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 ...

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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 ...

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(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 ...

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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 ...

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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 ...

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"'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 ...

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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 ...

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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 ...

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When I was an intern in medicine, I couldn’t wait to start my role as a radiology resident. Even though I cared for my patients to the best of my ability and studied their diseases, I knew that my time in the department was limited. I wish I could say that I put my whole heart into my work, but with all of the extraneous demands of intern year -- ...

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Perhaps the greatest flaw in medical training is our blatant avoidance of any education related to the business of medicine. Primarily focused on treating illness, trainees often don't want to hear about how they are going to be compensated in the future, and medical school administrators fear that such training would further decrease interest in specialties that reimburse at a lower rate per unit time. Some doctors get 10s and ...

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