A professor recently romanticized my idea of clinical reasoning as he began our session by saying, "When you're a physician, you're a detective." He elaborated: "Every fact you have, every piece of evidence you have, must be consistent with your leading diagnosis." As he said this, my eyes narrowed, and I sat up a little taller. My fellow first-year medical students and I have begun our official training in clinical reasoning, ...

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I can still recall my first day of medical school orientation. A humbling silence fell across a sea of 162 enthusiastic and largely arrogant aspiring trainees as the dean proclaimed, “As doctors, you will all kill someone at some point in your career.” I did not give this declaration much thought at the time. I already had a career as a diagnostic radiologist in my sites and believed that radiologists were ...

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The sky was overcast as my girlfriend dropped me off at the airport on a June day several years back. I was headed to Chicago to take the last meaningful high stakes exam of my medical training, a mandatory board exam available only at two sites, a test that 1 in 6 residents now fail. One might think of such an event as something to look forward to, ...

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It was a common enough reason for someone to have a CT scan. The order read, “Abdominal pain, colon cancer resected in January.” It was now March, only two months post-surgery. Yet the patient’s CT scan showed a number of large masses in the liver, consistent with metastatic cancer. I compared the current study to the CT performed before surgery. The liver had looked perfectly normal at that time. "That’s an amazingly ...

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Some radiologists perceive teleradiology as the “dark side” of our profession. I may have counted myself among those skeptics, but I now see the light and am happy to share a place among the converts. Most of my career has been in traditional private practice, but there’s not a great deal of difference in how they operate versus a teleradiology practice. Both organizations exist to provide clinicians and patients with diagnostic ...

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Your first is always special. It is a mixture of youthful inexperience, awkwardness, anticipation, and giddiness that creates a cacophony of emotions and physical changes that is hard to describe unless you have experienced it yourself. Your repertoire of techniques/maneuvers is quite sparse — to say the least. You might fumble around and accidentally put the wrong thing in the wrong orifice. Not knowing what body part should go where, if you are doing ...

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The numbers are scary: The average woman has a 12 percent risk of developing breast cancer at some point in her life. For women with certain genetic mutations or risk factors, lifetime risk can climb to 85 percent. Even more terrifying than the numbers, however, are the rumors; rumors that the contrast dye used in MRIs for breast cancer screenings is harmful; rumors that are driving women away from an adjunctive ...

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Jeanette Brown had lost twenty pounds, and she was worried. “I’m not trying,” she told me at her regular diabetes visit as I pored over her lab results. What I saw sent a chill down my spine: A normal weight, diet controlled diabetic for many years, her glycosylated hemoglobin had jumped from 6.9 to 9.3 in three months while losing that much weight. That is exactly what happened to my mother some years ...

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1. I am not omnipotent.  As health care providers our ability to treat is sometimes affected by factors beyond our control--- limitations in technology, variations in our work environment, and human nature.  While we always commit to performing our very best, our best may vary from day to day; if my best is not the best for you, then I will offer you all possible alternatives.  Furthermore, not all disease can be cured, nor every malady ...

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“We have a consult for radiation oncology regarding a 60-year-old gentleman with a history of lung cancer and is currently admitted. His oncologist is Dr. Heme Onc.” As a new radiation oncology resident, I was surprised to hear the consulting physician refer to the patient’s medical oncologist as “his oncologist.” What about the patient’s radiation oncologist? Indeed, I remembered the patient well: he was diagnosed with Stage IIIB non-small cell lung ...

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