Tag Archives: Medicine

Don’t Go to The RSNA for The Great Research

The Radiology Society of North America (RSNA) annual conference is one of the most popular and most well-attended conferences in radiology.  The deal is the same – you submit some academic work you completed, and if it is deemed worthy, you are offered a not-quite-golden ticket to attend the not-quite-chocolate-making conference center.

You spend upwards to one week in a place with 20,000 strangers pushing around, 4,000 some CME-worthy offerings, and another 700 vendors trying to decide whether you have money to buy a CT table.  Sometimes people say that you go to the RSNA conference to learn about the newest research, to get ideas from being bathed in the sheer high density of smartness that we assumed would somehow disperse by diffusion.  The research is great, the vendors are great, the city is amazing, but these aren’t the reasons to go to the RSNA conference. If the research is important enough you will see it in a journal, if you need a product you will find that vendor on the internet, and Chicago… is indeed amazing, but it would be more so in September than December.

The reason that tens of thousands of people come together on this one week is not for the great research.  It’s for each other.  Go for the great people.  The world-class research is just a bonus.

Registration Now Open

Radiology’s largest annual conference is held in Chicago this year from Nov 29 – Dec 4

On The NRMP Residency Match, And What People Meant by “It’ll All Work Out”

The optimal solution of the NRMP match algorithm is deceptively simple, but its implication for the lives of applicants is anything but simple.

Three years ago, my then-girlfriend and I sat down and parsed through what would become the most important determinant of our lives moving forward.

Because we attended different medical schools, we carried on a long distance relationship for five years. The NRMP match was more than just a residency choice. It was also a solution that could finally close our distance and take the relationship forward again.

The ranked list seemed like the most difficult decision we had to make. There were so many variables, each with differing levels of importance.

match

Icons made by Freepik from www.flaticon.com is licensed under CC BY 3.0

Continue reading

Disclosures – on Financial Conflicts of Interest

Conflicts of interest in medicine…

  1. Sometime leads to academic dishonesty
  2. Is pervasive
  3. Is probably unavoidable in the absence of infinite non-profit grants
  4. All of the above

Continue reading

Measure Differently to Think Differently

Credit: Innovation by Boegh, licensed by Creative Commons

There are many forms of innovations.  Sometimes medical innovation is nanotechnology, molecular imaging, high-precision targeted therapy, or 3D-printed prosthetic, which are advancements whose adaptation rate are limited by the rate of research.  This is a good thing.

And then, there exists technology that has become commonplace in every other industry but is still considered “innovation” in medicine due to their glacial adaptation rates in hospitals and clinics.  Case in point: When was the last time you saw a pager that doesn’t belong to a healthcare provider?

Continue reading

Different people are all different

Many teenagers find it enormously difficult to fit in with the crowd, particularly when they also feed the need to stand out.  The things that differentiate us from the next person – love of comic books, thick glasses, or the giant 1mm mole on the left pinky – are frightening to the developing adolescent.

Growing up is realizing that many parts of life require us to embrace our “abnormalities” – impressing a first date (“I never thought I’d find another person who also likes ____.”), acquiring a coveted career position (“My ______ makes me the ideal candidate for your company”), telling a dinner party story (“The most ridiculous thing happened the other day…”).

It seems that being different is extraordinarily difficult.  After all, only a small number of people can be at the tails of the bell curve, and it is easy to feel just so… average.

In medical blood labs, “normal” is a vague definition.  The normal value range actually encompasses only 95% of numbers you would find in healthy people because there is some overlap with lab values in sick patients.  This means that if we measure enough numbers (say, about 20), we would find some abnormal values in everyone, healthy or otherwise.

These laboratory values catch doctors’ eyes.  They warrant extra seconds of discussion on rounds, extra discussion at the bedside for symptoms, and/or repeat laboratory evaluations.  Most of the time further investigations affirms the simple fact that even the most normal person has some measurable outstanding lab values.

In medicine, we learn that the completely average person simply does not exist.

The difference between lab values and real life qualities is that running a panel of 45 blood labs is simple, but identifying our own eccentricities and innate talents takes introspection and feedback from honest friends.  Then, embrace it – life may not have dealt everyone an even hand, but it is fair in that everyone is playing from some kind of a crooked deck.

Why Can’t Hospitals Stop Over-Billing Us? (Part 1/2)

Update: On January 5, 2015, Stephen Brill published America’s Bitter Pill: Money, Politics, Back-Room Deals, and the Fight to Fix Our Broken Healthcare System, expanding on his popular Time article.

It is an interesting book, not because I agree with Mr. Brill’s data but because it happens to be a useful exercise in how data sometimes can be applied/misapplied to streamline a compelling narrative.

Below is a shameless self-reblog from my response to the original Brill article focusing on how data from a sub-sub-sub-specialized hospital should not be used to comment on an entire set of hospitals, some of which struggle to serve as the safety net for a vulnerable population.

 


 

In an article titled “Bitter Pill: Why Medical Bills are Killing Us,” Stephen Brill outlines a well-researched investigation on hospital over-billing.  In the article, Brill begins by highlighting the unreasonable mark-up MD Anderson places on every medication, service, and imaging that it provides.  He argues that this “hard-nosed approach pays off,” earning MD Anderson $531 million operating profit in 2010, and that this comprises a 26% operating margin.  $1.8 million of that went to the pockets of Ronald DePinho, the president of the cancer center.

Although Brill never outright states the connection, his implication is clear: general hospitals are the oft ignored mammoth in the health care debate, operating under the veil of legitimate non-profit business.  A general hospital funds its astounding operating income by making the uninsured and under-insured suffering patients an offer they cannot refuse – a markedly inflated bill.  It then funnels this unfairly earned profit into the pockets to the Godfather of the organization.

The logic is sensational, if only it were correct.

Continue reading

Why Can’t Hospitals Stop Over-Billing Us? (Part 2/2)

In a prior post, I read Steven Brill’s story on health care hospital bills and offered a brief analysis of the “average hospital” in contrast with MD Anderson (spoilers: sub-specialty cancer treatment is profitable, the average hospital is not).  The data show that average hospitals are low-margin organizations.

Below, I argue that although the data disagrees with the vilification of general hospitals in “Bitter Pill,” the article is spot-on that medical bills are incredibly over-priced.

Then, I offer a hypothesis on why.
Continue reading