It was 5:30 a.m., and I was startled to feel the nudge of my husband’s hand on my arm while vaguely hearing the sound of my alarm going off in the background. Although I was not prepared mentally to get up for another day, I quickly jumped out of bed so as not to allow the sound to wake my sleeping daughter in the next room. I cherished no actually, …
Residency and family: How this resident finds balance
Pink ribbons are everywhere, and we all know what that means: breast cancer. While this has helped raise awareness on a horrible killer and the importance of early screening, it does not address the fact that there is still no cure for stage IV cancer or the fact that men get breast cancer as well. Yes, it is important that we all know that breast cancer is prevalent in our …
Breast cancer awareness needs to change
I am not the first physician blogger to write about the difficulties of prior authorizations, denials, and appeals, but recent occurrences in my own practice have been so convoluted that I feel they must be shared.
The nonsensical denials would almost cause one to laugh, if not for the reality that each denial represents potential delay in care for the patient and redundant work for the physician. That’s work that expands …
A glimpse behind the scenes to make your test happen
I love breast cancer awareness month. As a breast medical oncologist, it gives me an opportunity to spread the message of how important early detection is for improving the success of breast cancer treatment. I am surprised regularly at the number of women who either are not doing mammography at all or who do it every couple of years when they remember. We know that women who are participating in …
This October, share the message of early breast cancer detection
A study published in JAMA looking at the brains of former football players donated to a brain bank, a highly selective sample, found signs of chronic traumatic encephalopathy (CTE) — a degenerative neurological disease — in nearly all deceased players examined.
The mainstream media converged towards numerical consensus.
Are CTE headlines overblown? A radiologist investigates.
I am a gynecologic-oncologist. I work in the high-stakes realm of cancer care. I strategize complex treatment plans involving surgery, radiation, chemotherapy and the newer biological agents to treat the myriad of disease that we call collectively “cancer.” Cure — or at least control — requires urgent and timely administration of these modalities along with various imaging or blood work to assure that the treatment prescribed is effective. I love …
Dear insurance doctor: You are not my peer
The age-old saying is that knowledge is power. But what happens when you are overwhelmed with the information you need to make a decision without the understanding of how that information fits together to answer your question? It’s like trying to put together a large, complex puzzle without a finished picture for comparison. Oh, and by the way, you also aren’t sure you have all the pieces. This situation can …
We are clinicians in the era of information overload
I bought a pocket ultrasound in 2011, determined to learn how to perform and interpret ultrasound at the bedside and thus transform my internal medicine practice. I bought it new, and it cost over $8,000. That was a staggering amount of money to spend on something I knew very little about. In 2015 after having performed many thousand ultrasound exams with my little GE Vscan with the phased array transducer, …
4 times a bedside ultrasound made a difference this week
“Can you hear it?” she asked with a smile. The thin, pleasant lady seemed as struck by her murmur as I was. She was calm, perhaps amused by the clumsy second-year medical student listening to her heart.
“Yes, yes I can,” I replied, barely concealing my excitement. We had just learned about the heart sounds in class. This was my first time hearing anything abnormal on a patient, though it was …
Sometimes high-tech care can be high value
I feel privileged to be practicing medicine. Many people consider doctor careers and imagine how great it may be. Is it the right thing for you? Yes there are days of frustration, exhaustion, and utter defeat, but at the end of the day I home and know that I helped at least one person if not two from the 16 I meet.
The fact that I alleviated one individual’s anxiety or …
10 reasons why being a doctor is a privilege
Here’s a question that has been debated for several years: Should radiologists talk to patients about their imaging results?
Citing several issues, I came down solidly on the “no” side in a 2014 blog post.
Two major radiology organizations have committees looking into the concept, and New York Times article said, “they hope to make their case [for it] by demonstrating how some radiologists …
Radiologists have an image problem
Being a radiologist, I rarely speak to patients, but I was asked to counsel Mrs. Patel (not her real name), who was worried about the risks of radiation from cardiac calcium CT scan. Because of her risk factors for atherosclerosis, her cardiologist wanted her to take statins for primary prevention, but she was reluctant to start statins. They eventually reached a truce. If she had even a speck of calcium …
How useful is a cardiac calcium CT scan?
During breakfast with my father over the holidays, a friend of his asked me what kind of doctor I am. “I’m a radiologist,” I answered.
I was met with a puzzled expression and a reply of “Oh, I thought you were a doctor doctor.” I smiled and returned to my banana.
Most radiologists, especially those like me who are not physician offspring, are faced with this sort of discourse at least once. …
Isolation threatens the practice of diagnostic radiology
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“Life is just a short walk from the cradle to the grave, and it sure behooves us to be kind to one another along the way.”
– Alice Childress, American playwright, actor, author (1912-1994)
I am awakened in the wee hours by the sound of rain. Ordinarily I would return to bed in hope of stealing more sleep from night, but this particular day I know I have to rise at 4:30 …
A day in the life of a radiologist
It was 1989. While alternating between NCAA basketball tournament games on broadcast television, reruns of an older version of the game show Wipeout on cable, and the 8-bit Nintendo game Top Gun, a child sat in a hospital bed in the middle of rural America wondering why he was there. All he knew was that he had a sharp pain in the left side of his chest and that couldn’t …
What a radiologist learned about a thoracentesis from a pulmonologist
In 2014, 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 me of the words of John Bradford, a heretic who was burned at the stake: “There, but for the grace of God, go I.” Many radiologists will sympathize with both the patient …
Does lead-time bias have a place in court?
Most of us are skeptical that insurance companies are devoted to our health. Answer the following question: Do you think your insurance company is more interested in your health or in controlling costs?
Pretty tough, huh?
There is a tension between medical quality and medical costs. If we had a system that offered perfect quality, it would be unaffordable. If we imposed rigid cost controls, then medical quality would be compromised. Where …
Why can’t we control outrageous health care costs?
You will probably never meet me in person. Your name will be on the bill my insurance receives from the hospital. Your signature will be on the line after the end of the report as you mumble report after report into the system. You will never know my story. I am my organs to you; organs will anomalies that you have to squint and sometimes lean back to look for. You …
Please dear doctor, give me my results. My life is on hold.
A popular meme is that the U.S. spends more on health care than other developed nations but has nothing to show for that spending. This is different from saying that the U.S. spends more, but achieves something, but the something it achieves is so little that it isn’t worth the public purse. The latter is difficult to assert because the asserter must then say how little is too little in …
Does the increased frequency of repair of AAA in the United States reap benefits?
After five years of doing bedside ultrasound, I’m still excited about it. Bedside, or point-of-care ultrasound is using an ultrasound machine during the physical examination of a patient in order to make a diagnosis. I use a pretty tiny machine that fits in my pocket. As an internist who works in the hospital and in rural clinic outpatient settings, I get to use my ultrasound all the time, and it’s …
5 cases where bedside ultrasound helped this doctor
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