MD Whistleblower

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When to Stop Blood Thinner Before a Procedure?

I review several dozen medication lists each week. I do so in my office visits as well as prior to performing procedures. This routine task is not always as easy it seems. One would think that this would be a breeze in the era of the electronic medical record (EMR). But it’s not. On a regular basis there are inaccuracies. There may be medicines listed that the patient is no longer taking. More challenging, there may be medicines being taken that do not appear on the list. Many patients are on more than 10 medicines. Medication dosages often change and I often have to hope that the recorded dosages are accurate. And, as every physician knows, patients are often unaware of the purpose or doses of some of their medicines. I regularly query patients if they are taking a particular medicine on the list and often they simply do not know. The medical profession has made progress is closing these gaps. For example, when patients a...

Polypharmacy Challenges Physicians

It can be daunting to keep track of new drugs, particularly if the doctor is not prescribing them regularly. During my medical training, I generally was familiar with all of the medicines that patients were taking. Not so anymore. Now, it is more likely than not that when I review medication lists, that some of the drugs are unknown to me. I do my best to remain current in my own specialty – itself a challenge. I am no longer well versed in the medicines used to treat diabetes, heart conditions and various autoimmune diseases, among others conditions. Medical illnesses that formerly were managed with just a medicine or two now have many more options. And the medication lists keep growing. I wonder at times if some of these new pharmaceutical additions truly add a material advantage over existing options. For instance, there is an array of effective heartburn medicines that I believe are largely equivalent to each other with respect to safet...

Humility in Medicine

After a few decades of medical practice, I am increasingly humbled by how much I do not know. In some ways, I felt more confident just after completing my training in internal medicine and gastroenterology (GI) than I do now. While some aspects of the profession have remained unchanged, such as the value of taking an accurate medical history from patients, other aspects of medicine have morphed into a more expansive and complex landscape. Compared to yesteryear, the array of diagnostic tests and medications has truly exploded. It has been a great challenge to remain current in my own specialty of GI, particularly since I am a GI generalist who has seen a very broad range of digestive conditions. Nowadays, there are more and more drugs to become familiar with and more complex disease monitoring and treatment strategies to know. It is incumbent on those who advocate a new treatment to demonstrate that actual human patients will benefit. While...

Building a Strong Doctor-Patient Relationship

With some regularity, a patient will contact my office and demand a prompt call back. While the patient may be understandably preoccupied with the issue at hand, in most cases there is no medical urgency present. I take my customer service responsibility seriously. In fact, with rare exceptions, before the end of every work day, I or my staff have contacted every patient who has reached out to us. The system works best when all parties are being reasonable and considerate. Patients have told me over the years of rude treatment they have received from staff as well as medical professionals. I believe that this does happen and it is inexcusable. Medical professionals and staff must maintain decorum and high standards even when challenged. When patients relate these anecdotes, I do not challenge them but I am aware that there may be competing versions of what transpired. Patients also have a responsibility to tend the doctor-patient relatio...

Is My Esophagus Causing Chest Pain:?

Gastroenterologists see patients for chest pain regularly. This is because the esophagus is a potential origin of various chest symptoms. We all know that heartburn and belching, for example, can be manifestations of gastroesophageal reflux disease, or GERD. But the esophagus is not always the culprit responsible for chest distress! When I am seeing a patient with chest pain, my highest professional obligation is to consider if there might be a cardiac explanation. If I am at all suspicious, then I will direct the patient to an appropriate practitioner, which may be the primary physician. Years ago, I sent a patient with chest pain directly to the emergency room. From there, he was sent for cardiac catheterization when a stent was placed.. Nearly every doctor could relate a similar anecdote. Oftentimes, chest pain patients are sent to me by cardiologists so I can be secure that a cardiac explanation has been excluded, On oth...

Meatloaf, a baseball mitt and medicine?

An important part of the human experience is the connections we forge and cultivate with others. We all have our own universe populated with a cast of characters who play roles in our personal and professional lives. You might recall the words of a rather well known playwright who began a monologue with, All the world’s a stage, and all the men and women merely players… Familiarity breeds comfort. Comfort creates satisfaction. Change triggers anxiety. The three maxims above are not incontrovertible, but they are often true. Indeed, we have all experienced them throughout our lives. As of this writing, my mother is 90-years-old. She is managing reasonably well in her own apartment in New Jersey, in the same town where I was first raised over 60 years ago. During one of my recent visits to her, when she was of the tender age of 89, she prepared an amazing and unforgettable surprise for me. She made me her special meatloaf, the same one ...