There’s a new term that has entered the medical lexicon. The word is wellness. Hospitals and medical offices are incorporating this term into their mission statements, corporate names, business cards, medical conferences and other marketing materials. The Cleveland Clinic Foundation has appointed a Chief Wellness Officer, an intriguing fluffy title that does not clearly denote this individual’s role and function. This is deliberate, as the word wellness is designed ...
Michael Kirsch, MD
Medical ethics in the office should not be a private matter
Medical ethics has properly gained a foothold in the public square. There is a national conversation about euthanasia, stem cell research, fertilization and embryo implantation techniques, end-of-life care, prenatal diagnosis of serious diseases, defining death to facilitate organ donation, cloning and financial conflicts of interest. Nearly every day, we read (or click) on a headline highlighting one of these or similar ethical controversies. These great issues hover over us.We ...
Honored to care for many priests and nuns in my practice
Our society thrives on tension and competition.
- GOP vs Democrats
- Civil Libertarians vs Eavesdroppers
- Ohio State vs Michigan
- Creationists vs Darwinists
Gastric bypass is not a short cut to treat obesity
Recently, 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 ...
CT scans and x-rays draw patients into risk and overutilization
Many patients erroneously believe that x-rays and CAT scans have no risk.In their minds, they are non-invasive studies that can cause no harm. Since there are no incisions or anesthesia, they regard the experience as having the same risk as taking a family photograph. How wrong they are. In my mind the danger from non-invasive radiology studies may surpass the risk of hard core medical treatment. True, radiology tests won’t ...
Why total body scans are a scam
Folks across the country are paying hard cash for total body scans, abdominal aortic aneurysm testing, CAT coronary artery scans and carotid artery evaluations to prevent disease or find important lesions early. It’s a seductive argument, and it’s a scam.Ordinary patients don’t understand about pre-test probability and positive and negative predictive values. Indeed, all physicians were taught to consider Bayesian theory when ordering diagnostic tests. This is very tough concept for ...
DTC advertising is annoying but should it be banned?
Should the public be shielded from medical information that can mislead it?Many argue against direct-to-consumer (DTC) advertising, which is omnipresent in print and on the airwaves. Opponents of this practice argue that it promotes the use of expensive medications when patients ask their doctors if the "drug is right for them," the tag line that appears at the end of every ad. This phrase is the drug company’s limp disclaimer ...
Physicians should not be used for FDA ad enforcement
One of the advantages of marrying an immigrant is having intense exposure to another culture. My wife’s Russian heritage, and her family, have enriched my own life immeasurably. The trip that I took with her and my brother to Russia in 1990, where she served as our personal translator, was unforgettable.During the early years of our relationship, I heard stories about her family that seemed incredible to an American like ...
Unnecessary testing needs more than tort reform to cure
Recently, while covering for one of my partners on a weekend, I was consulted by a physician to do a procedure.The doctor wanted his patient to undergo an EGD, which is a scope test that examines the esophagus, stomach and first portion of the small intestine called the duodenum. We gastroenterologists do this test routinely to search for an explanation for a patient’s symptoms, or to determine if these organs ...
C. Diff and how dentists overuse antibiotics
Why do dentists prescribe antibiotic prophylaxis so often?Because they can.Why am I dissing my dental colleagues? Because I can.Perhaps, this is a simple case of dental envy, since their profession remains within secure borders far beyond the health care reform line of fire. Consider these dental incidentals:• Not a syllable in the ~2000 page health care reform law that affects dentists. Every filling is still worth its weight in gold • ...
How doctors choose which specialists they refer to
There is an aspect of professional sports that I greatly admire. This transcends the athleticism and skill of the athletes, the work ethic, coaching expertise, teamwork and the thrill of the game. This is one of the only institutions that is a pure meritocracy. The philosophy is simple and not blurred by arguments for diversity or massaging the qualifications for admission to serve another agenda. Coaches, managers and owners want ...
Transparent medical pricing lowers health costs
My friend, the Buckeye Surgeon, has resisted reforms in medical residency training programs, that have eased some of the inhumane exhaustion on young interns and residents.I have a different view on the subject. This issue generates spirited debate in the blogosphere and in teaching hospitals across the country.Not all medical education reforms, however, provoke controversy. I learned recently from an Ohio medical student that they are now being taught ...
