In the service industry — which as physicians, we certainly are a part of — a popular saying is that the customer always comes first. The implication is that in order to thrive in an industry, you have to cater to the customers/patients as it is they who will ultimately decide where they take their business. In medical school, the emphasis on prioritizing the patient was evident, culminating in the Hippocratic Oath ...

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I’m a member of the ACR (American College of Radiology). One of their recent online postings is entitled: Choosing Wisely. Number three (of ten things physicians and patients should question) is: "Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam." In only 2 percent of cases, will it make a difference in management. Thirteen years ago, I was working on the queue of cases that ...

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I consider myself one of the lucky ones because my wife and I couples matched to the same institution for residency. At the time we put our residency match lists in, we were just boyfriend and girlfriend, and the decision to couples match felt like a bigger leap forward for our relationship than deciding to ask her to marry me about a year later. It was the right decision for ...

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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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Transformation of health care is underway: The landscape is filled with innovation, and the horizon is dotted with technological possibilities of “Star Trek” ilk. In a recent New England Journal of Medicine Catalyst article, there was a compelling argument for how artificial intelligence (AI) of the future will help deliver us from a high cost, high variability, poorly resourced state and help deliver the IHI triple aim quest we in ...

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A male interventional radiologist who is active in the #HeForShe campaign recently told me that he is being pressured to stop advocating for women. My first instinct was the biggest sigh and eyeroll of my life followed by thoughts of locker room peer pressure and boys' club type discussions. But the criticism did not just come from men; many women are asking him to stop. That they don't need a knight ...

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One of the great teaching experiences in a young medical student or resident's life is to be placed in front of his or her peers with an attending physician quizzing him or her on the spot about a particular patient. Often, when radiology imaging is involved, the said victim will be asked to interpret the study and point out any salient features. I have been subject to this numerous times in my ...

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I think one of the biggest frustrations I have as a doctor is being at the mercy of people who either have no medical training or are so detached from medicine that they have lost touch with those on the front line. The American Board of Radiology (ABR) essentially governs over radiologists who typically need the important board-certified designation to find a place of employment. I have always played by the rules ...

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Patient access to care is a high priority for all neurosurgeons. Unfortunately, many of our practices are thwarted in these efforts from unwarranted insurance denials. Know, you are not alone. Take this common scenario:

When Ms. Mary Smith (not the patient’s real name) started her new job several years ago, she purchased the premium insurance policy that her company provided. Recently, she developed severe neck and left arm pain. Imaging of ...

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My dad flew to California in the spring to meet his grandson, who was about five months old at the time. He wasn’t that interested in baby care. He mostly wanted to sight-see and spend the evenings watching TV. One weekday morning, he ventured out on a hike alone, while I was at work. He left at 9 a.m. and never came home. We live at the base of a dusty ...

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In the United States, any person who has tried getting their own (or their patient’s) radiology images from another hospital or practice will find the practice painful. Here are several obvious reasons why the CD-ROM — briefly the darling of large data transfer — is a truly terrible way to share radiology images in 2018: They require physical transfer. Remember the term “snail mail”? Do people still say that? They are slow. When you bring a ...

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