MD Whistleblower

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...

I wouldn't call it rogue, but at times we do go it alone.   In fact, I recently performed a medical procedure on a patient without obtaining formal informed consent. Was this a brazen violation of medical ethics? Should I be reported to the Ohio Medical Board? Could my action be considered as a criminal battery? Hopefully, none of the 3 above inquiries will be responded to in the affirmative. Obtaining informed consent for medical testing and treatment is a bedrock precept of medical ethics.   Patients are entitled to know the risks, benefits and alternatives to our proposed recommendations.     Too frequently, informed consent is regarded as a pro forma exercise.    Signing consent forms drafted by hospital attorneys may offer the hospital legal protection, but this is not obtaining informed consent as I understand it.     I have summarily signed my own medical consent forms without reading through the documents.   I surm...

 A few days before preparing this post, I greeted a patient who was about to undergo her 5 th colonoscopy.  I was the pilot for the 4 prior excursions.   “You should’ve signed up for the rewards program,” I quipped.  “This one would’ve been free!”  Our patients, with rare exceptions, enjoy our light atmosphere seasoned with some humor.  This does not detract from our seriousness of purpose and commitment to their welfare, and they know it.  Our endoscopy team is comprised of outstanding medical professionals. I care for many patients for whom I have performed all of their colonoscopies, which may exceed 10 procedures.   I recently performed an examination on one of my colitis patients who has unique findings which have remained stable for years.   I know his colon as well as I know his face!   Indeed, if I were shown a photo of his colon, I would immediately be able to name the individual.   So, when we gastroenterologists c...