MD Whistleblower

Photo Credit Two days from this writing, I will go mano a mano with a computer screen.    This will be my second gastroenterology (GI) board recertification.    Last week I suggested that the 490 minutes of unfettered fun might not be money well spent.   A reader could infer my view that the $1200 fee has more to do with securing the finances of the American Board of Internal Medicine than it does to enhance my knowledge of GI.    Perhaps, I was hyperventilating about the cost.   When I calculate the GI board CPM (cost per minute), I determine that the exam only costs $2.45 per minute    In other words, a full minute of quality board testing time costs about the same as a slice of pizza.   Clearly, the test is a bargain, and I retract any prior Whistleblower whisperings that contradict this.   Yesterday, I took another exam, this one to recertify me as a qualified Advanced Cardiac Life Support (ACLS) practitioner.   A...

Photo Credit This coming Thursday, I will have the joy and pleasure of taking the gastroenterology (GI) board recertification exam.    There will be many entertaining elements to the experience, as other board certified physicians already know.   Although there will be many fun delights, some will clearly be more amusing than others. Which of the following features of the GI board examination will be most fun?   While more than one answer may be correct, choose the best answer . (1)     A 490 minute all day exam is a thrill, by definition (2)     Losing a day of income (3)     Paying the American   Board of Internal Medicine (ABIM) $1200 (4)     Pleasing my partners who will cover my practice (5)     Having my palm vein recognition scan to verify my identity every time I reenter the room During this exam, each giddy examinee will be provided with a computer station.   I am nostalg...

Painting of Paul's Damascus Road Conversion Electronic Medical Records (EMR) promises to be the holy grail of modern medicine.    It aims to deliver us from the Smith Corona era into the digital age.    I’m a gastroenterologist who has already been practicing digitally for two decades.   I guess I am way ahead of my time Is EMR progress?      Consider these two hypothetical   patient assessments.   The assessment is a critical section of the medical record where the physician shares his thinking on the patient’s condition.    The assessment answers the question, “What do you think is going on here and why?”   The Old Fashioned, Archaic, Fossilized and Sclerotic Assessment The quality and timing of the patient’s abdominal pain is strongly suggestive of mesenteric ischemia (lack of blood supply to the guts), as the pain consistently develops   45 minutes after meals.   The patient has numerous risk factors for...

Missouri, the ‘show me’ state, is showing the country an interesting and novel concept. Judges there will be apprised of the financial costs of various punitive options before issuing a sentence. For example, a judge would be informed that a convicted drug user could be sentenced to 5 years in prison for $50,000, or could do community service with a probationary period instead for a fraction of the cost. Blind justice? This new policy has generated spirited debate. Some welcome the reform, which aims to bring some measure of cost sanity to the justice system. Others oppose the effort arguing that justice must be meted out without regard to financial costs. Is this issue being driven by difficult economic realities? Some are hostile to incarceration for reasons independent of its exorbitant expense. These folks favor rehabilitation and treatment over confinement as a matter of policy. Is there any cost of justice that is too high? I viewed this report through the prism of a prac...

Our society thrives on tension and competition. GOP vs Democrats Civil Libertarians vs Eavesdroppers Ohio State vs Michigan Creationists vs Darwinists Ideas, like sports teams, compete to win. We are the referees of these contests. Many of these competitions in the public square are ongoing. Some of these duels are locked in a dead heat. Others are in overtime. Some are ‘challenge matches’ when a vanquished idea wants another shot to change the original outcome. Many of these controversies may never be resolved. In addition, the outcomes may change because we – the referees – have changed. What was considered to be a foul years ago may now be regarded as fair play. The medical profession is riddled with many internal conflicts that will not be easily resolved. Here are a few, and I’m sure readers could add generously to the list.  Primary Care vs Medical Specialists Physicians vs Insurance Companies Obstetricians vs Medical Malpractice Attorneys Fee-for-Service vs Sala...

Two weeks ago, I did what had to be done. Months of procrastination had to end. Fears had to be put aside. Anxiety and misgivings had to be overcome. Second opinions always confirmed the need to proceed. So, when the excuses ran out, I jumped. What decision did I make? Did I… (a) Finally have rotator cuff surgery? (b) Begin electronic medical records (EMR) in the office? (c) Retire from medicine to be a full time ‘Whistleblower’? (d) Agree to a family vacation when we will hike up and down the Grand Canyon sans mules? (e) Agree to become an expert witness for a medical malpractice plaintiff’s attorney? (f) Apply an Obama 2012 bumper sticker on my car? Two weeks ago, our office entered the paperless universe. The era of ink on paper was over. The manner that I had seen office patients for 20 years suddenly evaporated. And, I wasn’t happy about it. For our small group of gastroenterologists, even though we are aware of the potential advantages of computerized charts, we adopted EMR be...

Last week, a female patient saw me in the office for the first time to discuss her chronic digestive issues. Luckily for her, my recommendations did not include probing into her alimentary canal with the endoscopic serpents that we gastroenterologists rely upon. As the visit concluded, she advised me that she intended to have a gastric bypass (GIB) procedure performed, and even used the medical term of bariatric surgery. I suppose that she mentioned it because the issue falls within my specialty, and she wanted my reaction to her plan, although she didn’t directly solicit my opinion. Nevertheless, she received it. I am not surprised anymore when the critical medical issue emerges at the end of the office visit. Every physician has this experience regularly. “So, Mrs. Fleets, I think that this new medicine will really help your constipation. My nurse will be happy to arrange your next appointment. Do you have any questions?” “How come I now have trouble breathing when I walk ...