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

Why does Medicaid increase emergency department use?

Policy
January 11, 2014

The interpretation of results of a policy study lies in the political inclination of the beholder.

If one likes the results they are “ground breaking.” If they are not in line with our world view there are “nuances” of hypothesis testing that detractors have overlooked, it’s too “premature” to draw conclusions and “further research” is needed. Statisticians, like lawyers, can be recruited to argue any point of view to meaningless insignificance.

This …

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Why does Medicaid increase emergency department use?

Stop asking radiologists to rule out disease

Physician
December 23, 2013

When you get frustrated with my interpreting a chest x-ray as “atelectasis at the right lung base, pneumonia can’t be excluded,” trust me, I don’t enjoy it. But when you ask me to rule out pneumonia you leave me no choice but to tell you that pneumonia can’t be ruled out.

To rule out a disease a test must have a sensitivity of 100%, meaning there should be no false negatives. …

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Stop asking radiologists to rule out disease

Radiologists and primary care doctors need to talk to one another

Physician
December 8, 2013

Recently, I spoke with a primary care physician (PCP) about a young runner who had a syncopal episode. Because of the increasing awareness of sudden cardiac death in athletes, she had an electrocardiogram and an echocardiogram to look for structural abnormalities of the heart.

The PCP was inclined to dismiss the syncope as an isolated episode. However, the echocardiogram, otherwise normal, equivocated: “possible hypertrabeculation of the left ventricular apex, consider cardiac …

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Radiologists and primary care doctors need to talk to one another

Breast density laws are based on anecdote

Conditions
November 24, 2013

You know that old joke. What’s a radiologist’s favorite plant? The hedge.

Radiologists are famous for equivocating, or hedging. “Pneumonia can’t be excluded, clinically correlate,” or “probably a nutrient canal but a fracture can’t be excluded with absolute certainty, correlate with point tenderness.”

Disclaiming is satisfying neither for the radiologist nor the referring physician. It confuses rather than clarifies. So one wonders why legislators have decided to codify this singularly unclinical practice …

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Breast density laws are based on anecdote

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