MD Whistleblower

It used to be that doctors knew best.  We told you what to do and you obediently complied.  The world has changed and the paternalistic system of yore has given way to the shared decision model where patient autonomy is respected.   The Old Way:   “Well, I’ll be setting you up for surgery soon.” The New & Improved Way: “Let’s discuss all of the reasonable options with their respective advantages and drawbacks.  Then, you make the call.” To paraphrase the mantra of Fox News:  D octors Report – You decide! Has our current fidelity to patient autonomy improved medical outcomes?  I have no idea.  It has certainly changed patient’s (and our) experience, but I do not know if it has improved patients’ health.   I wonder if doctors and patients who have experienced both systems believe that the current system have improved medical outcomes. Has anyone measured if the new system is better? Not every patient wants this level of authority.  I cannot count how ofte

The nation pauses to give thanks for health and family and freedom.  As during any holiday or celebration, some of us are in the valley or have been there.  There is always a way forward, even if the pathway is obscured.  We gather together. The First Thanksgiving We converse amiably. 'I'll kill you!' We dine. Blessed with bounty... We talk turkey. Pardon me?

The computerized era has introduced all of us to a genre of errors that never existed during the archaic pen and paper era.   The paper medical chart I used during most of my career never ‘crashed’.  Now, when our electronic medical records (EMR) freezes, malfunctions, or simply goes on strike, our office is paralyzed.  Although I appear to the patients as a breathing and willing medical practitioner, I might as well be a storefront mannequin who appears lifelike, but cannot function.  We cannot access the patients’ records, write a prescription or enter a new office visit.  Mannequins appear lifelife but don't function well. Of course, like any business who faces this crisis, we expect instantaneous rescue from our IT professionals, as if we are their only client and they are permanently stationed in our waiting room just waiting for us to sound the alarm. This is among one of the most frustrating aspects of EMR for medical professionals.   We simply don’t have

One of the skills and stresses about being a doctor, is giving advice to or about patients we have never seen.  If readers think these are rare events, it happens nearly every day.  Often during weekend or evening hours when I am on call, my partners’ patients will call with questions on their condition or about their medications.  Radiology departments contact me during off hours with abnormal CAT scan results of patients I do not know.  Or, a doctor may call me during the day for some informal advice about one of his patients.  These physician-to-physician inquiries are called ‘curbside consults’, which are appropriate for simple questions that do not require a formal face to face consultations. Physicians must be cautious when providing a curbside opinion on a patient he has not seen as even informal advice could result in legal exposure if the patient later files a medical malpractice claim.  Consider this hypothetical example. An internist contacts a gastroenterologist fo

There's a common affliction that's rampant in my practice, but it's not a gastrointestinal condition.  It's called polypharmacy, and it refers to patients who are receiving a pile of prescription and other medications.  I see this daily in the office and in the hospital.   It's common enough to see patients who are receiving 10 or more medications, usually from 3 or 4 medical specialists.  Of course, every doctor feels that he is prescribing only what is truly necessary.  If an individual has an internist, a cardiologist, a gastroenterologist, a urologist and a dermatologist – which is not unusual - and each prescribes only 2 or 3 essential medicines, then polypharmacy is created.  Each day, the patient swallows a chemistry set. First of all, I don't know how these patients, who are often elderly, manage the logistics of taking various medicines throughout the day and evening, before meals, after meals and at bedtime.  Who can keep track of this?  Nurs

To accomplish certain tasks, we need a little help from our friends.  No one can do it all, although many of us are more resourceful than others.  Some folks are adventurous and dive into a new arena with excitement.  They may be tinkerers who aren’t afraid to play with new gadgets.  Sure, they might break some china, but they are apt to widen their skill set and enrich their lives.  Others, eschew this dive bomb approach and prefer to wade cautiously into new experiences.  Their comfort zones are narrower.  They never break the china, but their personal growth is likely more stultified.  For some activities, we should simply call upon the professionals straight away.  Here are some examples of jobs that we should pay others to do for us. Cut down a huge dead tree on our front yard.          Replace damaged roof shingles. Investigate why smoke is seeping out of the hood of our car. Prepare our last will and testament from www.DIEWITHCASH.com or some similar website.

Let me post a question that neither I nor readers can answer. How much of what I do during the course of a day directly benefits patients? Perhaps, I don’t want to really know as I would be dismayed at how much of my effort benefits no one. Ask a nurse who works on a hospital ward, how much of his or her effort is directly applied to patient care.  I would recommend that you have a double dose of antacid in hand – one dose for you and the other for the nurse.  Just today, I was gently reproved by a hospital physician administrator for a lapse in one of my recent progress notes, which I write after seeing every hospital patient I consult on.  Which of the following transgressions do you think I was cited for?  Only one answer is correct. I did not perform an adequate physical examination I failed to address the results of an abnormal CAT scan I neglected to write the time of day along with the date of the note. I did not discuss the case with the patient’s family.