To paraphrase Tolstoy, all competence is alike, but every incompetence is incompetence in its own way. Every time I think I’ve seen the horizon of incompetence, I’m dealt a surprise. The sun never sets on incompetence. In health care, incompetence can be found in odd places, such as three recent examples I encountered with third-party payers. Case 1: Downgrading caviar to boiled salmon A patient was referred for a CT angiogram run ...

Read more...

A 52-year-old man is evaluated for low back pain of 3 months' duration that is nonradiating, progressive, and worse with ambulation. He reports no preceding injury. Medical history is notable for smoldering multiple myeloma diagnosed 1 year ago; he has been stable since that time. His only medication is as-needed acetaminophen. On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 132/82 mm Hg, pulse rate is 70/min, and ...

Read more...

Diagnostic tests such as CT scans are not perfect. A test can make two errors. It can call a diseased person healthy: a false negative. This is like acquitting a person guilty of a crime. Or a test can falsely call a healthy person diseased: a false positive. This is like convicting an innocent person of a crime that she did not commit. There is a trade-off between false negatives and false positives. To ...

Read more...

Ran into a radiology colleague today.  He will retire soon, and was happy to discuss the stress on radiology.  I have observed more interpretation errors (or at least I think I have) over the past five years.  We now strongly stress that the learners review all films and question radiology reads. My friend opined that volume expectations have become unsustainable.  We order too many imaging studies.  When you ask physicians to ramp ...

Read more...

(Because sometimes my brain processes information in the form of a radiology report.) EXAMINATION: Analysis of physician burnout CLINICAL INDICATION: Increasing use of term physician burnout, particularly via social media, and need to address associated connotations/perceptions TECHNIQUE: Non-scientific retrospective review of popular published pieces on the topic and comments platforms on these articles COMPARISON: Innumerable articles on the topic and experiences of professional and personal contacts FINDINGS: The number of articles about physician burnout have ...

Read more...

The United States Preventive Services Task Force (USPSTF) was created by the federal government in 1984 to provide recommendations to primary care practitioners on the scientific efficacy of screening. In 2010, the federal government linked USPSTF recommendations with national healthcare policy when the Affordable Care Act mandated free coverage by Medicare and private insurance for all screening exams that receive a USPSTF recommendation of A or B.  The ...

Read more...

I grew up in a house of spirituality, homeopathy, palmistry, astrology, art, and science alike. My father, with a masters degree in statistics, is a computer systems architect. He also fancies himself an amateur palm reader. The irritation with which I reluctantly used to give my hands over to my father, before the SATs, college decisions, medical school admissions, and my residency match results was real, but I was always ...

Read more...

"'Normal' is one of the most powerful words a radiologist can use." - Curtis P. Langlotz, professor of radiology, Stanford University After I used “clinically correlate” thrice in a row in my report, the attending radiologist asked, “How would you feel if the referring clinician said on the requisition for the study 'correlate with images'? When you ask them to clinically correlate, you’re reminding them to do their job.” I had been a ...

Read more...

Computed tomography (CT) is a powerful diagnostic tool that allows rapid diagnosis of disease.  CT is widely available in the U.S. and is a mainstay of medical diagnosis.  Estimates state that 85 million CT scans were performed in the U.S. in 2012.  To create images, CT scanners pass ionizing radiation (x-rays) through the body thereby exposing patients to radiation.  Patients who are imaged with CT have a theoretical ...

Read more...

I enjoyed Agatha Christie’s Hercule Poirot. Not only did the ingenious Belgian solve the murder so artfully. But someone identifiable is killed, and someone identifiable is the killer. Epidemiological studies are whodunits, too. Except you don’t know who has been killed, what the murder weapon is, or who the killer is. You only know that a murder may have happened. A study found a higher incidence of breast cancer with ...

Read more...

26 Pages

Most Popular