For content related to the science and practice of medicine

They made me do it!

Submitted by PeterElias on Sat, 02/15/2014 - 06:00

After reading this excellent study in the BMJ showing no benefit and some risk of harm from annual mammographic screening for breast cancer (see also this discussion in the NY Times) I suggested to a local institution that they should reconsider their Pay for Performance (P4P) initiative which penalizes their clinicians (by lowering their pay) if their female patien

Ordering x-rays

Submitted by PeterElias on Wed, 01/15/2014 - 06:00

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.

If I diagnose symptomatic gall stones or an incarcerated hernia, I refer the patient to the surgeon. I don’t pick the procedure the surgeon will do. My office and I don’t schedule the operating room time and notify the patient.

The decharger

Submitted by PeterElias on Wed, 01/08/2014 - 06:00

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.”