Welcome to the Skeptical Physician
After four decades working as a physician, I've witnessed far too many unnecessary tests, procedures, and advice promoted under the guise of promoting health and wellness. Today’s medical-industrial complex is driven more by profits than genuine care for patients. Nutritional nonsense, in particular, is rampant, with every other celebrity or influencer pushing the latest superfood, supplement, or fad diet as a panacea for all that ails us. Many doctors fall victim to these unfounded trends and confidently recommend unproven, sometimes harmful "cures" and regimens. Throughout my career as a pathologist, I've seen the negative impacts of such practices first-hand - wasted money, dashed hopes, and real health consequences. We must apply a heavy dose of skepticism to the endless stream of nutritional advice and healthcare interventions and demand solid scientific evidence before subscribing to the latest cure-all claims.
This is where I will post all my essays about medicine, nutrition, and health care. Subscribing is free, and you can always unsubscribe with a simple click. I plan to post thoughtful and challenging commentaries about health-related issues each week. Most of you know my bias towards science and proven facts rather than the flimflam provided by influencers and celebrities.
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The Healthcare system (it is really the sick-care system)
It’s time to tackle health care. You may not care as ‘we have the best health care in the world’. Every politician says so. Most TV commentators follow suit. It just happens to be wrong. It is the most expensive, but this is another example where the price-value equation does not square. How do I know this? Personal experience. Not my own, of course - I provided wonderful care to all my patients, but that doled out to my mother. She won't mind me telling these stories. She survived a robust 99 years, despite multiple attempts of the health care system to kill her - testimony that South African women are really tough. Others with less fortitude would have succumbed years ago. “Ah ha,” you say, “you are being unfair. She lives in the south, where they are backward and still eat grits instead of polenta. We have great medicine in the northeast because we are close to Canada.”
The first inkling that something was amiss occurred about twenty-five years ago. A routine and entirely unnecessary urine test detected a few red blood cells. This launched what is known in medical circles as the snowball effect, also known as the “malpractice-attorney-may-have-a-boat-payment-due, so I had better CYA.” The next step was an ultrasound of the kidneys in case of a lurking tumor. Her kidneys were pristine, or at least as good as sixty-year-old kidneys could be expected, but as the technician was moving the transducer - technically known as the ‘thingy’ - from one side to the other, she happened to cross the liver. There, she noted multiple ‘holes’ in my mother’s liver. Obviously, this required a couple dozen more lab tests (all normal) and a CT scan of her belly. A week later, I got the call. “Dr. Benjamin, your mother has cancer of the head of the pancreas with metastases to the liver.” This was not good news. I called one of my adult oncology colleagues, and his advice was direct and simple. Tell her to get her affairs in order and say goodbye. I booked the first flight I could and also asked to have the images shipped to me. When they arrived, I consulted with a radiologist colleague who took the briefest glance and said - “Denis, these are benign little blood vessel lesions. She has had them her entire life.” I suggested this alternative diagnosis, and many tests later, including the use of radio-active red cells, they concurred. Had I given her medicinal mushrooms, it would have been a miraculous cure. We had a wonderful visit, and the shrimp and grits were more than worth the trip.
A few years later, she developed a cough that we all get occasionally. But this one was pretty vicious and accompanied by a high fever. She consulted her practitioner by phone, actually his nurse, who spoke to the doctor (maybe) who called back a day or two later and referred her for a chest X-ray. It was a Thursday. By Sunday, feeling even more miserable, she had heard nothing back and called for the result. The on-call physician for the long weekend knew nothing about the X-ray and had no access to her records. He suggested she wait to hear when her doctor returned from a three-week golfing vacation in Aruba. Many days later, she was admitted to the hospital with severe pneumonia. She never did get the result of the original X-ray, although I know for a fact that Medicare and her supplemental insurance paid vast sums for it - enough to cover the national debt. The good news was her physician had lowered his handicap (could not resist the stereotype.) I recommended a new golfer, but being too respectful of the profession, it took her a couple of years and a few more bad episodes to fire him. Her excuse was, “he is such a nice man, and he spends time with me, and many of the residents in the retirement resort use him.”
We are not done yet. The good stuff is yet to come. Perhaps you have noticed that as we age, our skin changes - all sorts of blemishes appear. The same thing is going on internally; we can’t see them. Mom became concerned with some unsightly blemishes and visited a dermatologist, who dutifully biopsied a few. Since we are all pre-malignant and become more so as we age unless we have maintained a pure pomegranate and acai berry diet - it was no surprise that one was a trifle worrisome. He recommended a surgeon for what is known as a Moes procedure. This is when they chip away at one form of skin cancer, doing dozens of frozen sections until the hacker and the pathologist are convinced that they have it all. The only problem was that he operated on a completely benign lesion on her other arm, even though she told him repeatedly that he was cutting in the wrong place. As an apology, he discounted his bill. Turns out he never read her records and then claimed that she probably needed it anyway and that he had prevented a possible future cancer. This is known as preventative care. We were so thankful that she had been saved.
A number of months ago, someone opened the door to a bathroom that she was about to exit, smashing her into the sink. Although stoic, this injury required an ER visit. After filling out all the required papers and signing a dozen consent forms, one of which offered her organs for sale, she was left to languish in a corner for a couple of hours - perhaps to ripen the wounds. Eventually, she was visited by a very senior ER doc, who never touched her, briefly listened, and ordered a hip X-ray. A few hours later, he returned to say that her hip was not broken and that she could go home. When she whispered that she could barely breathe and was in exquisite pain (10 plus on the pain scale as carefully recorded in the ED notes), he admitted her and finally gave her an overdose of Demerol. Because of his age, he was unaware that age and certain medications don’t mix very well. By the time her room was ready about four hours later, she was in a state of moderate confusion. I called the hospitalist the next day, gently suggesting that she might have broken ribs. Three days after her fall, they X-rayed the correct body part, and indeed, a couple of ribs were fractured.
And so it goes. Some of you will rightly note how the medical system did wonders for old Uncle Joe. But I would bet that far more can recount stories quite similar to the ones above. Inefficient - inadequate - non-caring and unbelievably expensive. My advice is to never leave a loved one alone in the clutches of the hospital system unless you have no desire to see them again. If this is ‘the-best-healthcare-in-the-world’, we may not have to worry about overpopulation. We do have to worry about bankruptcy.
The Skeptical Physician
PS. Had the woman in this story not had a son for a physician, at least four lawsuits might have been in order. This is from someone who despises tort law and the excesses it breeds, but the system needs to be held accountable.
Denis I first found about you from your Sensible Medicine post comment. Thanks for your reply there. I read your above post. And as expected my father recent hospitalization mirrored your mother's breach of "standard of care." In my Sensible Medicine post I did not mention other clear breaches in standard of care (SOC). But since I was there at my father's bedside I detected and alerted his nurse (who contacted attending physician), none of those breaches of SOC lead to injury.
Not much point reporting to state professional agency as nothing will change. It is one of largest health system in state. And it will be well connected. I discovered from others that nothing substantive will change as no harm came to patient. There is also remote but possible risk of defamation claims against me or my license.
As I stated in that other SensibleMedicine Substack post, non-medical people have "deck stacked against them." To this I will add the medical advocate ideally needs to be there in person especially if patient in higher acuity setting (e.g. Intensive Care Unit or ICU stepdown unit). In my father's case one missed medical issue (if not addressed within 10 minutes) would have potentially been fatal.
so true..patients don't get examined anymore . They just get tested . Every patient with knee pain over 60 has a torn meniscus on MRI. They then get scoped and then they have a really symptomatic arthritic knee