MD Whistleblower

Here’s a great power word for readers to casually toss around with friends.  Iatrogenic . This refers to a medical condition or complication caused by a medical treatment.  For example, if a person undergoes a knee replacement and suffers blood clots afterwards, this complication is considered to be an iatrogenic illness – it is a direct result of a medical intervention. The volume of iatrogenic illness is enormous.   I am not suggesting that the medical profession is culpable, although adhering to strict safety guidelines and best practices can lower the case load.   Indeed, many such safety practices are in place today that were not present when I entered the profession.   Among the most common iatrogenic conditions are medication side effects.   On a regular basis, every physician and health care practitioner has wondered if a patient’s new or worsening symptom might be the result of a medication.   Sometimes this is an easy call.   For exa...

Next month my schedule will change.  I will henceforth be off on Fridays with my work week truncated to Monday through Thursday.   I am excited to be enjoying a long weekend every weekend.  And while the schedule change is relatively minor, this event does feel like an important career moment for me.  It is the first step on a journey that will ultimately lead beyond my professional career.  It is this recognition that makes this modest schedule modification more significant than one would think it deserves.  As some readers know,   my current employed position has been a dream job for me.   Prior to this, I was in a small private practice, which I loved, but was much more challenging professionally and personally.   My partner and I ran the business.   Working nights, weekends and holidays were routine for decades.   On an on-call night, if I slept  through until morning, I felt as if I had won the lottery.   And w...

Cologuard is a sophisticated stool test that checks for microscopic blood and altered DNA which can signal the presence of colon cancer or precancerous polyps.  Some patients are attracted to this non-invasive option rather than to traditional colonoscopy experience which includes the ever popular cathartic cocktail. This test was approved by the Food and Drug Administration (FDA) in 2014.    The test was initially quite popular as patients and physicians were enthusiastic about this new colon cancer screening option.   Often in medicine, what’s new becomes popular but initial enthusiasm tends to ebb over time.   (With time, the initial safety and efficacy reports for medicines and diagnostic tests may not be sustained.   This is why post-marketing surveillance after initial approval is so critical.) Patients were advised early on, as they are now, that a positive Cologuard test meant that a follow up colonoscopy was mandatory.   Certainly, when I or...

Some time ago, a man came to see me requesting a colonoscopy.  His last colon exam was done about 5 years ago.  He is well into his 80’s and has several significant chronic medical conditions.  He wanted reassurance that he did not have colon cancer.  Who wouldn’t want to be reassured of this?  After questioning him closely and reviewing the medical data I advised him that I was not suspicious that he was harboring a colon malignancy.  The patient, however, was not mollified.  As the professional, I advised that in my judgement the risks of the procedure exceeded the potential benefits.  Indeed, this is the risk calculation that physicians utilize daily when advising patients on diagnostic and therapeutic options. While I didn’t categorically refuse to perform the procedure, I was reluctant to proceed.   I asked the patient’s internist, who knew the patient well, to delve into this issue further with him.   As I did not hear back from ...

Fortunately, most of the issues that patients discuss with us are routine – at least in terms of making a correct diagnoses.   For example, if you come to the doctor with complaints such as back pain, fever & cough, rectal bleeding, jaundice or burning with urination – it is likely that a secure diagnosis will be made expeditiously.   Of course, any of these common symptoms might be caused by a rare illness, but in general, common symptoms are caused by common conditions.    That is why a physician who is evaluating a patient with a fever is not likely to consider malaria as a leading diagnostic consideration, even though a Google search will include this illness on the fever list. . The above symptoms are objective and concrete.   Vague symptoms are much more difficult to unravel because they can often be explained by a variety of medical and psychological conditions.   Do you think a physician would have an easier time evaluating a patient with a ...

Gallbladder removal, known as cholecystectomy, is one of the most common surgical procedures performed.  Over a million Americans will give up their gallbladders this year.  The most common gallbladder symptom is abdominal pain which is usually caused by gallstones.  There are other reasons that gallbladders are removed which I will leave aside in this post. It’s very gratifying for physicians when a patient enjoys a pain free life after gallbladder removal.  However, every gastroenterologist and general surgeon has seen patients whose abdominal pain lives on after cholecystectomy.  This is a frustrating scenario primarily for patients but also for the medical professionals.  Some of these disappointed patients had consulted with numerous physicians for advice on their abdominal pain.  Did all of these physicians mess up?  How could this happen? Of course, physician error can never be excluded since we doctors, like everyone, are flawed member...