I had an interesting conversation with a patient in the office some time ago. He was sent to me to evaluate abnormal liver blood tests, a common issue for gastroenterologists to unravel. I did not think that these laboratory abnormalities portended an unfavorable medical outcome. Beyond the medical issue, he confided to me a harrowing personal tribulation. Often, I find that a person’s personal story is more interesting and significant than ...

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When I am facing an alcoholic in the office, I do not advise him to stop drinking. Other physicians may advocate a different approach.  We live in a free society and individuals are free to make their own choices.  I have decided, for example, not to own a firearm, ride a motorcycle or bungee jump as these activities are not only beyond my risk tolerance threshold, but are also activities that ...

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I was covering for my partner over the weekend and saw his patient with end-stage liver disease, a consequence of decades of alcohol abuse.| He was one of the most deeply jaundiced individuals I have ever seen. His mental status was still preserved. He could converse and responded appropriately to my routine inquiries, although he was somewhat sluggish in his thinking. It’s amazing that even after the majority of a liver ...

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What should a medical consultant do when the referring physician wants a procedure that the consultant does not favor? Of course, this sounds like a layup. The consultant, readers would surmise, should have a conversation with the referring colleague to explain why the procedure is not in the patient’s interest. The colleague then thanks the consultant for his thoughtful input, and for sparing the patient from the risks and expense of ...

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Physicians spend a lot of time counseling patients on the phone. Often, these conversations occur at night with patients we have never met before. When I am on-call in the evenings or on the weekends, these are some typical phone calls I receive from patients I have never met.

  • I have a very bad stomach ache for the last hour.
  • I started having rectal bleeding an hour ago.
  • My wife tells ...

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Free speech is one of our bedrock constitutional rights. The battle over what constitutes lawful free speech is ongoing. But the issue is more complex than I can grasp with legal distinctions separating political speech, commercial speech and noncommercial speech. And, of course, the right of speech does not permit the free expression of obscenity or "fighting words" along with some other exclusions. There is no right to free speech in ...

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From time to time, friends, patients, and relatives ask my advice on participating in a medical experiment.  My response has been no.  More accurately, once I explain to them the realities of research, they don’t need to be persuaded.  They back away. Here’s the key point.   When an individual volunteers to join a research project, the medical study is not designed to benefit the individual patient.  This point is sorely misunderstood ...

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Why are the costs of prescription drugs so high? While I have prescribed thousands of them, I can’t offer an intelligent answer to this inquiry. Of course, all the players in this game — the pharmaceutical companies, pharmacy benefit managers, insurance companies, consumer activists and the government — offer their own bromides, where does the truth lie? While I don’t fully understand it, and I don’t know how to fix it, ...

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Here’s a quote that readers will not readily recognize: "It is a pity that a doctor is precluded by his profession from being able sometimes to say what he really thinks." I’ll share the origin of the quote at the post’s conclusion. How’s that for a teaser? I'll give you a hint below. Physicians, by training and experience, are guarded with our words. To begin, we are never entirely sure of anything, ...

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Knowledge is power. Increasingly, patients are demanding and receiving access to levers in the medical machine that would have been unthinkable a generation ago. The informed consent process, which I support, can overwhelm ordinary patients and families with conflicting and bewildering options. Television and the airwaves routinely advertise prescription drugs directly to the public. Consider the strategy of direct-to-consumer drug marketing when millions of dollars are spent advertising a drug that ...

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