Saurabh Jha is a radiologist and can be reached on Twitter @RogueRad. 

For quality experts, a point of tension with ProPublica

Physician
October 26, 2015

Recently, I was speaking with a less is more advocate. He used his superior knowledge of statistics — he had an MPH — to debunk randomized controlled trials. We discussed overdiagnosis, overtreatment, and the shakiness of medical sciences.

We spoke about measuring the quality of physicians. I remarked that quality metrics have as much evidence as Garcinia Cambogia — we had just laughed about Dr. Oz. I expected a chuckle. Instead, …

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For quality experts, a point of tension with ProPublica

Doctors are thanked by the false positives but sued by the false negatives

Physician
October 24, 2015

Diagnostic tests such as CT scans are not perfect. A test can make two errors. It can call a diseased person healthy: a false negative. This is like acquitting a person guilty of a crime. Or a test can falsely call a healthy person disease: a false positive. This is like convicting an innocent person of a crime that she did not commit. There is a trade-off between false …

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Doctors are thanked by the false positives but sued by the false negatives

Blame the system, not Martin Shkreli

Meds
October 8, 2015

Toxoplasma gondii is a parasite that causes opportunistic infection in helpless people. It may have met its match. The cost of treating toxoplasmosis, a rare but extant infection, just shot up exponentially. Drug-resistant strain, you ask? Have physicians in infectious disease gone mercenary, you wonder? No. A change in ownership.

Daraprim (pyrimethamine) is a nifty drug that kills parasites. It’s been around for eons. I still recall its name from my …

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Blame the system, not Martin Shkreli

Antibiotics for appendicitis: 3 unintended consequences

Conditions
September 3, 2015

A Finnish group randomized patients with acute appendicitis to surgery and antibiotics and found that antibiotics were successful in 73 percent of patients. Depending on how this is framed, you can celebrate a 70  percent success or lament a 30 percent failure. Much of the debate in health care is a battle of framing.  The study has limitations. Finland is not just a land of the Read more…

Antibiotics for appendicitis: 3 unintended consequences

When a bad surgeon is the one you want: ProPublica introduces a paradox

Physician
July 23, 2015

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When report cards of performance became available, cardiac surgeons in New York and Pennsylvania avoided high risk patients. Could something similar happen, nationally, after the forthcoming revolution in transparency inspired by ProPublica’s data release?

Take two fictional orthopedic surgeons, Cherry Picker, MD and Morbidity Hunter, MD.

Cherry Picker lives in the Upper East Side of New York. His patients give …

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When a bad surgeon is the one you want: ProPublica introduces a paradox

Indian radiologists have more to worry about than teleradiology

Physician
June 29, 2015

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Teleradiology has the same effect on radiologists as Lord Voldemort has on Muggles. It’s the feared end point of the commoditization of imaging, with Rajeev in Bangalore outpricing Rajeev in Chicago for reading follow-up CTs for lung nodules.

But despite the fears of U.S. radiologists, their counterparts in India have more pressing things on their mind.

“U.S. radiologists think that Indian radiologists are …

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Indian radiologists have more to worry about than teleradiology

It’s time for radiologists to stop hedging

Physician
June 24, 2015

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There’s a simple way to define value. Ask why we exist.

Imaging exists because clinicians are uncomfortable with uncertainty. Imaging exists because emergency physicians feel that being 98 percent correct about the absence of pulmonary embolism is not good enough. Radiologists exist because imaging is not an assay on a Western blot with a 100 percent accuracy. Radiologists exist because information is …

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It’s time for radiologists to stop hedging

Should I go into radiology? A radiologist gives honest answers.

Physician
May 27, 2015

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I used to be a surgical resident in the U.K. One day, I was a little dispirited during a brutal call, and my senior resident asked, “Do you love surgery?”

“I like surgery,” I replied.

“If you don’t love surgery, love it unconditionally I mean — like loving your child — you will be unhappy.” He warned.

I really liked surgery. I like radiology. …

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Should I go into radiology? A radiologist gives honest answers.

The Digital Doctor: A reasoned look at the state of health IT

Tech
May 21, 2015

Following the recession, the Obama administration sought shovel-ready projects.

One unlikely shovel-wielding aggregate demand was health information technology. The Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009 directed 5 percent of the stimulus towards digitizing medical records.

Computerization of medical records doesn’t induce the images of public works as building freeways during the Great Depression does, but the freeway is a metaphor for exchange of information between …

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The Digital Doctor: A reasoned look at the state of health IT

Dr. Oz shouldn’t be fired. And here’s why.

Physician
May 15, 2015

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If I could invite four people for dinner, alive or dead, they would be Mark Twain, William Shackleton, Christopher Hitchens and Homer Simpson (Bart’s dad). If Mehmet Oz turned up with a bag of Garcinia cambogia, I would excuse myself.

Few things drive me to the abyss more reliably than the banality of status updates on Facebook and the monotony of health …

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Dr. Oz shouldn’t be fired. And here’s why.

A radiologist vs. Marc Cuban: 6 answers to his questions

Physician
May 5, 2015

To his credit, Mark Cuban, engaged on Twitter in response to my post.

Mark, I’m sorry I had to leave Twitter abruptly. My wife threatened to kill me and then divorce me — in that order — if I didn’t get off Twitter instantly and get the groceries.

However, I caught the tail end of the Tweets. I’ll do my best to respond.

1. “Why is this contingency …

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A radiologist vs. Marc Cuban: 6 answers to his questions

A health care proposal for Mark Cuban

Physician
April 20, 2015

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Businessman and maverick, Mark Cuban recently opined, “If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health.” I’m unsure why he said quarterly, not weekly, daily or hourly. ‘

He further opined that this must be done to “create your own personal health profile and history. It …

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A health care proposal for Mark Cuban

After a verdict: Doctors need to be taught a lesson. Really?

Physician
April 12, 2015

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Recently, a jury awarded a young California resident $28.2 million for a delayed diagnosis of a pelvic tumor. The jury found Kaiser Permanente (KP) negligent. Doctors in the system, touted to be one of the finest systems by the president, allegedly refused an immediate MRI for back pain in a 17 year old. The patient eventually received an MRI three months after …

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After a verdict: Doctors need to be taught a lesson. Really?

Awesome is the new average: The problem with patient satisfaction

Physician
March 30, 2015

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Recently, I was asked to fill a questionnaire during check-out at a hotel in India. I was very pleased with my stay, so I agreed to provide feedback. It is worth pointing out that if I was only mildly satisfied I would not have agreed. If I was disappointed with my stay, I would have filled the form more enthusiastically.

When I …

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Awesome is the new average: The problem with patient satisfaction

Heal the ill but don’t hound the well

Physician
March 25, 2015

An iconoclast must not only have abundant common sense but the gift of the gab to state the obvious. Simply stating won’t do. You must rub it in.

My favorite iconoclasts are Peter Skrabanek and Thomas Szasz. Skrabanek was a general practitioner who authored Death of Humane Medicine and Rise of Coercive Healthism. Szasz, a psychiatrist, who volunteered that he entered psychiatry to unveil its pseudoscience, is the Voldermort …

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Heal the ill but don’t hound the well

The vexing problem of dying for the medical profession

Physician
March 21, 2015

Thomas Hobbes described life as pitifully “nasty, brutish, and short.” Thanks to the free market and the state, life is no longer a Hobbesian nightmare. But death has become nasty, brutish, and long.

Surgeon and writer, Atul Gawande, explores the medicalization of aging and death in Being Mortal. Gawande points to a glaring deficiency in medical education. Taught to save lives and fight death, doctors don’t bow out gracefully and say enough …

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The vexing problem of dying for the medical profession

Do physician assistants and nurse practitioners really save money?

Policy
January 24, 2015

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In his popular tome, The Innovator’s Prescription, Clayton Christensen proposes several cures to health care’s cost disease, known as disruptive innovations. One is the replacement of physicians by advanced practice clinicians (APCs). That is, by nurse practitioners and physician assistants. APCs meet the requirements for Christenson’s disruptive innovators: They cost less (than physicians) and are good enough.

There is little doubt that APCs …

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Do physician assistants and nurse practitioners really save money?

6 priorities for the new surgeon general: Advice for Vivek Murthy

Policy
January 19, 2015

In defiance of dire predictions, children haven’t been sent to workhouses and women haven’t been chained to utensils after the GOP gained strength in the House and the Senate. And Vivek Murthy, the unabashed Obamaphile, was finally confirmed surgeon general.

To be honest, I always thought the controversy surrounding Murthy’s nomination because of his stance on gun control was rather daft. Stopping doctors from pontificating over guns, such as the docs …

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6 priorities for the new surgeon general: Advice for Vivek Murthy

Health reform and Gruber: We want simple solutions to complex problems

Policy
December 17, 2014

In the giddy days after the passage of ACA, I was chatting with a PhD student in health economics. He was in love with the ACA. He kept repeating that it would reduce costs, increase quality and increase access. Nothing original. You know the sort of stuff you heard at keynotes of medical meetings; “Healthcare post-Obamacare” or “Radiology in the new era.” Talks warning us that we were exiting the …

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Health reform and Gruber: We want simple solutions to complex problems

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