February 28th, 2011 by Elaine Schattner, M.D. in Opinion, Research
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There’s a new study out on mammography with important implications for breast cancer screening. The main result is that when radiologists review more mammograms per year, the rate of false positives declines.
The stated purpose of the research*, published in the journal Radiology, was to see how radiologists’ interpretive volume — essentially the number of mammograms read per year — affects their performance in breast cancer screening. The investigators collected data from six registries participating in the NCI’s Breast Cancer Surveillance Consortium, involving 120 radiologists who interpreted 783,965 screening mammograms from 2002 to 2006. So it was a big study, at least in terms of the number of images and outcomes assessed.
First — and before reaching any conclusions — the variance among seasoned radiologists’ everyday experience reading mammograms is striking. From the paper:
…We studied 120 radiologists with a median age of 54 years (range, 37–74 years); most worked full time (75%), had 20 or more years of experience (53%), and had no fellowship training in breast imaging (92%). Time spent in breast imaging varied, with 26% of radiologists working less than 20% and 33% working 80%–100% of their time in breast imaging. Most (61%) interpreted 1000–2999 mammograms annually, with 9% interpreting 5000 or more mammograms.
So they’re looking at a diverse bunch of radiologists reading mammograms, as young as 37 and as old as 74, most with no extra training in the subspecialty. The fraction of work effort spent on breast imaging –presumably mammography, sonos and MRIs — ranged from a quarter of the group (26 percent) who spend less than a fifth of their time on it and a third (33 percent) who spend almost all of their time on breast imaging studies. Read more »
*This blog post was originally published at Medical Lessons*
May 12th, 2010 by AlanDappenMD in Better Health Network, Health Policy, Opinion, Primary Care Wednesdays, True Stories
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A common problem in healthcare is the number of times that small adjustments are needed in a person’s care. Often for these little changes, a physical exam and face-to-face time have nothing to do with good medical decision making.
Yet the patient and doctor are locked in a legacy-industrialized business model that requires the patient to pay a co-pay and waste at least half of their day driving to and from the office, logging time in a waiting room, and then visiting five minutes with their practitioner for the needed medical information or advice.
Today I’d like to visit the case of a patient I’ll call “DD,” who I easily diagnosed with temporal arteritis (TA) through a 15-minute phone call after she’d spent four weeks as the healthcare system fumbled her time with delays and misdirection via several doctors without establishing a firm diagnosis. Read more »
March 12th, 2010 by Medgadget in Better Health Network, Health Tips, News
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Menssana Research, Inc is touting results from a trial testing its Breathscanner for diagnosing patients with active pulmonary tuberculosis. Menssana has developed technology that may bring breath testing for a variety of conditions, including the already FDA approved breath test for heart transplant rejection.
Some details about the technology from Menssana:
The Mycobacteria that cause pulmonary TB generate a very distinctive pattern of volatile organic compounds (VOCs) when grown in the laboratory. If these VOCs could also be detected in the breath of infected patients, it might provide a new method for detecting active infection with pulmonary TB. Read more »
*This blog post was originally published at Medgadget*
July 8th, 2009 by KerriSparling in Better Health Network, Patient Interviews, True Stories
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After a hectic week with the conference in Philly and then Chris’s great news, I need to spend some time today catching up on everything. Thankfully, Jessica Phillips has offered to guest post today, writing about marking 500 days with type 1 diabetes. She’s come a long way, and I’m proud to host her words here on SUM.
Heeeeeeere’s Jessica!
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As I was injecting myself with insulin on a lunch break at work, a co-worker walked by and exclaimed, “I could
never do that! EW! I hate needles!” Less than two years ago I might have agreed. I never had a strong phobia of needles, but that is not to say that I particularly liked them either. I was known in my childhood to run out of doctor’s offices into the parking lot at the first mention of “shot”. Now when I hear such a strong and callous remark to my now normal routine of insulin injections, I struggle with trying not to angrily reply, “Well you would have to give yourself shots if you had to in order to live!” or, “How do you think I feel? You think I want to do this?” I’ve learned as of late to simply smile and say, “It’s not easy.”
Reactions like this are commonplace for those of you who have experienced Type One Diabetes for many years, and even some for the majority of your life. For me, June 9th, 2009 marked my 500th day with type 1 diabetes. I was diagnosed in my hometown of San Diego, California on January 25th, 2008 at 26 years-old. For a couple months prior to diagnosis I had been experiencing the typical signs of hyperglycemia and a failing pancreas as I was constantly dehydrated, urinating, and tired. Being a college student and in a constant state of stress, I quickly attributed the majority of my symptoms, from dizziness to infections, to be solely related to my immune system’s battle with my constant stress. After many weeks of procrastinating, I finally urged my doctor to order a blood test. I went in to the lab on January 23rd and was called by my doctor 24 hours later while I was driving to school. The tone in her voice immediately caught my attention and set me in a state of alarm. She informed me that my blood sugar the day before was above 300 mg/dL and I was to avoid sugar and be referred to an endocrinologist immediately.
Luckily I was able to see an experienced endocrinologist the next day, and he diagnosed me with type 1 within minutes of being seated in the exam room. I was in complete shock, and felt confused, angry, and overwhelmingly sad all at the same time. I felt a struggle between trying to remain alert to the bombardment of information he was feeding me, and trying desperately not to cry. The doctor left the room to retrieve my new meter and insulin pens, and I lost it. Luckily I had some moral support with me, but I have never felt so alone and lost. I kept thinking, “how did this happen?” and, “what did I do wrong?” To have gone many years without having anything major occur medically, not even a broken bone, it was a major shock to hear I had something irreversibly wrong with me. I not only had something wrong, but I could not do anything to change it.
The next few days were extremely challenging to say the least. I was unable to give myself insulin and had to have someone else do it for me for the first couple days. I would sit and look at the needle and could not conceive of how this tiny piece of metal was going to go through my skin. I just kept thinking it was so wrong, and foreign. I also cried. A lot. And I researched online and in books so much that I felt as though I could speak at a lecture on the biology of diabetes. I found the knowledge empowering, and the more I grasped what my body was actually doing, and not doing, I became more confident in my ability to control my state.
Now, 500 days later, this diabetic routine is normal to me. I can hardly even remember a time when diabetes wasn’t on my mind. The memories have faded of when my blood sugar was not a concern, and when I was able to look at food as just food. The last year and a half has been a giant emotional roller coaster, full of ups and downs, but they have changed me. Sometimes I get the look of sympathy from others when I detail my hardships with this disease, anywhere from medical costs to just the simple annoyance of pricking myself all the time, and I have found myself realizing that although I would not choose to have this disease, I consider myself lucky. I am lucky of course to not have something worse, but having gone through this change has made me look at my life through a new and clearer lens. My bottom-line now is a cliché idea, but it is so true … life is short, and you only get one shot, so make it worth it, no matter what.
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Thanks for sharing your story, Jessica. (And for the record, Jessica is the one with the fantastic hair on the right in that photo. Also for the record, I just realized that today is my 8,209th day with diabetes. Holy crap, my pancreas is lazy.)
*This blog post was originally published at Six Until Me.*
May 27th, 2009 by DrRob in Better Health Network
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“That doesn’t make any sense.”
The patient sits across the exam room and looks at me with a combination of surprise and hurt. He had answered all of my questions to the best of his abilities, hoping that I would figure out what was causing the symptoms and fix his problem. A bit of doubt shows on his brow as he goes over what he feels and what happened in the past. Did he say things wrong? Did he mistake the way it felt? Is he just bad at explaining things?
“I am not accusing you of being untruthful. Your symptoms are your symptoms, and you felt what you felt. Unfortunately they don’t always read the medical textbooks and so make me earn my keep. I believe your symptoms are real; I just don’t understand how they fit together. It’s confusing.” I say this as reassuringly as possible. He relaxes visibly as I speak.
But that doesn’t change the fact that the symptoms defy logic. It’s my job to figure things out and fix things, right? Isn’t this an admission of defeat? Isn’t it a confession of my inadequacy? Won’t this undermine the thing that I have said is the cornerstone of a doctor/patient relationship: trust?
Some people seem impatient for an answer, but most are OK with me not knowing for a while. The thing that makes it acceptable for me to be confused is the longstanding nature of the relationship of a patient with their PCP. This is one page in the book, not the whole story. This concept – of the patient’s “story” – is one I actually use in this situation. I say:
You know when you see a movie that is really confusing in the start? You don’t know who is who, or why one person was mad at the other, etc. It is just hard to figure out what is going on. But later on in the movie things become clear. You say “Oh, so that’s who that guy was! That’s why she was so mad at him.” It all clears up over time. With your illness, we may just be at that confusion part of the movie. It may just take time for us to be able to make sense of what is going on.
I have to say that I actually am glad for those cases where things are confusing at the start. No, I am not happy for the patients, but the hard stuff is what separates the good docs from the bad ones. If I can sort through things and come up with an answer when one wasn’t apparent, I am showing the merit of all of my hard work. I justify my salary. I go home feeling like I am more than just a bunch of algorythms.
I don’t want everyone to be confusing, but just because things seem to not add up it doesn’t mean we won’t come to a good answer eventually.
*This blog post was originally published at Musings of a Distractible Mind*
