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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Sometimes things go just the way you want them to, and sometimes they don't. Compare and contrast the case of two different patients, and how things went trying to get them the care they needed. The first patient, let's call him Mr. Smith, called up one day last week with a brand-new symptom, which after a phone call was ultimately determined to be disturbing enough that he was offered a same-day appointment. After ...

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As a radiologist, I interpret thousands of imaging studies every year. Of the millions of medical images that have crossed my screen, they all have one thing in common. They were all acquired by a technologist in the radiology department. Imaging technologists perform a vital role in medicine. All have specialized training that is unique and critical to patient care. Truth be told, many of them have a greater knowledge base ...

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Doctors know high-pressure exams. The day before one is the worst. There is cramming followed by anxiety and insomnia. When sleep finally beats anxiety, the dreaded nightmare falls upon anxious test takers. Every doctor knows. Walking into the testing center, opening the exam, realizing you studied for the wrong exam. The questions might as well be a foreign language. This nightmare was a reality according to this year’s group of ...

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Computed tomography, or CT scanning, is one of the most powerful diagnostic tools to emerge during my medical career. Just look at the detail in the brain images above, taken at 90-degree angles through the brain. And I was there at the beginning. I remember well when I was a medical student taking neurology, and the first CT scanner arrived at the Mayo Clinic. By today’s standards, it was incredibly ...

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As I sat in a frozen yogurt store a couple of years back, I watched as two young men pulled up in an expensive vehicle. They were wearing athletic attire from a private faith-affiliated university in the neighborhood. Both grabbed sample cups and cup-by-cup consumed about ten dollars-worth of yogurt each before jestfully yelling “Gracias” to the Latin store employee and walking out the door without paying for anything. Then ...

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“I give up! I can’t help these people.” Emily was completing the final month of her emergency medicine residency and flopped into her chair with exasperation. “What’s up?” I asked. We were on the final two hours of our shift together. And I, as her attending, was already feeling apprehensive about the patient encounter that awaited me. “They want so much from me, and I can’t fix them!” She began to tell ...

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Let’s begin with a quiz question: Patients may be allergic to: A. oxygen B. carbon C. iodine D. none of the above If you answered anything but "D," better keep reading. Consider this scenario: If a patient is allergic to penicillin, you would document “penicillin” in the medical records. It would never occur to you to list “antibiotics” as an allergy, and you certainly would not call it a “carbon” allergy for slang, just because penicillin contains ...

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Today is a strange day. I treated myself to a slice of nondescript doughy hospital pizza for lunch today. If this was an actual pizza place, and I had a choice, I would never order this pizza. But today, the pizza tasted fantastic. In fact, it tasted like the best pizza I’ve ever had. Why you ask? Because this would likely be the last time I’d ever eat this hospital pizza. I enjoyed ...

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Having worked at both community hospitals and major medical centers, the issue of ultrasound in pregnancy has revealed itself to be more complex over the years. As a resident, I worked with an obstetrics office that only scanned their own patients who had private insurance and would send uninsured or Medicaid patients (often with a high risk of inadequate prenatal care) to the hospital late in the day to be ...

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In a 2012 blog post called “Things that puzzle me about surgical education,” I wrote the following:

There was the emphasis that still exists today on making sure every resident did research. At last, some are questioning the value of this for the average clinical surgeon. Contrary to the prevailing wisdom, there is no evidence that a resident who is dragged kicking and screaming through a clinical research project or ...

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Artificial intelligence, or AI, is a term that is often associated with robots or computers that “learn” by having material introduced to them. Different people have different reactions to the idea of AI, especially with its potential use in medicine. AI can perform many tasks at the same time and in the same way producing results that will always be precise, but not necessarily accurate. This is relevant to fields ...

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