An excerpt from Looking Within: Understanding Ourselves through Human Imaging. It started as a routine weekend shift, reading studies on patients in the hospital and the emergency department, when the phone rang. Jessie, the nuclear medicine technologist, spoke on the telephone, his matter-of-fact tone slightly colored by ...

Read more...

In the dark radiology reading rooms, only the gentle hum of the computers and the quiet chatter of residents dictating radiology reads break the silence. Among the computers sits Dr. Exner, a senior radiology resident at Hospital Woeisme. He has recently become known for a peculiar habit – he has begun adding Rorschach interpretations into every radiology report he completes. The Rorschach test, created in the 1920s and sometimes referred to ...

Read more...

A medical diagnostic company recently posted the following tweet: "The best way to beat cancer is early detection. A full-body scan will provide you with a look inside your body and peace of mind." I wanted to type a reply, but I like to tell stories, and Twitter will only allow 280 characters. *** A young woman sits on the examining table. Texting. As I approach her, she dangles her legs and checks ...

Read more...

First, you have to call up your daughter to pick you up and take you to the lab. It’s hard for the nurse to find your vein. The pain from his fishing around in your arm is not nearly as bad as the pain you always have in your hip, and back, and shoulders, but it’s the straw that breaks the camel’s back, and you cry a little bit. The ...

Read more...

A recent study published in Science, one of the world’s leading academic journals, found that a predictive health care algorithm discriminated against black patients. The tool, created by Optum, was designed to identify high-risk patients with untreated chronic diseases, thereby helping administrators re-distribute medical resources to those who’d benefit the most. But there was a glitch in the algorithm, according to researchers. Rather than ranking the needs ...

Read more...

Graduation from my residency program was a bittersweet experience. At the time, my specialty was suffering from a crippling job shortage, so our futures were uncertain, and a dark mood had come to permeate my radiology residency. We were disgruntled with the specialty, with the system, and with medicine in general. I attended my graduation without any guests and only stayed long enough to receive my certificate. I was, however, honored ...

Read more...

I overheard a disappointing phone call while supervising a radiology resident recently. I could tell that the resident was struggling in a conversation with an emergency department physician, so I asked him to switch over to speakerphone. Eventually, I heard the emergency physician say, "Listen. This is how it works. A patient points to what hurts. Then I have that part scanned, and you tell me what is wrong." Disheartening as ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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, ...

Read more...

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 ...

Read more...

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, ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

“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 ...

Read more...

17 Pages

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories