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Bloomberg Soda Ban Ignites Controversy. What's Next?

I’m a gastroenterologist and I should be against obesity. I should counsel patients who have reached a designated rung on the body mass index (BMI) ladder on the risks of carrying excessive poundage and the benefits of achieving a more streamlined silhouette. I should encourage them to pursue a regular pattern of exercise and to choose food and beverage items wisely. I should advocate that the optimal tactic to achieve and maintain weight loss is to adopt a sustainable lifestyle change, rather than engage in a short distance sprint. Any controversy so far? I doubt it. While I want my patients, and indeed everyone, to make wise choices in life, I won’t make them do it. Doctors advise and patients decide. Intelligent folks who know the risks of their choices are entitled to make them freely. Mayor Michael Bloomberg, a RINO (Republican in name only), has recently issued a citywide sugary drink ban that has made news across the country and beyond. While there are loopholes that will

Choose Wisely Takes Aim at Unneccessary Medical Tests. Shooting Blanks?

Low Hanging Fruit As I write this, it is months away from the election. The election season has been fascinating. I watched many of the Republican ‘debates’ which ranged from informative to entertaining to absurd. Candidates came and candidates went. Many enjoyed short lived surges, only to flame out afterwards. I was drawn early on to Jon Huntsman, but it seems that decent folks who tell the truth without pandering can’t succeed. So, now we are left with Romney vs Obama, a contest that at present seems too close to call.  The continued anemic job creation statistics, which may not be the president's fault, will hurt him.  If the economy appears to creep forward in the months ahead, and there are no unforeseen events to sandbag the president, then I think he will prevail. It is the unforeseen that worries the Democrats. If several economies in Europe implode and drag us to the edge of the cliff, it will have a political impact here in November. Neither candidate is ideal.

Improving Patient Satisfaction: What’s Holding Doctors Back?

Some time ago, I endured a medical staff meeting, where attendance is taken and 50% attendance of all meetings is required. I learned that they are serious about this rule when, a few years ago, I was demoted from active staff when I failed to attend enough meetings. This demotion did not demoralize me, as I was only losing my right to vote, which I did not regard as a cherished right with respect to voting on hospital affairs. I learned later, however, that the hospital’s insurance panels all required active staff status of its physician members. I decided that the right to make a living superseded the right to vote. My attendance lapses were remedied and my honor was restored. Today, a hired consultant was advising us on the importance of improving our patient satisfaction scores. Which of the following reasons to improve were offered to the staff, all of whom regard ourselves as paragons of the medical profession? As in all standardized test questions, choose the best answer (1

Better Patient Satisfaction – Which Model to Follow?

Patient satisfaction is an important element of medical care. It was always important, but it has taken on a new significance since hospitals and physicians will be graded on their bedside manners. And, these grades count for cash. Money motivates. Who believes that a leopard can’t change its spots? Throw a leopard into the pay-for -performance arena, define spots as inferior quality, and watch what happens. We would all witness a Darwinian tour de force as leopards would become spotless in just a few generations. Recently, I was exposed to 2 models of customer service. First, I endured the experience of setting up cable service for TV and wireless internet. Sounds easy, but I would not advise this task for anyone who has a heart condition. What should have been easily accomplished in one phone call took multiple calls to screw it all up. Of course, every single call ‘was important to them’ and required a generous amount of waiting time for me. With one exception, every customer serv

Pharmaceutical Gifts Corrupt Doctors: A Physician Confesses

I write now in a moment of introspection wondering if I am a corrupt doctor. Why would I even consider that my integrity is in question? I am not on the payroll of any pharmaceutical company. I am not paid to speak to physicians or the public about the latest medical breakthrough for flatulence. I submit squeaky clean billings to Medicare and insurance companies. I do not order medical procedures on patients for personal gain. My failing, if it truly exists, is an example of the power of the pen. In our office, many of the pens floating around are labeled with the name of a new drug. I assume that these evil instruments are left by pharmaceutical representatives, but I never actually see them make the drop. They are the ‘Adam and Eve’ of medical practices; they are fruitful and they multiply. These pens over time have mutated, like bacteria and viruses, and can now exist in a variety of harsh environments. For example, when I am in a restaurant about to sign my credit card bill, the

Informed Consent: The Right to Refuse Medical Treatment

There are some patients we doctors never forget. They linger in our memories for various reasons. Often, it is their serious or unusual medical condition that stays with us. On other occasions, it is a zany or unique personality that we recall, even years later. Rarely, when the doctor-patient relationship becomes injured, then the patient may become unforgettable. I remember a particular patient from 20 years ago for a very different reason. I recall him clearly because he rejected my medical advice to him with aplomb. Although I haven’t seen him for two decades, I will never forget him. He taught me a lesson, which is not surprising since patients are our best teachers. There are no CME credits for these lessons, but I’ve learned more from them than I have at many medical conferences or from medical journals. It was July 1991, a month after I completed my fellowship in gastroenterology. I had jointed a multispecialty group, and I was the only gastroenterologist in this particular

Reglan and Tardive Dyskinesia: Medical Malpractice or Guilt by Association?

There was phone message on my desk to call a lawyer. I had no idea what he was seeking, but knew that I couldn’t be a target since plaintiff attorneys do not personally contact their victims to make a introduction. I had no idea if his inquiry even pertained to a medical malpractice issue. Perhaps, he was cold calling to convince me that his estate planning skills could enrich the next several generations of Whistleblowers. Maybe he was going to notify me about a huge inheritance. Could it be that he wanted a screening colonoscopy for himself ASAP, and threw out his lawyer title to assure he would get a prompt call back? I then drifted into a reverie where lawyers were lined up outside my office all waiting for me to perform colonoscopies on them. I returned the call and he asked if I would help in the defense of an internist who is being sued for medical malpractice. Years ago, this physician prescribed Reglan, an anti-nausea medicine, to a patient who subsequently developed tardive