Dr. Saurabh Jha

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

The rational ignorance of Jonathan Gruber

Policy

November 24, 2014

I think it’s fair to say Jonathan Gruber will not be offered the role of Pinocchio. Although intelligence agencies, in search of the truth serum, might have an interest in the ingredients of what he drinks.

Please put away the pitchforks. Gruber deserves credit for honesty and bipartisanship. Plus a complete rejection of Disneyland economics. If you’re looking for transparency, the other face of honesty, Gruber is ground zero.

Stupidity, though, was …

No CT scans for old smokers?

Dr. Saurabh Jha

Conditions

November 6, 2014

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“Traditionally, doctors used to be called in when needed. But this is now changing. Increasingly it is the doctor who calls the person in by issuing an invitation. Healthy people are asked to visit the surgery for a ‘check-up,’ or ‘screening,’ when their computerized records show they are ‘due.’ Non-attendance is known as ‘non-compliance,’ indicating an element of recklessness and irresponsibility.”

– Petr …

Read more…

No CT scans for old smokers?

Instead of being hysterical about Ebola, respect it

Dr. Saurabh Jha

Conditions

October 29, 2014

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Some years ago I was in Australia’s Northern Territory. The intrepid explorer that I was, I was croc-spotting from the comfortable heights of a bridge over the East Alligator River. The river derives its name because it is east of something. And because it’s croc-infested.

I was reading a story about a German tourist (it’s usually a German) who was attacked by …

Ebola and the tension between bureaucracy and medical judgment

Dr. Saurabh Jha

Conditions

October 22, 2014

If another case of Ebola emanates from the unfortunate Texas Health Presbyterian Hospital, the root cause analysts might mount their horses, the Six Sigma black belts will skydive and the safety champions will tunnel their way clandestinely to rendezvous at the sentinel place.

What might be their unique insights? What will be their prescriptions?

One never knows what pearls one will encounter from after-the-fact risk managers. I can imagine Caesar consulting a Sybil …

It’s time to talk trade-offs in health care

Dr. Saurabh Jha

Policy

October 10, 2014

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An advantage of being a foreigner, or a recent immigrant to be precise, is that it allows one to view events with a certain detachment. To analyze without the burden of love, hate or indifference for the Kennedys, the Clintons or the Bushes. To observe with both eyes open, rather than one eye looking at the events and the other looking …

A serial killer and the origins of maintenance of certification

Dr. Saurabh Jha

Physician

September 30, 2014

Britain’s most prolific serial killer was a general practitioner (GP), Dr. Harold Shipman. He wasn’t England’s most famous murderer. That accolade goes to Jack the Ripper. The Ripper killed five women in the streets of Whitechapel. Shipman might have been responsible for over 200 deaths.

Shipman’s legacy to the medical profession was not just a permanent simmering of mistrust. He triggered the introduction of revalidation, Britain’s version of maintenance of certification …

The quixotic quest for precision in medicine

Dr. Saurabh Jha

Physician

September 21, 2014

88.2% of all statistics are made up on the spot.
– Victor Reeves

There’s a growing movement in medicine in general and imaging in particular which wishes to attach a number to everything. It no longer suffices to say, “You’re at moderate risk for pulmonary embolism (PE).”

We must quantify our qualification.

Either by an interval: “Your chances of PE are between 15 and 45%.”

Or, preferably, a point estimate: “You have a 15% chance …

To those who admire the NHS: Empower primary care physicians

Dr. Saurabh Jha

Policy

September 7, 2014

A recent report from the Commonwealth Fund, which placed U.S. last amongst developing nations in health care, analyzed Britain’s high score on the management of chronic conditions. The authors attributed care coordination to the widespread adoption of health information technology in the National Health Service (NHS).

That’s like someone saying Chinese food is tasty because chopsticks are widely used.

Like quants so fastidious about decimal points they’ve missed the overall point.

Where do …

Employer-sponsored insurance or Medicaid? An ideological debate.

Dr. Saurabh Jha

Policy

September 1, 2014

The recent disagreement between Uwe Reinhardt and Sally Pipes in Forbes is a teachable moment. There’s a dearth of confrontational debates in health policy, and education is worse off for it.

Crux of the issue is the more efficient system: employer-sponsored insurance (ESI) or Medicaid. Sally Pipes, president of the market-leaning Pacific Research Institute, believes it is ESI. Employers spend 60% less than the government, per person: $3,430 versus $9,130, …

The Affordable Care Act will face many more Halbigs

Dr. Saurabh Jha

Policy

August 18, 2014

“Then you should say what you mean,” the March Hare went on.

“I do,” Alice hastily replied; “at least–at least I mean what I say–that’s the same thing, you know.”

“Not the same thing a bit!” said the Hatter. “You might just as well say that “I see what I eat” is the same thing as “I eat what I see!”

The brilliant Lewis Carroll had a field day with logical fallacies in …

Who is the better radiologist? Hint, it’s not that easy.

Dr. Saurabh Jha

Physician

August 9, 2014

There’s a lot of talk about quality metrics, pay for performance, value-based care and penalties for poor outcomes.

In this regard, it’s useful to ask a basic question. What is quality? Or an even simpler question, who is the better physician?

Let’s consider two fictional radiologists: Dr. Singh and Dr. Jha.

Dr. Singh is a fast reader. Her turnaround time for reports averages 15 minutes. Her reports are brief with a paucity of …

The $16.7 million x-ray: Possible beats probable in court

Dr. Saurabh Jha

Physician

August 3, 2014

In a recent verdict a jury in Massachusetts awarded $16.7 million in damages to the daughter of a Bostonian lady who died from lung cancer at 47, for a missed cancer on a chest x-ray.

The verdict reminds one of the words of John Bradford, the heretic, who was burnt at the stakes. “There but for the grace of God go I.”

Many radiologists will sympathize with both the patient who …

The Match: A testament to the genius of central planning

Dr. Saurabh Jha

Education

July 12, 2014

My father who was a junior doctor in Britain’s National Health Service (NHS) in the seventies would have been grateful for the match scheme, an algorithm that places medical students in residency programs in the U.S. The training in the NHS was unstructured. Physicians carved their own training by joining a patchwork of hospital positions in disparate places.

Over a few years we lived in Yorkshire, East Anglia, Wales, East London …

The VA “works” because veterans are less demanding patients

Dr. Saurabh Jha

Physician

June 30, 2014

While rotating through the local Veterans Affairs (VA) hospital during my residency in radiology, I noticed a curious phenomenon. When the weather was pleasant a large number of veterans would not show up for their scheduled CT scan or MRI. When the weather was miserable or dangerous the attendance would be maximum.

We named this phenomenon the “VA paradox”: a paradox because this is the opposite of what usually happens.

After deeper …

Rebutting a physician’s plea to declare independence

Dr. Saurabh Jha

Policy

May 22, 2014

Writing in the Wall Street Journal, Daniel F. Craviotto Jr. an orthopedist, made a plea to physicians to declare independence from third parties and emancipate themselves from servitude to payers, mandates and electronic health records (EHR).

As rants go, this was a first class rant. But its effect was that of a Charles de Gaulle’s whisper to Vichy France rather than a Churchillian oratory at the finest hour.

The article went viral (it has …

Forget ultrasound: Do a proper history and physical instead

Dr. Saurabh Jha

Education

April 13, 2014

A recent editorial in the New England Journal of Medicine lauded, albeit cautiously, point-of-care ultrasound that has risen to such an extent that it is now becoming an integral part of medical education.

Could the availability of ultrasound revolutionize clinical medicine in much the same way Laennec’s stethoscope broke the acoustic barrier?

Certainly this possibility can’t be ruled out. But I am not so sanguine. One thing I’m sure about: Indiscriminate …

Checklists alone do not produce a culture of vigilance

Dr. Saurabh Jha

Physician

March 30, 2014

A respiratory physician who I worked for had an uncanny ability of predicting the diagnoses the admitting junior doctor would fail to consider in patients presenting acutely with difficulty in breathing. He was using a checklist, which he developed after years of observing his housestaff.

As a surgical intern I was once praised for my presence of mind in cross matching blood for a patient with a rare blood group who …

CT in neck trauma: Changing the culture in the ED

Dr. Saurabh Jha

Conditions

March 15, 2014

Schuur and colleagues in JAMA Internal Medicine listed five low value services in the emergency department (ED). Although compilation was not solicited by the American College of Emergency Physicians as part of the Choosing Wisely program, it has its ethos.

The list was developed by a technical expert panel after multiple iterations. The list is not only wise but derived from sound methodology. Most importantly, the recommendations are …

Why imaging industry should pay attention to clinical trials

Dr. Saurabh Jha

Conditions

February 1, 2014

Would you tell me, please, which way I ought to go from here?
That depends a good deal on where you want to get to.
I don’t much care where –
Then it doesn’t matter which way you go.
– Lewis Carroll

In the new world, payers will increasingly ask before reimbursing medical imaging: why did you bother finding out? This is why we must pay attention to clinical trials.

An instructive case is in the …

The FDA and 23andMe puts a libertarian in a dilemma

Dr. Saurabh Jha

Conditions

January 25, 2014

An advantage astrologers have over genetic testing is that the prediction of astrologers are personally verifiable. An astrologer once emphatically stated that I had no chance of a career in international cricket or Bollywood. So far both claims have turned out to be remarkably accurate.

How does one personally verify a “12.5%” increased chance of lung cancer, the sort of number the vendor for genetic testing 23andMe produces? If one develops …

Dr. Saurabh Jha

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