Dealing with a surgeon with “questionable” practices?

[coroner]

There is a surgeon at my hospital who I’ve noticed make some head-scratching moves and I was wondering how you might handle it if another medical staff member did the same. Some background: he’s been there 20+ yrs, in his mid-50s and in that particular hospital, he gives our group a significant amount of volume (we cover other hospitals though). I have been with my group a few years; but, only 1 yr at this particular hospital. There is one other pathologist with me at that hospital. I have mentioned these things I’ve noticed, and my colleague sort of nods his head in agreement; but, that’s about it. Here are some of the surgeon’s actions:

1) Right partial ileocolectomy for DLBCL. – The pt. was 19 y.o. and had a 4-5cm cecal mass which was not biopsied prior to surgery. The tx. would be chemo, not resection. I guess he presumed it was a carcinoma which would need resection, or he could have stated the tumor was causing obstruction and required relief of sx. I don’t know what the pts. sx. were. However, I saw the gross lesion and it was not fully obstructing the lumen. Either way, I think pretty much any situation (unless urgent) would render a histologic dx before going straight to resection.

2) Scheduling surgery before getting bx results. – Similar to #1, except this time the pt. had a bx. But, the slides of the bx of a colon polyp/mass came out on a Wednesday and the pt was being wheeled into surgery for a colectomy on the same day before I even signed the case out. Fortunately, (unfortunately for the pt.), it did turn out to be adenoca. requiring surgery. But what if it turned out to be benign/tumor not requiring surgery?

3) Right partial ileocolectomy w/ appendectomy for appendicitis. – There was no perforation grossly. However, he stated the pt. had inflammation, and granulation tissue at the appendiceal orifice so he couldn’t do a routine appendectomy. I looked at it grossly and to seemed it didn't have any more than the amount of exudate at the orifice in a case of acute appendicitis.

4) Multiple (3) skin biopsies with no designation/orientation in a pt. with separate lesions are all thrown into the same jar. – What if 1 out of the 3 lesions was malignant? How does he know which one to go back and re-excise? As an aside, we can’t bill 88305 x 3.

Other: Any colon polyp with high grade dysplasia gets an automatic colectomy (vs polypectomy). Also, he pages pathology for intraoperative gross consults on every colectomy, benign or malignant. Malignant for margins. Benign i.e. diverticulosis, necrotic bowel, etc. no idea why he needs us...

Some of this is beyond aggressive; and, either negligent, if not malpractice. This surgeon is well known and seems to have a lot of clout in the hospital. My colleague, as I mentioned doesn’t feel the need (or want to) rock the boat as this surgeon is a major provider for us. However, I would be interested in any of your thoughts. Do something or nothing…how would you approach it, if at all?

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[deleted314957]

Isn’t pathology fun? How long have you been in practice?

 

[robellis]

Your priority is always first to the patient, everything else is secondary.

 

[coroner]

Isn’t pathology fun? How long have you been in practice?

I've been out of training in the 5-10 year range. I'm guessing you're asking because it's highly likely pathologists will encounter numerous suspect practices by clinicians over the entirety of a career in pathology spanning 30-35 yrs. I agree and I have other stories about clinicians. But, this guy seems to be taking the cake so far in just one year that I've worked with him...

 

[AZpath]

There is a surgeon at my hospital who I’ve noticed make some head-scratching moves and I was wondering how you might handle it if another medical staff member did the same. Some background: he’s been there 20+ yrs, in his mid-50s and in that particular hospital, he gives our group a significant amount of volume (we cover other hospitals though). I have been with my group a few years; but, only 1 yr at this particular hospital. There is one other pathologist with me at that hospital. I have mentioned these things I’ve noticed, and my colleague sort of nods his head in agreement; but, that’s about it. Here are some of the surgeon’s actions:

1) Right partial ileocolectomy for DLBCL. – The pt. was 19 y.o. and had a 4-5cm cecal mass which was not biopsied prior to surgery. The tx. would be chemo, not resection. I guess he presumed it was a carcinoma which would need resection, or he could have stated the tumor was causing obstruction and required relief of sx. I don’t know what the pts. sx. were. However, I saw the gross lesion and it was not fully obstructing the lumen. Either way, I think pretty much any situation (unless urgent) would render a histologic dx before going straight to resection.

2) Scheduling surgery before getting bx results. – Similar to #1, except this time the pt. had a bx. But, the slides of the bx of a colon polyp/mass came out on a Wednesday and the pt was being wheeled into surgery for a colectomy on the same day before I even signed the case out. Fortunately, (unfortunately for the pt.), it did turn out to be adenoca. requiring surgery. But what if it turned out to be benign/tumor not requiring surgery?

3) Right partial ileocolectomy w/ appendectomy for appendicitis. – There was no perforation grossly. However, he stated the pt. had inflammation, and granulation tissue at the appendiceal orifice so he couldn’t do a routine appendectomy. I looked at it grossly and to seemed it didn't have any more than the amount of exudate at the orifice in a case of acute appendicitis.

4) Multiple (3) skin biopsies with no designation/orientation in a pt. with separate lesions are all thrown into the same jar. – What if 1 out of the 3 lesions was malignant? How does he know which one to go back and re-excise? As an aside, we can’t bill 88305 x 3.

Other: Any colon polyp with high grade dysplasia gets an automatic colectomy (vs polypectomy). Also, he pages pathology for intraoperative gross consults on every colectomy, benign or malignant. Malignant for margins. Benign i.e. diverticulosis, necrotic bowel, etc. no idea why he needs us...

Some of this is beyond aggressive; and, either negligent, if not malpractice. This surgeon is well known and seems to have a lot of clout in the hospital. My colleague, as I mentioned doesn’t feel the need (or want to) rock the boat as this surgeon is a major provider for us. However, I would be interested in any of your thoughts. Do something or nothing…how would you approach it, if at all?

Speak as a friend and colleague. You will likely have greater influence.
Don't hit them with all the problems at once.
Try to see if you can get success on the 1st/ worst issue then try another in a few months.

Are there surgeons at the hospital that he respects that behave differently ?
It may be an opportunity for a department or group discussion on standards.

If complications arise they are at risk for malpractice on some of these problems.
The complication may be defendable but not the surgery.

Tread lightly

 

[Thr0mbus]

Keep in mind you don’t always know the whole story on any of these cases.

 

[coroner]

Speak as a friend and colleague. You will likely have greater influence.
Don't hit them with all the problems at once.
Try to see if you can get success on the 1st/ worst issue then try another in a few months.

Are there surgeons at the hospital that he respects that behave differently ?
It may be an opportunity for a department or group discussion on standards.

The other surgeons don't operate as much as him at this hospital, and he is an independent contractor. But my experience with the other surgeons is nothing out of the ordinary. Regarding the surgeon of question, we're not friends nor enemies, just a standard professional relationship. From what I can tell, he is quick to complain in general, so I don't think constructive criticism from a pathologist would go over well with him.

Keep in mind you don’t always know the whole story on any of these cases.

I see your point regarding not completely knowing the patient's sxs./clinical presentation, their wishes to undergo surgery, etc. But when multiple examples of this keep resurfacing, I think it's fair to question the practitioner. And, in some instances, no story is needed e.g. biopsying multiple, separate skin lesions and throwing them into the same jar.

 

[y2k_free_radical]

There is a surgeon at my hospital who I’ve noticed make some head-scratching moves and I was wondering how you might handle it if another medical staff member did the same. Some background: he’s been there 20+ yrs, in his mid-50s and in that particular hospital, he gives our group a significant amount of volume (we cover other hospitals though). I have been with my group a few years; but, only 1 yr at this particular hospital. There is one other pathologist with me at that hospital. I have mentioned these things I’ve noticed, and my colleague sort of nods his head in agreement; but, that’s about it. Here are some of the surgeon’s actions:

1) Right partial ileocolectomy for DLBCL. – The pt. was 19 y.o. and had a 4-5cm cecal mass which was not biopsied prior to surgery. The tx. would be chemo, not resection. I guess he presumed it was a carcinoma which would need resection, or he could have stated the tumor was causing obstruction and required relief of sx. I don’t know what the pts. sx. were. However, I saw the gross lesion and it was not fully obstructing the lumen. Either way, I think pretty much any situation (unless urgent) would render a histologic dx before going straight to resection.

2) Scheduling surgery before getting bx results. – Similar to #1, except this time the pt. had a bx. But, the slides of the bx of a colon polyp/mass came out on a Wednesday and the pt was being wheeled into surgery for a colectomy on the same day before I even signed the case out. Fortunately, (unfortunately for the pt.), it did turn out to be adenoca. requiring surgery. But what if it turned out to be benign/tumor not requiring surgery?

3) Right partial ileocolectomy w/ appendectomy for appendicitis. – There was no perforation grossly. However, he stated the pt. had inflammation, and granulation tissue at the appendiceal orifice so he couldn’t do a routine appendectomy. I looked at it grossly and to seemed it didn't have any more than the amount of exudate at the orifice in a case of acute appendicitis.

4) Multiple (3) skin biopsies with no designation/orientation in a pt. with separate lesions are all thrown into the same jar. – What if 1 out of the 3 lesions was malignant? How does he know which one to go back and re-excise? As an aside, we can’t bill 88305 x 3.

Other: Any colon polyp with high grade dysplasia gets an automatic colectomy (vs polypectomy). Also, he pages pathology for intraoperative gross consults on every colectomy, benign or malignant. Malignant for margins. Benign i.e. diverticulosis, necrotic bowel, etc. no idea why he needs us...

Some of this is beyond aggressive; and, either negligent, if not malpractice. This surgeon is well known and seems to have a lot of clout in the hospital. My colleague, as I mentioned doesn’t feel the need (or want to) rock the boat as this surgeon is a major provider for us. However, I would be interested in any of your thoughts. Do something or nothing…how would you approach it, if at all?

Unfortunately,despite lip service,administrators protect income producers even when suspect in my experience.Don't expect rousing support for doing the right thing.Be sure to not put your job in jeopardy or risk a suit from the surgeon.The CAP will not protect you.

 

[deleted314957]

Dealing with “these kind of folks” is best done by a committee established by the medical staff. They are usually called something like “physician practice performance” or some such. This is the same committee that deals with the instrument throwers, screamers, intimidators, etc. If your committee has some teeth and is generally supported by the main med staff players, the offenders usually clean their act up quickly, or take their show on the road, i.e. leave.

 

[coroner]

Thanks to those who have replied with actionable suggestions.

Unfortunately,despite lip service,administrators protect income producers even when suspect in my experience.Don'tect rousing support for doing the right thing.Be sure to not put your job in jeopardy or risk a suit from the surgeon.The CAP will not protect you.

That's my concern. There is nuance to handling these type of situations and I feel that it may be an uphill battle. I discussed this with someone else who mentioned, unless I can prove patient harm occurred, it gets into a grey area and potentially thrown out the window. And, I cannot prove that as I don't follow up with the patient's afterwards.

This is the same committee that deals with the instrument throwers, screamers, intimidators, etc.

These folks are a dying breed. I heard a lot of those stories about docs like that in the 80s and 90s though. There may be a few still left...

 

[Napoleon1801]

Thanks to those who have replied with actionable suggestions.


That's my concern. There is nuance to handling these type of situations and I feel that it may be an uphill battle. I discussed this with someone else who mentioned, unless I can prove patient harm occurred, it gets into a grey area and potentially thrown out the window. And, I cannot prove that as I don't follow up with the patient's afterwards.


These folks are a dying breed. I heard a lot of those stories about docs like that in the 80s and 90s though. There may be a few still left...

Do you have some sort of peer review committee? Maybe reach out locally to some senior staff at your hospital to discuss further? I would not confront the surgeon as this only paints a target on your back. Physicians do not like being told they are in the wrong even diplomatically. However, everyone has a boss.

 

[coroner]

Do you have some sort of peer review committee? Maybe reach out locally to some senior staff at your hospital to discuss further? I would not confront the surgeon as this only paints a target on your back. Physicians do not like being told they are in the wrong even diplomatically. However, everyone has a boss.

Yes, we do [have a committee]. I think this may be the best approach as mike also suggested. Yet, doing so carefully as others have mentioned. It's not a simple matter of doing "what's best for the patient". I could wind up being perceived as a whistleblower without enough supporting evidence and no backup from hospital admin. This could get me on the wrong side of a senior member of the medical staff or potentially jeopardize my job security/group's volume which is why I came on here for suggestions. These are some of the challenges that we are presented with as physicians which aren't taught in the books/exams, rounds with patients, residency, etc. There's many ways to handle each situation which don't always have a clear cut answer. Thanks to all.

 

[y2k_free_radical]

Yes, we do [have a committee]. I think this may be the best approach as mike also suggested. Yet, doing so carefully as others have mentioned. It's not a simple matter of doing "what's best for the patient". I could wind up being perceived as a whistleblower without enough supporting evidence and no backup from hospital admin. This could get me on the wrong side of a senior member of the medical staff or potentially jeopardize my job security/group's volume which is why I came on here for suggestions. These are some of the challenges that we are presented with as physicians which aren't taught in the books/exams, rounds with patients, residency, etc. There's many ways to handle each situation which don't always have a clear cut answer. Thanks to all.

I fear politics and money often triumph over patient care in medicine.In some ways one could become like the reporter in the movie "KILL THE MESSENGER" even if one is doing the "right thing".It has happened to me.

 

[LADoc00]

This sounds like the worst possible medical "Karen" move...
1. I doubt you know the entire clinical picture with these cases.
2. This isn't your role to QC surgeons, stay in your lane.

Every hospital has these surgeons. DO NOT BE A MEDICAL KAREN.

 

[deleted314957]

This sounds like the worst possible medical "Karen" move...
1. I doubt you know the entire clinical picture with these cases.
2. This isn't your role to QC surgeons, stay in your lane.

Every hospital has these surgeons. DO NOT BE A MEDICAL KAREN.

As re QC for surgeons; I was the chair of the physician Practice performance(3P) committee established by med exec. Every (major) specialty was represented. There also was the admin’s man, the CMO who really only dealt with physician situations. If we had a “bad” ob-gyn, we would assign the committee ob-gyn and CMO to have a low key talk with the offender. Nothing was done after a thorough discussion of the clinical situation justified the situation. If that did not work they were required to appear before the committee. At that time they may be required to be proctored for x numbers of y surgery. They may have to get cme. They may have to attend anger management course, etc.

It can be done. Just don’t make yourself the lone ranger.

 

[robellis]

This sounds like the worst possible medical "Karen" move...
1. I doubt you know the entire clinical picture with these cases.
2. This isn't your role to QC surgeons, stay in your lane.

Every hospital has these surgeons. DO NOT BE A MEDICAL KAREN.

it’s absolutely not a “Karen” move if you see someone potentially committing malpractice and hurting patients to let others know..if the OP is preventing harm of patients that is not being a “Karen”

 

[LADoc00]

it’s absolutely not a “Karen” move if you see someone potentially committing malpractice and hurting patients to let others know..if the OP is preventing harm of patients that is not being a “Karen”

And you absolutely better be 100% correct. This will very easily bounce back at you with dire consequences if you are not.

IF the OP is "preventing harm" is one very iffy IF.

But go ahead and do what you want and report back here.

 

[Euchromatin]

We also have one surgeon who produces some pretty questionable resection specimens sometimes, although issues are not to the degree of the individual coroner refers to. Any individual case could usually be explained by bad luck or an unusually bad/invasive tumor making resection unusually difficult. But when taken in aggregate, one starts to question either the choice of which patients should be operated on at all or surgical skills. We have discussed on the DL with the more senior surgeon on that service and they agree with us/are aware of issues, but since the hospital tends to have difficulty recruiting in general and they really need surgeons in that specialty...nothing is going to change for now.

On a somewhat related note, we are picking up a hospital soon with a couple of breast surgeons who have already informed us that they will be absolutely insisting on intraoperative gross evaluation of margins for all of their invasive lumpectomies/mastectomies and referred us to a crappy paper they produced a couple years ago showing their data on that practice with the prior pathology group. As one would expect, when we calculated the stats from their data, the sensitivity of a "grossly positive margin" (e.g. there is fibrous tissue at the margin) is 33% with a specificity of 72% and accuracy of 47%.
We were planning on hiring a PA anyway for the increased specimen volume, so I think we are just going to stick a PA at that site to do it instead of picking a fight with them over this even though it is a complete waste of everyone's time.

 

[Alteran]

We also have one surgeon who produces some pretty questionable resection specimens sometimes, although issues are not to the degree of the individual coroner refers to. Any individual case could usually be explained by bad luck or an unusually bad/invasive tumor making resection unusually difficult. But when taken in aggregate, one starts to question either the choice of which patients should be operated on at all or surgical skills. We have discussed on the DL with the more senior surgeon on that service and they agree with us/are aware of issues, but since the hospital tends to have difficulty recruiting in general and they really need surgeons in that specialty...nothing is going to change for now.

On a somewhat related note, we are picking up a hospital soon with a couple of breast surgeons who have already informed us that they will be absolutely insisting on intraoperative gross evaluation of margins for all of their invasive lumpectomies/mastectomies and referred us to a crappy paper they produced a couple years ago showing their data on that practice with the prior pathology group. As one would expect, when we calculated the stats from their data, the sensitivity of a "grossly positive margin" (e.g. there is fibrous tissue at the margin) is 33% with a specificity of 72% and accuracy of 47%.
We were planning on hiring a PA anyway for the increased specimen volume, so I think we are just going to stick a PA at that site to do it instead of picking a fight with them over this even though it is a complete waste of everyone's time.

Why not just do 6 touch preps on the lumpectomy and bill 88333 and 88334 x 5. Then it becomes worth your while.

 

[coroner]

Any individual case could usually be explained by bad luck or an unusually bad/invasive tumor making resection unusually difficult. But when taken in aggregate, one starts to question either the choice of which patients should be operated on at all or surgical skills.

That's what I was alluding to in my example. I admitted I didn't know the whole story of the pt's clinical presentation and did not follow up afterwards to prove whether or not harm occurred. That being said, I've worked with many other surgeons before. Seeing how this surgeon continually has instances of clinical actions which keep piling up that do not correlate with the most other surgeons I've worked with at least raises an eyebrow. Given the lack of complete clinical info I have, I think I'll "stay in my lane" on this one.

As one would expect, when we calculated the stats from their data, the sensitivity of a "grossly positive margin" (e.g. there is fibrous tissue at the margin) is 33% with a specificity of 72% and accuracy of 47%.

Intraoperative grosses on breast? Wow, I thought I had it bad with intraoperative grosses on colon. Both of which should be going the way of the dodo. So an accuracy rate of less than 50% is enough to justify potentially excising more tissue that is more likely than not to be unnecessary? Seems like that's not very good evidence-based medicine to me...But, we often have to make concessions in our field and look at the larger picture sometimes i.e. acquiring a new hospital contract.

We were planning on hiring a PA anyway for the increased specimen volume, so I think we are just going to stick a PA at that site to do it instead of picking a fight with them over this even though it is a complete waste of everyone's time.

How is hiring a PA going to help with this if you're off-site? The pathologist still has to make the dx. (unless you're doing it remotely via video).

 

[Euchromatin]

Intraoperative grosses on breast? Wow, I thought I had it bad with intraoperative grosses on colon. Both of which should be going the way of the dodo. So an accuracy rate of less than 50% is enough to justify potentially excising more tissue that is more likely than not to be unnecessary? Seems like that's not very good evidence-based medicine to me...But, we often have to make concessions in our field and look at the larger picture sometimes i.e. acquiring a new hospital contract.

From the initial conversations we've had and their paper, they don't seem particularly concerned with taking extra tissue. Primary goal seems to be preventing patients from needing to go back for a separate additional surgery. At some point we might try to talk them into just taking extra tumor bed margins by default on all cases. We have one surgeon already in our system who does this fairly often. From what I can tell, they are already taking extra margins about 2/3 of the time based on the results of the gross margin evaluation as it is. Would probably save them time vs waiting around for us to ink and breadloaf the lump, but you know how surgeons can be once they are used to doing things a certain way.

How is hiring a PA going to help with this if you're off-site? The pathologist still has to make the dx. (unless you're doing it remotely via video).

We already do frozens at one of our other sites remotely with slide imaging technology. So, yes, we are tentatively planning on getting another slide scanner for frozens and validating a similar process for the breast gross evals at that hospital.

 

[Thr0mbus]

From the initial conversations we've had and their paper, they don't seem particularly concerned with taking extra tissue. Primary goal seems to be preventing patients from needing to go back for a separate additional surgery. At some point we might try to talk them into just taking extra tumor bed margins by default on all cases. We have one surgeon already in our system who does this fairly often. From what I can tell, they are already taking extra margins about 2/3 of the time based on the results of the gross margin evaluation as it is. Would probably save them time vs waiting around for us to ink and breadloaf the lump, but you know how surgeons can be once they are used to doing things a certain way.


We already do frozens at one of our other sites remotely with slide imaging technology. So, yes, we are tentatively planning on getting another slide scanner for frozens and validating a similar process for the breast gross evals at that hospital.

No kidding you could destroy your career here.

I would tell those breast surgeons to F off. Are you willing to be liable for all those miscalls and redos?

FLEE PATHOLOGY NOW!!!

 

[y2k_free_radical]

No kidding you could destroy your career here.

I would tell those breast surgeons to F off. Are you willing to be liable for all those miscalls and redos?

FLEE PATHOLOGY NOW!!!

He might end his career at his hospital if he refuses.

 

[chocomorsel]

Money, money, money, money, MONEY!!!
Give me some more!!!

Come on OP. Think about it. Use your brain. You people (pathologists) are some smart people.

I will give you a hint. It is a five letter word.

Welcome to the greed that is rampant in Medicine!

 

[coroner]

Money, money, money, money, MONEY!!!
Give me some more!!!

Come on OP. Think about it. Use your brain. You people (pathologists) are some smart people.

I will give you a hint. It is a five letter word.

Welcome to the greed that is rampant in Medicine!

mmmkay...that said a whole lot of nothing. The implication that the surgeon is aggressive to line his pockets doesn't offer anything in regards to how to approach the situation.

Are you like the primary care version (or whatever your specialty is) of Thrombus...with the whole anti-establishment rhetoric, all caps, and exclamation points? We already got one in our thread...don't need an imitator. p.s. no disrespect to the real Thrombus, you're the o.g., keep it real

 

[cmz]

mmmkay...that said a whole lot of nothing. The implication that the surgeon is aggressive to line his pockets doesn't offer anything in regards to how to approach the situation.

Are you like the primary care version (or whatever your specialty is) of Thrombus...with the whole anti-establishment rhetoric, all caps, and exclamation points? We already got one in our thread...don't need an imitator. p.s. no disrespect to the real Thrombus, you're the o.g., keep it real

Most of the "questionable practices" you brought up could actually be argued in favor of the surgeon, so I would seriously tread lightly. The next time you have one of these questionable cases, pick up the phone and give him a call and discuss things in a civil manner. In that regard, you will gain more insight into why he does what he does.

 

[WEBB PINKERTON]

Number 4 is about the only one I would make a big deal about. You can't lose those 88305s.

 

[y2k_free_radical]

There is a surgeon at my hospital who I’ve noticed make some head-scratching moves and I was wondering how you might handle it if another medical staff member did the same. Some background: he’s been there 20+ yrs, in his mid-50s and in that particular hospital, he gives our group a significant amount of volume (we cover other hospitals though). I have been with my group a few years; but, only 1 yr at this particular hospital. There is one other pathologist with me at that hospital. I have mentioned these things I’ve noticed, and my colleague sort of nods his head in agreement; but, that’s about it. Here are some of the surgeon’s actions:

1) Right partial ileocolectomy for DLBCL. – The pt. was 19 y.o. and had a 4-5cm cecal mass which was not biopsied prior to surgery. The tx. would be chemo, not resection. I guess he presumed it was a carcinoma which would need resection, or he could have stated the tumor was causing obstruction and required relief of sx. I don’t know what the pts. sx. were. However, I saw the gross lesion and it was not fully obstructing the lumen. Either way, I think pretty much any situation (unless urgent) would render a histologic dx before going straight to resection.

2) Scheduling surgery before getting bx results. – Similar to #1, except this time the pt. had a bx. But, the slides of the bx of a colon polyp/mass came out on a Wednesday and the pt was being wheeled into surgery for a colectomy on the same day before I even signed the case out. Fortunately, (unfortunately for the pt.), it did turn out to be adenoca. requiring surgery. But what if it turned out to be benign/tumor not requiring surgery?

3) Right partial ileocolectomy w/ appendectomy for appendicitis. – There was no perforation grossly. However, he stated the pt. had inflammation, and granulation tissue at the appendiceal orifice so he couldn’t do a routine appendectomy. I looked at it grossly and to seemed it didn't have any more than the amount of exudate at the orifice in a case of acute appendicitis.

4) Multiple (3) skin biopsies with no designation/orientation in a pt. with separate lesions are all thrown into the same jar. – What if 1 out of the 3 lesions was malignant? How does he know which one to go back and re-excise? As an aside, we can’t bill 88305 x 3.

Other: Any colon polyp with high grade dysplasia gets an automatic colectomy (vs polypectomy). Also, he pages pathology for intraoperative gross consults on every colectomy, benign or malignant. Malignant for margins. Benign i.e. diverticulosis, necrotic bowel, etc. no idea why he needs us...

Some of this is beyond aggressive; and, either negligent, if not malpractice. This surgeon is well known and seems to have a lot of clout in the hospital. My colleague, as I mentioned doesn’t feel the need (or want to) rock the boat as this surgeon is a major provider for us. However, I would be interested in any of your thoughts. Do something or nothing…how would you approach it, if at all?

I agree that this is overly aggressive to bad medicine with unnecessary scarring of his patients.

 

[LADoc00]

Money, money, money, money, MONEY!!!
Give me some more!!!

Come on OP. Think about it. Use your brain. You people (pathologists) are some smart people.

I will give you a hint. It is a five letter word.

Welcome to the greed that is rampant in Medicine!

You mean like Gilead marketing a COVID drug, making $40B worldwide and then finding it out it doesnt work?

Even your most industrious surgeon would have a very hard time competing with pharma and hospital industry complexes.

 

[LADoc00]

Pfizer CEO sells millions in stock the same day he announces the alleged "early results".....any bets on this all being B.S. and the vaccine is nowhere near that effective AND has serious side effects??

Again, your random surgical shenanigans in your random community hospital is NOTHING compared the evil on the larger stage folks.

 

[KeratinPearls]

Pfizer CEO sells millions in stock the same day he announces the alleged "early results".....any bets on this all being B.S. and the vaccine is nowhere near that effective AND has serious side effects??

Again, your random surgical shenanigans in your random community hospital is NOTHING compared the evil on the larger stage folks.

The Pfizer stock sale comes just a few months after executives at Moderna (MRNA), a biotech also working on a Covid-19 vaccine, sold shares following the release of promising trial results.

Critics accused Moderna of overhyping the vaccine trial results, but the company nonetheless raised $1.3 billion in a stock sale immediately following the vaccine trial announcement.

Executives then sold tens of millions of dollars worth of Moderna shares before the company's stock price fizzled a week later.

Some former SEC officials called on Moderna to be investigated for potential illegal market manipulation.

 

[Spikebd]

Pfizer CEO sells millions in stock the same day he announces the alleged "early results".....any bets on this all being B.S. and the vaccine is nowhere near that effective AND has serious side effects??

Again, your random surgical shenanigans in your random community hospital is NOTHING compared the evil on the larger stage folks.

MRNA tech is the wave of the future in pharm and they’re excited to test out the covid vaccines on all of us to see how well they work. Revolutionary stuff for sure