Skip to main content

Posts

Whistleblower Wishes All a Happy Fourth of July 2017

How's our sacred Honor doing? "And for the support of this Declaration,  with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our Lives, our Fortunes, and our sacred Honor."

Why I Don't Prescribe Pain Medicines

It may seem strange that a gastroenterologist like me does not prescribe pain medicines.  Let me rephrase that.  I don’t prescribe opioids or narcotics.   I write prescriptions for so few controlled substances that I do not even know my own DEA number.  You might think that a gastroenterologist who cares for thousands of patients with abdominal pains would have a heavy foot on the opioid accelerator.  But, I don’t.  Here’s why. I truly do not know my DEA number. I believe that one person on the health care team should manage the pain control.  In my view, this should be the attending hospital physician or the primary care physician in the out-patient setting.  There should not be several consultants who are prescribing pain medicines or changing doses of medicine prescribed by another physician.   With one physician in charge, the patient’s pain is more likely to be managed skillfully while the risk of fostering drug dependency and addiction is lessened.  We all know add

Yikes! When Your Doctor's Computer Crashes!

Earlier this week, as I write this, our office lost a skirmish against technology.  It was my procedure day, where lucky patients file in awaiting the pleasures of scope examinations of their alimentary canals.  A few will swallow the scope (under anesthesia), but most will have back end work done.  We are a small private practice equipped with an outstanding staff.  We do our best every day to provide them with the close personal attention they deserve. The first patient of the day is on the table surrounded by the medical team.  The nurse anesthetist and I have already briefed the patient on what is about to transpire.  Propofol, the finest drug in the universe, is introduced into her circulatory system, and her mind drifts into another galaxy.  I pick up the colonoscope, which is locked & loaded for action, and the screen goes dark.  Our nurse goes through a few steps of messing around with plugs and doing a quick reboot, but we are still in the dark.  I glance at the back

Obamacare - Repealed and Replaced!

The House of Representatives enjoyed success weeks ago, depending on how one defines success.  Unquestionably, the passage of TrumpCare was a great political success that was not easily achieved.  I can’t fathom the intensity of threats and pressure that was utilized to convert a few ‘no votes’ into TrumpCare supporters.  The president and his team desperately needed a win after so many setbacks domestically and internationally.  And, this is a clear win, at least in the short term.  We will see if this vote becomes one that GOP House members can run on or will try to run from in 2018.  Indeed, the GOP high-fiving and Rose Garden ceremony seemed premature considering that they have ascended only about 20% of their upward trek on an icy mountain as they hope to slog to the summit.  They may never get there.  The Senate, who have been quietly working on their own reform bill, are unlikely to endorse the House bill which contains antagonistic policies toward Medicaid expansion and pr

Are You A Victim of Abuse or Neglect?

Words matter.  Patients can get spooked by the words we use.  All of us have heard vignettes of how some inadvertent harsh words from a physician have caused injury.  I know there were times that I wish I could rewind and erase some errant words.  Sometimes, an innocent remark from the doctor doesn’t land innocently.   When I ask as a matter of routine, ‘is there a family history of colon cancer’, as I do with every patient, this may provoke anxiety in a patient who is seeing me for a bowel disturbance. Words Matter We ask every patient who arrives at our ambulatory surgery center if they have a living will.  This often causes the patient to utter a nervous joke.  We then go on to ask if the patient has ever been ‘a victim of abuse or neglect’.   We are required to ask this..  It would seem rather unlikely that a patient who has just purged themselves for the pleasure of a colonoscopy, would confess to a nurse that (s)he is meeting for the first time that (s)he has been

Memorial Day 2017

Freedom is not Free. Expressing profound gratitude to all those who served our nation and serve today, and to their families who share their sacrifice.

Why My Patient Will Quit the Military

I had an interesting conversation with a patient in the office some time ago.  He was sent to me to evaluate abnormal liver blood tests, a common issue for gastroenterologists to unravel.  I did not think that these laboratory abnormalities portended an unfavorable medical outcome.  Beyond the medical issue he confided to me a harrowing personal tribulation.  Often, I find that a person’s personal story is more interesting and significant than the medical issue that led him to see me. I am taking care to de-identify him here, and I did secure his permission to chronicle this vignette.  He is active duty military and is suffering from attention deficit disorder (ADD).  He likes his job.  He was treated with several medications, which were either not effective or well tolerated.  Finally, he was prescribed Vyvanse, which was a wonder drug for him.  The ADD symptoms melted away.  This is when military madness kicked in.  He met with military medical officials who concurred that this