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CME Medical Course Draws Hundreds of Physicians

Some time ago, about 200 physicians met one evening for a conference. This is not newsworthy. Medical education is deeply engrained in our professional culture. Indeed, physicians are committed to lifelong learning and self-improvement. To stay current, we read several medical journals and professional communications, we attend lectures at our hospitals, we engage in on-line educational pursuits, we learn from colleagues and we travel to medical conferences. Conscientious physicians devote many hours to educational activities each week On this night, however, we were not learning about new treatments for heart disease or diabetes. We were not learning about emerging strategies to diagnose cancer at a curable stage. There was no talk about new techniques to reduce hospital infections or other preventable complications. We were not even learning about ‘soft’ subjects, such as medical ethics or doctor-patient communication issues. We were together at the strong urging of our medic

Medical Errors Earn Hospitals Money - Who Knew?

Though I have been accused by various commenters as protecting my own specialty when I point out excesses, flaws and conflicts of interest in the medical profession, this accusation would be handily dismantled after a fair reading of prior posts.  Indeed, my own specialty of gastroenterology and my own medical practice has felt the effects of the honed Whistleblower scalpel.   If an individual or an institution will not willingly engage in self-criticism, then it creates a credibility gap that may be impossible to bridge.  If you want a seat at the table, then arrive exposed and humble. My Preferred Instruments A study was published in the prestigious medical journal JAMA, the Journal of the American Medical Association in April 2013 publishing what we have known for decades: hospitals make more money when medical errors are committed.   As an aside, I have much more respect for JAMA than I do for the AMA , but I’ll resist the strong temptation to digress. Here’s how it

Unnecessary Colonoscopies: Confessions of a Gastroenterologist

We gastroenterologists are regularly summoned to bring light into dark places.   We are the enlightened ones who illuminate anatomical shadows.   Sure, we have ‘tunnel vision’, but we like to believe that we can think broadly and creatively as well.  We are the scope doctors. Am I Just a Tool? We are commonly consulted by primary care physicians and hospitalists to perform colonoscopies, upper endoscopies (EGDs) of the esophagus and stomach and other gastrointestinal delights.  We deliver a probing element to patient care.  We are called to serve as technicians – plumbers, if you will - although we actually have cognitive knowledge of our specialty.  Yes, we can think.  Often, we have tension over what we are asked to do and what we think we should do. Do I think that every procedure I am asked to do is medically necessary.  Of course, not.  Before you target me for investigation and professional censure, realize that every physician in America and beyond would

Don't Call Me a Health Care Provider - I'm a Doctor

One thing doctors like to do is to use fancy language.  Patients, however, want physicians to use simple terms.   Perhaps, using highfalutin language makes physicians feel more scholarly and important.  Of course, this bombast only confuses patients who may be too timid to respond that they don’t have a clue what we're saying.  If your doctor is speaking in tongues, then ask for a translator. He'll get the message. Icon of Pentecost when Apostles spoke in tongues Many professions have their own technical languages which is necessary for internal communications or scholarly work.  Beyond this, there is also a pomposity that drives this lexical elitism.  In the medical profession, medical terms seem to offer no advantage over colloquial alternatives.  Yet, physicians want to ‘speak like doctors’, whatever that means. Cool Medical Term            Lame Alternative Thrombus                                    Clot Stenosis                                  

Does Your Doctor Know Advanced Cardiac Life Support (ACLS)?

Folks must think than all doctors know all things medical.  I know this is true by the questions that I have been asked over the years.  While my expertise spans hemorrhoids to heartburn, I am routinely queried on medical issues well beyond the specialty of gastroenterology.  When I can’t answer questions about a new medicine for hypertension or if an MRI of the shoulder makes sense, folks look at me quizzically as if I must not be a real doctor. Today, more than ever, physicians are highly specialized with a very narrow medical niche.  There are ophthalmologists, for example, who only treat retinal disease.   Perhaps, there are even retinal specialists for the left eye only.   It wouldn’t surprise me.  My partners and I perform routine gastroenterology procedures in an ambulatory surgery center.   Patient safety is our priority and our staff and us are dedicated to this mission.  All of us are required to be certified in Advanced Cardiac Life Support in the unlikely event th

The Sunshine Act Exposes Physician Payments: New App Suggested

A few weeks back, a drug rep, aka a pharmaceutical representative, came to the office hawking a new constipation medicine.  These guys are in a tough racket.  They need to sell products that we physicians are often unable to prescribe.  It’s the Formulary, Stupid. The Best Disinfectant In the olden days, before I entered the hallowed halls of healing, pharm reps, or drug detailers, developed relationships with physicians who would then prescribe their drugs.  Physicians to this day deny the incontrovertible truth that we are influenced by pharmaceutical company marketing techniques, which still feature face time between sales folks and prescribing physicians.  These days, many of the sales tools used years ago have been properly prohibited.  Physicians cannot be flown to exotic locales and paid big bucks so they can serve as ‘expert consultants’ who will be subjected to push polling on the new pharmaceutical product.  (Why didn’t any company ever ask me to serve as an ‘exp

A Tale of Divine Healing: Faith and Reason

I’ve posted a piece on this blog on the issue of faith and reason in healing. Indeed, the protagonist of that post is an inspirational figure, a selfless man who exudes grace and humility. I was honored that the post was shared with many Catholic clergy who appreciated my heartfelt words for one of their own. Faith and reason reentered my medical universe recently. A patient underwent surgery to resect a colon cancer. The tumor had metastasized to the lymph nodes, an unfavorable prognostic event. The surgeon entered the room and advised the patient that her survival is likely limited to 1-2 years. The patient and her husband were devastated. The distraught husband spent the next 24 hours sobbing in a painful and despondent state. He related the tragic news to his 3 children, ages 3, 5 and 8. Was this the appropriate time for the physician to relay such ominous news to a patient and family? Was it prudent for the overcome husband to share this traumatic news with his 3 young ch