MD Whistleblower

Cologuard has become a popular colon cancer screening option.  Indeed, it has many advantages over the traditional colonoscopy. Refer to the list below. No prep! No prep! No time off of work. No driver needed. No procedural risk. Done at home. No driving or other restrictions afterwards.\ Much less expensive. Did I mention there is no prep:? Wow, Cologuard sounds like it will be hard to beat.  Not so fast! Cologuard is a sophisticated stool DNA test that detects altered DNA as well as microscopic blood in the stool. Studies have shown that it detects over 90% of colon cancers.   Keep in mind that the overwhelming number of patients undergoing colonoscopy do not have cancer so that this statistic doesn’t apply to them.   How does this stool DNA test perform with respect to colon polyps, which are the target lesions during colonoscopy?    Cologuard detects only 42% of larger precancerous polyps which seems to me to be rather lackluster performance.  ...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. I did hospital work for 30 years until I accepted a position almost 7 years ago as an employed staff gastroenterologist at a rather renown Cleveland-based medical institution.  I have been enjoying the luxury of practicing outpatient gastroenterology exclusively, freed from the rigors of hospital work and weekend and on-call responsibilities.  It’s a job description that I feel I have earned after 3 decades of hard labor, but I was lucky that this position was available to me. During my hospital career, I estimate that I have placed a hundred or so feeding tubes, primarily in elderly patients, many of whom were demented.   (In retrospect, gastroenterologists like me were p...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. Last week, I shared my thoughts on the essential physician skill of delivering serious medical news to patients. This week, as promised, I share a dialogue between me and a patient with some editorial comments intercalated in italics.  This is not a real patient, but the scenario I created is highly realistic and familiar to medical professionals and to many readers. While I welcome reader comments of all stripes, please keep in mind that I did not endeavor to cover every aspect of this issue.   I tried to emphasize some major points.   Now, onto the vignette. Comments of all stripes welcome on this and every post. Joe is a 50-year-old man who is about to undergo a routi...

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address  at this link  to receive my posts directly to your inbox. Life changes in an instant.  This truth becomes more self-evident as we age, although even the young may have to learn hard lessons before their time.  We may be comfortably coasting along in a carefree manner only to have a single phone call or a text shatter our equilibrium.  Certainly, every reader of these posts has had this experience.  I am referring here to an unexpected change of fortune.   It’s quite a different scenario if one has time to prepare for a disruption, such as knowing that you will lose your job in 6 months.   In this example, there is time to prepare and to forge an alternative pathway so that when the current job ends, in a best-case ...

I spend most of my time these days in the endoscopy suite.  Most of these patients are meeting me for the first time. The patients seem quite accepting that a perfect stranger will be performing their medical procedure.  This is one of the realities of practicing in an institution that manages an enormous volume of patients.  The patients assume that they have been linked with a competent practitioner.  This is analogous to a patient who is scheduling a chest x-ray or a CAT scan.  The patient has no idea or concern over which physician will be interpreting the films. They assume competence and no longer need an established rapport.  What I will state next may seem bizarre to readers, but stay with me on this.   From time to time, I have difficulty ascertaining the reason that a patient has been sent for a scope examination.     More often than you might think, the patient is unclear why the test was scheduled.   “My doctor ordered it,”...

 A few days prior to penning this post, I had an unexpected but valuable educational lesson.  The experience was brief but its effects are still lingering with me. Not surprisingly, when a physician becomes a patient, he or she views the medical profession through a different lens. For instance, much of the medical advice that we doctors blithely dispense to patients, feels a little less casual when we doctors are on the receiving end.   Consider the following example. Physician Dispensing Medical Advice:   So, it’s time for your yearly labs.   I see that you are due for your colonoscopy, so I’ll arrange this. And, are you ready to get that hernia fixed? Physician Receiving Medical Advice: So, it’s time for your yearly labs.   I see that you are due for your colonoscopy, so I’ll arrange this. And, are you ready to get that hernia fixed? I’ll let my discerning readers decide which of the above scenarios is easier on the doctor.   Time for your...