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Radiologists and Prostate Disorders: Winter post

Family practionioners, internists, and even urologists are referring males for pelvic ultrasound.  Symptoms of concern are hematuria or pain.

Radiologists are expected to render accurate measurements of the prostate.  Findings of prostatitis and epididymitis should be reported.

Any sign of cancer such as a peripheral zone solid mass should be noted and proper referral to a urologist for biopsy accomplished. Prostate cancer is the most common malignancy in older men. Many will die of other illnesses with contained tumor that has not yet metastasized.

In older men, an enlarged prostate (BPH) can indent or project into the bladder base and this must be reported.  The finding of an unrelated bladder tumor will be a mucosal based mass distant from the midline.  As the nation grows older, more referrals for male pelvic ultrasound are inevitable.  Radiologists carry the burden of distiguishing benign from malignant disorders.

Litigation against Radiologists: Summer 2014

Basic problems are:

#l Failure to Communicate Important Findings by Telephone

#2 Failure to Make Proper Recommendations

#3 Failure to Perceive Unexpected Findings

 

A Growing Peril in Radiology: Imaging of the Obese Patient

As of Year 2013, an estimated 1/3 of the U.S. population is obese (Body Mass Index or BMI greater than 30). By Year 2030 this will increase to 2/3 of the population.

Regardless, patients present to their physicians and emergency room departments with immediate need of radiologic procedures.  Even the most modern equipment (CTs and MRIs)

may not permit access of these patients (too small a gantry bore or manufacturer warning of table top weight limits).  Blood pressure cuffs for complications may be too small.  Intravenous contrast access is limited by difficulty in finding accessible veins for injections.

 

There is literature that suggests increased risk of injury due to health care provider obesity bias (intentional or not).  I have observed lack of continuity in care of these patients.  Their complaints may not be fully appreciated, and their proper examination is delayed.  To address this growing problem, table tops are available to accomodate larger patients.  A larger team in the radiology suite is needed to shift patients from emergency room gurney to radiology tables. 

A regular program in training radiology staff (technologists, clerks, assistants) to address this growing problem.  Health care of the obese should equal health care of any other patient.  We have seen this is not the case and must be quickly remedied.  If modern CT and MRI machine at one facility is judged to be inadequate, there should be posting of hours and phone numbers of sister hospitals and imaging centers.

The so called "open MRI" can accommodate 600 pound patients.  I refer such patients without hesitation.  Delay is proper patient diagnosis and management can be distasterous.

Until the national problem of obesity is solved (unlikely), radiologists must be the gatekeeper.  We must quickly inform our clinical colleagues if we can/cannot perform the ordered tests and suggest alternatives.

The Holiday season approaches.  America again gorges on too much food, too much TV, too much video games.  I maintain my high school weight.  If only others did the same.

Until a solution is found, radiologists must be prepared in advance for this growing problem!!!  To avoid medical malpractice, a program of non-judgmental health care by radiologists and their clinical colleagues will avoid potential disasters.

 

Key Words:

1. Obesity

2. Health care equal for all

3. A pre-planned approach for overweight patients

 

 

 

 

Why so much continued litigation over breast cancer?

I continue to be called as expert witness (for both defense and plaintiff) on breast cancer cases (in my capacity as radiologist).

Breast cancer is an emotional disease, affecting not only the patient but her entire family.  Expensive treatment, distrust of doctors and fear of recurrence bring these patients to attorneys.  The most common mistake made by clinicians and radiologists is failure to follow Federal guidelines.

If a patient has a breast complaint (pain, lump, discharge, or family history), this complaint must be worked up until resolved.

Delay in diagnosis is the most frequent source for litigation.  Prompt additional studies (spot views, ultrasound, re-palpation, proper skin markers) all help finish a workup.  There should be NO delay in referral to a breast surgeon for a second opinion.  This is very reassuring to an anxious patient.  Copies of radiology reports should go to all involved doctors (so that no patient "falls through the cracks" on any re-visit for a different matter). 

Many patients are still reluctant to have annual mammograms.  Both clinicians and radiologists must stress that early diagnosis is the best chance for a cure.  I always tell patients about First Lady Betty Ford.  She was diagnosed in 1975 and cured.

 

This was 38 years ago!  Imagine how much better diagnosis and treatment are today.  Enjoy your summer!

 

Doctor Bob

Medical Legal News for Summer, 2013!

To Readers of this Blog-

 

Thanks for your many comments.  At trial and when reading deposition testimony of other doctors,

I note the problem of "common biases".  This can be the source of errors in the practice of medicine.

Here are important definitions that I teach medical students and resident trainees:

 

Anchoring Bias: Settling on a diagnosis too early in the workup.  This discounts future changes in patient condition that should change or at least question the diagnosis

 

Emotional Bias:  Subconscious positive or negative thinking about a patient or even their primary doctor that

adversely effects interpretations of images and any recommendations.

 

Satisfaction of Search Bias:  Stopping searching when one explanation is found that explains symptoms.

In my case as a radiologist, if I see a cyst on a mammogram/ultrasound, I cannot stop looking for another problem such as microcalcifications that could represent an unrelated cancer.

 

 

Have a great summer!

 

Dr. Bob

There are others.   These I call the Big Three!!!

e-communication for radiologists and all physicians

The Boston Marathon disaster showed medicine at its best.  Medical providers were already onsite.  The fine hospitals of Boston had previously run disaster drills on a regular basis.

News reports did not disclose that even in the worst of circumstances, HIPPA laws were strictly adhered to.  Patient identification was rapid.  Families were notified only after giving proper identification.  Texting from ambulances to hospitals disclosed no patient name but only a descriptor of patient and nature of injury.

Face to face communication by Hospital staff was quickily documented using the electronic medical record system most facilities are now required to have in place.  The Press was kept at bay,

informed only of the number of patients, type and stage of injury.  e-communication proved effective but at no time was patient confidentiality breached.  My colleagues and friends at Brigham/Women's and at Massachusetts General Hospitals could view injuries either in radiology departments or in the Emergency Rooms using appropriate passwords and encryption of patient data.

The is a lesson for us all.  Even under stress, e-communication must be monitored.  When cell phones are dropped or stolen, the wireless provider should promptly be notified and all information from that phone blocked.  Advice from JCHAO is best seen at www.jointcommission.org/mobile/standards.

 

Dr. Bob

The Medical Record: What mistakes radiologists can make !

As we enter Year 2013, the medical record (including notes, transcribed reports and the electronic medical record) become even more important for optimal medical care.

Radiologists must report their imaging findings contemporaneously for accurate reporting.  Any corrections, alterations, addenda or late entries are acceptable.  They must be so labeled, dated, timed and the radiologist author clearly spelled out

Radiologists are held to the same standard of care as their clinical colleagues.  Nothing substitutes for a phone call to a clinical colleague that a report is being revised and why. I have never had a clinician object to a brief phone call explaining new observations that might help his/her clinical care of a patient.

Happy Holidays to all!!!

 

Recent Developments in Modern Radiology

Newer methods have proven successful to document brain injury in sports and trauma.

MRI techniques are widely available.  Call me for details.

Dr. Bob

Medical Societies

Member of the American Medical Association

American Medical Association

Member of the American College of Nuclear Medicine

American College of Nuclear Medicine

American Roentgen Ray Society

American Roentgen Ray Society

American Institute of Ultrasound in Medicine

American Institute of Ultrasound in Medicine

Johns Hopkins Medicine

Johns Hopkins Medicine

Society of Breast Imaging

Society of Breast Imaging

Contact Information

Robert Hurwitz, M.D.
8805 Jeffreys St. #2014
Las Vegas, NV 89123
Phone: 949-422-1453
E-mail: Bob95Fox@aol.com

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