In October 2011, the Centers for Disease Control and Prevention reported a 60% increase in “emergency department visits for sports– and recreation–related traumatic brain injuries, including concussions, among children and adolescents” over the past decade. That’s good news: as the CDC’s press release said, they believe the increase was due in part to “growing awareness among parents and coaches, and the public as a whole, about the need for individuals with a suspected ...
Posts tagged Radiology
How a doctor uses Google to market and recruit patients
When I relocated my radiation oncology practice from Jacksonville to Tampa, Florida, I had to figure out how to compete against urologists in a market that was radically different from the one I had left. Unlike their peers in Jacksonville, Tampa urologists owned their own radiation centers, guaranteeing I wouldn’t receive referrals from them.To break the referral pattern, I updated and posted my physician profile for free on an online ...
Radiologists who cheat on their board exams: Who’s to blame?
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an exam to become board certified in radiology have cheated by memorizing test questions, creating sophisticated banks of what are known as 'recalls,' ... The recall exams are meticulously compiled by radiology residents, who write down the ...
Why mammography is an imperfect test
It is a scenario familiar to all breast imaging practices.A patient feels a lump in her breast and calls her doctor. The doctor examines her, agrees that a lump is present, and refers the patient to a breast imaging facility for a diagnostic mammogram and breast ultrasound (also known as a sonogram). At her mammogram appointment, a little sticker is placed on the lump felt by the patient, and mammogram ...
I’m proud that I’ve never had an MRI or CT scan
What is your personal experience with MRIs? Was your last one fun? How much did it cost whoever paid for it? Did it make a real difference in your outcome?I am a 78-year-old American man in robust general health and with good comprehensive health insurance all my adult life and I have never had an MRI.Until 2010, I had also never had a CT scan. And I'm proud of that.Why ...
The media’s role in educating patients about MRI overuse
Thankfully, there have been more news stories recently illustrating the overuse of tests.Specifically with cancer screening, the PSA test and mammograms have come under increasing scrutiny.I think this type of media attention is long overdue, as the public needs to be aware of the potential downsides of diagnostic tests.Now comes the MRI.A recent piece in the
Why radiology is the cornerstone of any hospital
Radiology is the cornerstone of any hospital. An efficient, high-quality, well-run radiology department increases patient satisfaction as a result of its ability to improve patient care. Over time, a well-run radiology department adds significant patient volumes to the hospital, which, of course, favorably enhances the hospital's bottom line. Regardless of whether the hospital is not-for-profit or for-profit, a smooth-sailing radiology department vastly increases the profitability of the hospital. The ...
Our easy access to imaging has led to overutilization
With all the debate about cost control, it’s clear that we doctors will have to police ourselves – or else politicians and insurance companies will exert even more influence over our practices than they already do. The main question is:Are we willing to let our physician colleagues exert influence on our care decisions?Taking a case from my field: at a conference this past week I met a radiology resident ...
Practical tips for a more comfortable mammogram
By now you’ve probably seen the internet jokes that compare the mammogram experience to having your breast squashed in a refrigerator door. A few years back, I joined the club of women who have our annual mammograms, and I can’t say that I disagree with the imagery of the jokes. However, the benefits of early detection far outweigh the discomfort, so I’m willing to put up with it.I’d like to ...
Eric Appelt and his extraordinary commitment to medicine
Dr. Eric Appelt was born to be a superstar. During his career, he has redefined what it means to be committed to medicine, and he embodies the practice of perseverance on a daily basis. I am proud to say that he is one of my role models as I continue my medical education.As a young man growing up in Brenham, TX, Appelt was the kind of son every parent ...
The radiation delivered by CT scanners has gone largely unregulated
Although the medical profession has been harming unlucky patients for centuries, the patient safety movement didn’t take flight until 1999, when the Institute of Medicine published its seminal report, To Err is Human. And that report would have ended up as just another doorstop if not for its estimate that 44,000-98,000 Americans each year die from medical mistakes, the equivalent of a jumbo jet crashing each day.Come ...
Physicians referring patients to a diagnostic facility they own
Federal law generally prohibits physicians from referring their own patients to a diagnostic facility in which they have an ownership issue - a practice called "self-referral" - unless the facility is located in their own practice.This exemption exists to allow patients with access to a laboratory test, x-ray, or other imaging test at the same time and place as when patients are seeing their physician for an office visit. Less ...
How Microsoft Kinect can help in radiology to view a CT or MRI
Radiology has transformed into a core subject of medicine, since imaging procedures are getting more and more crucial to clinical decisions. Whether these developments, be it over-diagnosing or unnecessary radiation on the one hand or a more detailed and enhanced way of diagnostics on the other, are ...
Are doctors ordering too many tests, or practicing a new standard?
Are medical students and new doctors overly reliant on tests and technology to make diagnoses?That's an interesting thought I had when reading the latest TIME.com piece from emergency physicians Jesse M. Pines and Dr. Zachary F. Meisel.In their article, they give reasons why doctors order too many tests.Of course, they cite defensive purposes, saying, "once a doctor has ...
Defensive medicine accounts for 20 percent of MRI scans and x-rays
In the first, known prospective study, Pennsylvania orthopedic surgeons admitted that almost 20% of the imaging studies they ordered were for defensive purposes.All of the previous data that hinted at the rampant practice of defensive medicine relied on surveys or other forms of retrospective data.In this study,
A total of 72 orthopedic surgeons agreed to participate, submitting information on ...
Radiation risks from CT scans are underestimated by patients
Radiation from CT scans needs to be better taught to patients, as their risks are real.It's the best way to help curb the rampant ordering of these tests. Unfortunately, we aren't doing a very good job.In a study from the Annals of Emergency Medicine, most patients underestimate their risk from radiation.When asked to compare the amount of radiation from a CT scan to the amount that Hiroshima ...
CT scans and x-rays draw patients into risk and overutilization
Many patients erroneously believe that x-rays and CAT scans have no risk.In their minds, they are non-invasive studies that can cause no harm. Since there are no incisions or anesthesia, they regard the experience as having the same risk as taking a family photograph. How wrong they are. In my mind the danger from non-invasive radiology studies may surpass the risk of hard core medical treatment. True, radiology tests won’t ...
Pay close attention to what doctors say to patients
In a report from the Archives of Internal Medicine, it was reported that most hospitalized patients (82%) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted. Of the physicians, 67% thought the patients knew their name and 77% of doctors thought the patients "understood their diagnoses at least somewhat well". ...
Appendicitis in children and radiation exposure from CT scans
Recently, medical writer and pediatrician Perri Klass wrote in the New York Times about evolving issues regarding the diagnosis of appendicitis in children, which are also applicable to adults. There is well-documented concern regarding the excessive radiation exposure associated with CT scans.For example, a recent paper reported that a single abdominal CT scan with contrast delivers a radiation dose equal to undergoing more than 200 regular ...
The reassurance of a CT scan in the emergency department
There's little question that CT scans are on the rise, especially in the emergency department.A recent paper from Radiology put a number to the increased frequency of the test, concluding,
CT, a radiology tool that once took nine days to finish, was used 16.2 million times in 2007 to diagnose headaches, stomach aches, back pain, chest pain and the like. That was a huge increase from 1995 when it was ...
