For content related to the science and practice of medicine

Ordering x-rays

I just don’t understand the way we order radiologic tests and procedures. 


If I discover skin cancer during an office visit, I refer the patient to the dermatologist or surgeon for evaluation and treatment. I don’t have to order the specific procedure they will do, or fill out a prior authorization form for their biopsy or excision.

The decharger

Doctors often complain that patients indulge in maladaptive magical thinking and talk about how hard it is to get them to face reality. Sometimes, it is easier to join patients in their magical thinking.


I remember an incident from an Emergency Medicine clerkship during my fourth year of medical school. I was asked to see an agitated young man whose ED chart said: “Chest pain, agitation, hallucinations.”