A few days before I wrote this, a patient had a complication in my office. I have discussed previously the distinction between a complication, which is a blameless event, and a negligent act. In my experience, most lawsuits are initiated against complications or adverse medical outcomes, neither of which are the result of medical negligence. This is the basis for my strong belief that the current medical malpractice system ...

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We always want to get it right the first time when treating patients, but the truth is this is difficult. When there is uncertainty of disease course and prognosis, multiple treatment options, and variable responses to therapy this becomes even more challenging.  Our typical strategy to making it “just right” isn’t too different from Goldilocks. We have mild treatments (too cold), and aggressive treatments (too hot), and even in the ...

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One of the most frequent questions gastroenterologists are asked about is diet, health and disease; and some of the questions gastroenterologists are least comfortable answering are about diet, health and disease. This disconnect occurs for several reasons. Although the subject of nutrition is taught in medical school, it usually covers malabsorption of nutrients, vitamins and minerals that have limited relevance to the concerns of most patients. The modern physician does not see ...

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One catch phrase in health care reform is cost-effectiveness.  To paraphrase, this label means that a medical treatment is worth the price.  For example, influenza vaccine, or flu shot, is effective in reducing the risk of influenza infection.  If the price of each vaccine were $1,000, it would still be medically effective, but it would no longer be cost-effective considering that over 100 million Americans need the vaccine. Society could not ...

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Did you know that your digestive tract contains over 400 different types of bacteria? This complex ecosystem is called intestinal microflora. The concentration of bacteria in the gastrointestinal tract increases dramatically moving from the stomach towards the colon. In humans, the intestinal microflora is vital in many important functions including digestion of nutrients and prevention of infection. Disruption of the “normal flora” can lead to many problems including diarrhea, bloating, ...

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Prevent the overdose of OTC pain medications Recently in the emergency room, I saw a 35-year-old patient -- we’ll call her Jane -- who was vomiting blood. The source of the vomiting turned out to be a bleeding ulcer caused by unintentionally overdosing on ibuprofen. Jane was in pain -- she was taking prescription ibuprofen for her chronic knee pain -- but she was also taking over-the-counter (OTC) ...

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There he sat, hunched over with rugged, muscular arms stretched across his abdomen, his weary eyes stealing hopeful glances from behind an otherwise steely facade. Mr. J was a 53-year-old Latino agricultural laborer with a history of H. pylori who presented at our student-run free clinic with persistent abdominal pain, unchanged from his multiple previous visits. As I learned more about Mr. J and his story, I realized that treating ...

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I recently treated a patient who was hospitalized with paraplegia. During some routine lab testing I noticed that his liver function tests were elevated, and so I began looking for a cause. I discussed the patient’s drinking habits (he rarely drank alcohol), risks for viral hepatitis (no IV drug use or exposure to those with known hepatitis), and general medical history (nothing relevant to liver disease). I reviewed his current ...

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If you are a physician like me who performs procedures, then rarely you will cause a medical complication. This is a reality of medical life. If perforation of the colon with colonoscopy occurs at a rate of 1 in 1,500, and you do 3,000 colonoscopies each year, then you can do the math. Remember that a complication is a blameless event, in contrast to a negligent act when the physician is ...

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Is your doctor a hammer and you're a nail? Here's some insider advice coaxing patients to be more wary and skeptical of medical advice. Should you trust your doctor? Absolutely. But you need to serve as a spirited advocate for your own health or bring one with you. Ask your physician for the evidence. Sometimes, his medical advice may result more from judgement and experience as there may not be ...

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