6 Books for the Business Minded Healthcare Provider

6 Books for the Business Minded Healthcare Provider

1. Freakonomics was the gateway for me. The off kilter thought process, long range data evaluation and the deep-dive in to cause and effect thinking clicked.

2. Supercrunchers hammered it home. A/B testing. The power of large numbers. Data is good.

3. Nudge was a nice next step.  Opt in or out of your retirement contribution?  How much energy is my neighbor using? Wow, I should cut back.

You know the story of the ice bath and kidney snatcher? Why do you remember it?

Click here for the rest of my short book review.

CORE Exam – Free quality and safety study guide for radiology residents

CORE Exam – Free quality and safety study guide for radiology residents

62 question study guide to prepare for the upcoming Core Exam.

Questions go in order with the published guide – multiple choice, matching and “cloze” type questions.

The question and answer PDF’s are 17 pages each.

Please send any feedback and share as you like.

 

Wish you the best on the exam.

 

Core_Quality_and_Safety_Study_Guide_quiz

 

Core Quality and Safety Study Guide answer v2

 

Disclaimer – this post is in no way associated with the ABR. I created these questions for my residents as a study guide.

Also David Larson has a great youtube channel

ABR Core Quality and Safety Exam Review

https://www.youtube.com/playlist?list=PLLLzu3xBKm69CJkHYm4hIIdpyyskcNxIs

Reward for studying?

Try Amazon Prime 30-Day Free Trial

 

 

6 Books for the Business Minded Health Care Provider

6 Books for the Business Minded Health Care Provider

1. Freakonomics was the gateway for me. The off kilter thought process, long range data evaluation and the deep-dive in to cause and effect thinking clicked for me.

2. Supercrunchers hammered it home. A/B testing. The power of large numbers. Data is good.

3. Nudge was a nice next step.  Opt in or out of your retirement contribution?

How much energy is my neighbor using? Wow, I should cut back.

4. The Compound Effect reminded me of training for my Ironman.

Make a goal.  A hard, awesome goal. Then do it. One stroke,  one pedal and one step at a time.

5. Made to Stick Am I the last person to read this?

You know the story of the ice bath and kidney snatcher? Why do you remember it?

Can we use this to help people?

6. The Everything Store Please put medical supplies on your shelf, Jeff.  Please drive the prices to where they should be.

And thank you for Amazon Prime (and your welcome).

What would you add to the list?

The Checklist Manifesto – Radiology Perspective

Checklist Manifesto

Atul has nailed it – in order, without a step missed.

I need something from the store, I make a list.

Atul has put together a short, insightful and compelling piece and I am a little sad that I waited so long to read it.  This is a must read for anyone in healthcare who wishes to make a big difference in and out of the operating room.

 

 

In the field of radiology we have structured reporting: liver, gall bladder, right and left adrenal gland, pancreas, spleen and so on as we read a CT scan of someone’s abdomen and pelvis. I say we ‘have’ because not everyone likes to list each organ. What if there is a very complicated post operative patient that does not fit into nice blocked text? What if I did four years of residency speaking in normal language and not comfortable breaking it down by organ?  There is research to support reporting as a list and reporting in free text but the important thing is to have a reproducible system to decrease variability and hopeful decrease errors.

Atul has done a nice job relating the importance of simplifying checklists to make them useful and demonstrating their utility in aviation, finance and medicine. I’m not sure if everyone will embrace the concepts in this book, but I wouldn’t be surprised to see people catch on and start the next wave of mobile apps with checklist type functions.

Nice work Dr. Gawande.

Aspirated foreign body in a child

igpledge
After initial life saving measures, what is appropriate imaging for a suspected foreign body aspiration?
Depending on the age/size of the child, a chest radiograph is usually the first imaging exam.
It is helpful to know that you are worried about an ingested or aspirated object because I can look for secondary signs of bronchogenic obstruction, if it is radiolucent.
The overall appearance of the lungs or subtle mediastinal shift can help find the cause. Also, real time fluoroscopy can be useful to see paradoxical movement. Even with a clearly visible, radio-dense object these supporting finding are helpful to determine the degree of obstruction.
In short – it will be a team effort with the radiologist.  Tell me your concern and I can let you know if I see any of the subtle findings.
Of course, the team will expand to include a bronchoscopist if there is persistent clinical concern, even in negative imaging. Direct visualization is hard to beat.
Important: a thin watch battery or 2 thin disc magnets presents significant additional worry for further mucosal damage. It is important to differentiate them from a coin and you can use my experience to help you and your patient.
Educational purposes for licensed providers.
Note to Patients:Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

Cardiac #pacing device and #MRI ? #np #pa #ms #choosingwisely

 

Is there a way to get an MRI for your patient with a cardiac pacing device?

Possibly.

The exact manufacturing information must be available from the device, probably from the card the patient was issued.

Look up that exact information on here:

mrisafety.com/TheList_search.asp

Then careful coordination with the radiologist at the MRI center with the above information – additional cardiology coordination may be needed.

No implanted device can ever be assumed “conditional” or “safe” – it must always be referenced with the MRIsafety.com list and discussed with a radiologist.

Educational purposes for licensed providers.
Note to Patients:Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.
A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.Of course, this is not a substitute for medical care.
Cyclical Breast pain, ultrasound? #orderwhat  #AFPjournal #PCareProgress #AANP_NEWS #AAPAorg #choosingwisely

Cyclical Breast pain, ultrasound? #orderwhat #AFPjournal #PCareProgress #AANP_NEWS #AAPAorg #choosingwisely

If a woman has cyclical Breast pain, does she need an ultrasound? 

Probably not.

Cyclical breast pain, in a pre or peri-menopausal woman is probably benign and related to breast parenchymal response to hormonal changes.

If the pain does not coordinate with menses, a cyst or other structure could cause pain, in which case an ultrasound, or other imaging would be helpful.

Breast pain is not a common indicator of breast cancer.

More information here: 

webmd.com breast pain or mastalgia

Educational purposes for licensed providers.
sgk-logo_top
Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician’s Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

#Fat? So what?

#Fat? So what?

I read a lot of #CT scans. People come in different shapes and sizes.

Many requests say “abdominal pain” and more than half of my reports say normal or close to it.

Two patients, similar age with no acute findings to explain their pain.

What do the blue arrows represent?

Should my report still say normal?

Should my report include: Correlate with risk factors for metabolic syndrome?

Here’s what the Mayo Clinic thinks of metabolic syndrome.

As of right now, I do not include this on my report – should I?

Will it make a difference when you meet with the patient with the results of the scan?

Blue arrows are subcutaneous fat, btw.

____________________________

Educational purposes for licensed providers.
Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.Of course, this is not a substitute for medical care.
#Poop and #belly #pain!

#Poop and #belly #pain!

Too much stool? #orderwhat  @AFPjournal @PCareProgress @AANP_NEWS @AAPAorg

Many radiologist would not specifically comment on stool burden.  I have made it part of my practice to include “Dense stool and air filled colon, correlate with signs and symptoms of constipation” when I see a radiograph like this.

If you get a normal report and you see the colon looking like this, consider constipation.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

Image credit:

http://orainformatics.com/wp-content/uploads/2014/08/122704constipationaxr-232×300.jpg

Suspected Physical Abuse Child

Suspected Physical Abuse Child

2 years or younger? Over 2? Neurologic findings?  #NAT #orderwhat  @AFPjournal @PCareProgress @AANP_NEWS @AAPAorg
2 years old or younger, no focal neuro symptoms => Skeletal survey
2 or younger, head trauma with no focal neuro symptoms => Skeletal survey and non con head CT
2 or younger, WITH focal neuro symptoms => Skeletal survey and non con head CT, probably brain MRI
OVER 2, WITH focal neuro symptoms => Non con head CT, probably brain MRI

Any age with obvious chest, abdomen or pelvic trauma => Skeletal survey and indicated CT 


Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.