Instead of being hysterical about Ebola, respect it Some years ago I was in Australia’s Northern Territory. The intrepid explorer that I was, I was croc-spotting from the comfortable heights of a bridge over the East Alligator River. The river derives its name because it is east of something. And because it’s croc-infested. I was reading a story about a German tourist (it’s usually a German) who was attacked by ...

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If another case of Ebola emanates from the unfortunate Texas Health Presbyterian Hospital, the root cause analysts might mount their horses, the Six Sigma black belts will skydive and the safety champions will tunnel their way clandestinely to rendezvous at the sentinel place. What might be their unique insights? What will be their prescriptions? One never knows what pearls one will encounter from after-the-fact risk managers. I can imagine Caesar consulting a Sybil ...

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Its time to talk trade offs in health care An advantage of being a foreigner, or a recent immigrant to be precise, is that it allows one to view events with a certain detachment. To analyze without the burden of love, hate or indifference for the Kennedys, the Clintons or the Bushes. To observe with both eyes open, rather than one eye looking at the events and the other looking ...

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Britain’s most prolific serial killer was a general practitioner (GP), Dr. Harold Shipman. He wasn’t England’s most famous murderer. That accolade goes to Jack the Ripper. The Ripper killed five women in the streets of Whitechapel. Shipman might have been responsible for over 200 deaths. Shipman’s legacy to the medical profession was not just a permanent simmering of mistrust. He triggered the introduction of revalidation, Britain’s version of maintenance of certification ...

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88.2% of all statistics are made up on the spot. - Victor Reeves There’s a growing movement in medicine in general and imaging in particular which wishes to attach a number to everything. It no longer suffices to say, “You’re at moderate risk for pulmonary embolism (PE).” We must quantify our qualification. Either by an interval: “Your chances of PE are between 15 and 45%.” Or, preferably, a point estimate: “You have a 15% chance ...

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A recent report from the Commonwealth Fund, which placed U.S. last amongst developing nations in health care, analyzed Britain’s high score on the management of chronic conditions. The authors attributed care coordination to the widespread adoption of health information technology in the National Health Service (NHS). That’s like someone saying Chinese food is tasty because chopsticks are widely used. Like quants so fastidious about decimal points they’ve missed the overall point. Where do ...

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The recent disagreement between Uwe Reinhardt and Sally Pipes in Forbes is a teachable moment. There’s a dearth of confrontational debates in health policy, and education is worse off for it. Crux of the issue is the more efficient system: employer-sponsored insurance (ESI) or Medicaid. Sally Pipes, president of the market-leaning Pacific Research Institute, believes it is ESI. Employers spend 60% less than the government, per person: $3,430 versus $9,130, ...

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“Then you should say what you mean,” the March Hare went on. “I do,” Alice hastily replied; “at least–at least I mean what I say–that’s the same thing, you know.” “Not the same thing a bit!” said the Hatter. “You might just as well say that “I see what I eat” is the same thing as “I eat what I see!” The brilliant Lewis Carroll had a field day with logical fallacies in ...

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There’s a lot of talk about quality metrics, pay for performance, value-based care and penalties for poor outcomes. In this regard, it’s useful to ask a basic question. What is quality? Or an even simpler question, who is the better physician? Let’s consider two fictional radiologists: Dr. Singh and Dr. Jha. Dr. Singh is a fast reader. Her turnaround time for reports averages 15 minutes. Her reports are brief with a paucity of ...

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In a recent verdict a jury in Massachusetts awarded $16.7 million in damages to the daughter of a Bostonian lady who died from lung cancer at 47, for a missed cancer on a chest x-ray. The verdict reminds one of the words of John Bradford, the heretic, who was burnt at the stakes. “There but for the grace of God go I.” Many radiologists will sympathize with both the patient who ...

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