Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (23)

Sanjay Gupta As Surgeon General? Not So Fast

The Washington Post reported today that Sanjay Gupta, CNN’s medical correspondent, is being considered for the office of Surgeon General by President-elect Obama. This came as quite a shock to me, as I’ve met and interviewed 3 of the recent Surgeons General over the past few years. Of course, I like Sanjay Gupta as a reporter. He’s a fine communicator and does a good job covering subjects for a consumer audience. But I don’t think he has the gravitas or appropriate experience for the role of Surgeon General of the United States.

I spoke with one source close to the nomination proceedings, and he said that most senior people were secretly disappointed with the choice. My source requested that I not reveal his name.

If Sanjay Gupta is confirmed as Surgeon General he will achieve the immediate rank of admiral, even though he has no previous military or public health experience whatsoever. It will be difficult for Gupta to be taken seriously by peers at the Pentagon and State Department. The office of Surgeon General is a very important position given only to the most senior and experienced medical professionals with decades of achievements in their fields. Gupta is a good reporter, he should consider a role in public relations for the U.S. government, not the office of Surgeon General.

When the Bush administration chose an inexperienced person, Mike Brown, to head FEMA – it was a disaster. I hope that the Obama administration doesn’t make a similar mistake with Gupta. However, a nomination is not a confirmation – Gupta still has to be approved by Senator Kennedy’s Health, Education, Labor and Pensions Committee before taking the office of Surgeon General. Unfortunately, it’s possible that the committee will feel pressured to confirm Gupta to maintain a good relationship with the new administration, rather than to vote their conscience. But I can tell you that many people are not pleased with this nomination, and feel that there are more appropriate choices that are being overlooked.

It will be interesting to see how far this nomination goes, and if there will be an outcry from the military and medical community over Sanjay Gupta’s apparent nomination. What do you think?

You may also like these posts

Read comments »

23 Responses to “Sanjay Gupta As Surgeon General? Not So Fast”

  1. Val – I agree with you, it is concerning as this position needs someone who has a lot of backbone (probably another form of gravitas)…I wonder what motivated Obama’s choice. Given the changes and overhaul needed in the healthcare system, I hope Kennedy et al will be thorough and principled in their assessment.

  2. Interesting, Val – I neglected to consider the military issues related to the appointment. I should remember C Everett Koop in his uniform.

  3. Strong One says:

    I think there might be more to the story. Or should I say I hope. Very concerning to pick a high profile ‘celeb’ reporter, when the duty calls for lots of ‘GRAVITAS’, which is something he might be lacking.
    I’ll be interested to see how this turns out.
    Interested… and a lil worried.

  4. PalMD says:

    I don’t know, Val. I’m cautiously optimistic. I mean he’s young, but a well-respected physician and communicator, and damned smart. Many of teh blagz have talked about his various blunders, but he’s not a shill for pseudoscience.

  5. mudphudder says:

    Wow–this is the first I’ve heard regarding Sanjay Gupta being considered for Surgeon General. I have to agree that he lacks not only the gravitas (good word), but also the political and military experience that is typical of past Surgeon Generals. That being said, if I want to argue the other side–the pro-Gupta side–I’d say that perhaps his persona (the political, Washington-outsider, television-personality celebrity) could connect better with the American people…that he would have a larger audience of citizens, residents who actually listen to what he has to say. No doubt his relative youth is an asset to reach out to the younger generation (and, again, have them actually pay attention to what he’s saying!). I ask this, what good is a candidate who has the gravitas and the experience, but who the American people couldn’t care less about? How many people can name the Surgeon General of past administrations? If Gupta is picked, no doubt that number will sky rocket (and as a result, so will the importance of health-related issues). Just my two cents.

  6. Becky says:

    Yes, but he is a shill for the pharmaceutical companies and in their debt. He pushed Gardasil hard while under contract with Merck for a side venture he had going, without telling anybody — all over the news shows. Whether or not you loath Michael Moore or praise him as courageous, Gupta’s fact checking on Sicko was proven wrong. It wasn’t that he was biased as much as he was just mistaken. You’re either accurate, or you’re not.

  7. Eye candy. Sweet! I’d want to work for Sanjay Gupta. But on a more serious note, I believe that the Surgeon General must have military experience. Gupta is a pretty boy, but I’d rather have C. Everett Koop.


  8. News Review says:

    After going over his background, he has a lot of achievements that might qualify him to the position. The fact that he is qualified, however, does not guarantee that he is well-fit for the job. Are there any more candidates other than him?

  9. shadowfax says:

    Bear in mind that Gupta was a White House fellow and worked for FLOTUS Hillary Clinton on health policy in the ’90s. He wasn’t always just a pretty face.

    Also, I could be wrong, but the SG wears the uniform of the public health service, not the military, and the background of surgeons general is generally not military.

    I too an surprised at the designation, but on second look I don’t think it’s as outrageous as some seem to think…



  10. DrV says:

    Here’s the elephant in the room: Why him. I’m with you. I like him but don’t think he has the background for such major administrative public health responsibility

  11. Biff says:

    If Sanjay Gupta is confirmed as Surgeon General he will achieve the immediate rank of admiral, even though he has no previous military or public health experience whatsoever. It will be difficult for Gupta to be taken seriously by peers at the Pentagon and State Department.

    Not sure that the Pentagon/State Department remark is at all relevant. The Surgeon General, while technically head of a US “Uniformed Service,” i.e. the US Public Health Service, is not under the jurisdiction of the Pentagon, the Department of Defense, or the Department of State. The Surgeon General’s official responsibilities are completely separate from those other organizations. The Surgeon General and the PHS is part of the Department of Health & Human Services. While there may be some need for coordination or consultation among cabinet departments, the functions are quite independent.

  12. Biff says:

    PS. Don’t forget that it was considered controversial at the time when C. Everett Koop decided to start wearing a uniform.

    PPS. Contrary to some of the comments, there is no military experience requirement for the position of Surgeon General, and many, if not most, recent SGs have not had military backgrounds. As an aside, there is not even an explicit requirement for public health experience – most recent appointees have been surgeons, endocrinologists, etc – including Dr. Koop, who was a practicing pediatric surgeon until his appointment.

    Anyway, if people in public health are complaining about Gupta, imagine how the intelligence professionals are feeling about Obama’s rumored appointment of Leon Panetta to run the CIA!

  13. Vicky says:

    I don’t know why we’re even discussing this. I’m a physician and have seen Gupta’s pieces. Yes, they are good and he interviews well, because he has time and a staff to look research a topic before he enters stage. He’s a few years older than me. And I’ll tell you that this is insane. There’s no way he will be accepted

  14. Kody Black says:

    The Youtube/American Idol president selects another minor celeb to be Surgeon General.

    I’m shocked.

  15. Rogue Medic says:

    Does he have the gravitas to stand up to those attempting to kill our children, by stopping vaccination? Jenny McCarthy might humiliate him, and she’s more boob than brain.

  16. starrs says:

    This is exactly what concerned me about Obama– first… Panetta and now Gupta nice people but not qualified for these leadership positions –poor judgement/lack of experience and so it starts.

  17. Sam says:

    Dr Gupta is the best man for the job of SG. He is also a future President of the US, and this is just a stepping stone for him.

  18. Jay says:

    The Hindu American community lauds the appointment of Dr Gupta and we are 100% behind him. May Lord Krishna bless him and bless this nation.

  19. jenny says:

    Great choice, Dr Gupta is the perfect man for the job. Congrats to Dr Gupta. He will serve the country well.

  20. Dr. Gwenn says:

    I’m with Dr. Val on this one! I was shocked and disappointed especially knowing some top docs in the country were also being considered. I do a lot of work with the American Academy of Pediatrics and knowing who they tossed in the hat to be considered for the Surgeon General post, Gupta’s only claim to fame is he’s more well known.

    Dr. Gwenn

  21. Amedstudent says:

    As a third year medical student I’m maddened by the choice of Dr. Gupta. Most people do not have a clue what medical school and residency are like or what public health issues are facing the world. I’m just starting my medical journey and am still dazed about why the President-elect would choose someone who has neither served at any public health agency nor been formally educated in public health.

    So many other qualified physicians are out there who have, for decades, worked towards improving American’s public health. They did not choose to specialize and open a private practice in a well-to-do neighborhood. They walked the walk and I have been inspired by them. It is a travesty that they are being overlooked.

  22. judy davis says:

    The misty eyed mom asks for the right to not vaccinate her kids. The media plays major backup to her story over and over. Public health is looking at a totally new GIG in keeping our kids safe. But we don’t need a ROCK STAR.There are thousands out there so able/ready/honest to do this job.

  23. LastoftheZucchiniFlowers says:

    Sanjay may not have ‘worn the uniform’, but he performed at least four or five neurosurgical cases in forward deployed units in Iraq. I HAVE worn the uniform in the MC/USNR and having worn it know that it is not a patent endorsement of any SG candidate. Why are people worried about his ‘automatic rate of Admiral’. He would (IF he takes the job) then be an officer in the US Public Health Service. He would engage young medical professionals in Government service and Public service. He is relevant and his good looks along with his youth and trustworthiness in the media makes him an ideal candidate. What is wrong with a good looking and relevant MD/neurosurgeon as the top doc? This does not mean he’ll be Obama’s personal physician. Quite the contrary. I hear a LOT of sour grapes and frank green eyed monsters posting here. Lacks gravitas? How? Have any of YOU deployed to the hot zone with the Marines and performed surgery while under fire? No, I thought not. Lots of military lifers are dead wood, just hanging around awaiting their rewards which may be expected after a long career in uniform. Trust me – it often works that way. C. Everett was a good man. So was Jocelyn. But look how she was eviscerated in the media. Sanjay will able to go toe to toe with media and has ‘worn the uniform’ in the most significant way – he’s WORKED his profession FOR REAL. I hope he’ll take the job, but I suspect we won’t, valuing his personal freedoms far too much.

Return to article »

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

Read more »

See all interviews »

Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


Click here for a musical take on over-testing.

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »