suicide. A Montana physician had refused this request from a terminal cancer patient, who died in December 2008 without medical assistance. No state in the union currently has a constitutional right to die, although physician-assisted suicide is a legal practice in Oregon and Washington. In 1997 the U.S. Supreme Court ruled that there is no fundamental constitutional right to physician-assisted suicide, although it did not prohibit the practice entirely. Once the balance of the U.S. Supreme Court shifts leftward in the coming years, perhaps a constitutional right to medical euthanasia will be ‘discovered’ in the U.S. Constitution. If the Montana plaintiff’s view prevails, would physicians there be breaking the law by refusing to assist a patient who requested a doctor-assisted death? Would such principled doctors be denying a patient