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Dec 31
2009

Communities of Practice: A Broad Church

Posted by Prashant Bhatt in Working people , Teaching , Management , Health Policy , Culture , Clinical Radiology Sessions , Career , Business

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Prashant Bhatt

How independent can one be in a modern technology driven specialty branch dependent on referring physicians?

Systems and communities of practice

In the previous blog we had examined some practice options (Part Time?)

As Dr. Sridhar rightly pointed out that we are a referral dependent specialty and in his interact on Forum of Super specialty in Radiology has observed that one really does not often meet radiologists who are practicing as independent super specialists. We meet Neurologists, Cardiologists..but…super specialist radiologists?

In Blog End of Individual Goliaths we had examined how if one has to hold ground one has to be part of some system of practice.

Does the person who is working “For Himself” really work alone or are they part of several practices.

One surgeon friend did not want to initially invest on costly radiology equipment as he had invested in operation theatre and Intensive care units. He asked his radiology friend to invest and set up the radiology department.

“I am a man of limited means and you can use your real estate to become independent any time, once the initial loss making ‘teething’ period is over” the radiologist replied frankly.

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Nov 19
2009

Unanticipated unfavorable Outcomes: Communicating Errors

Posted by Prashant Bhatt in Practice , Health Policy , Ethics

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Patients report wanting to be told about all harmful errors
in their care, and consider disclosures an important part
of a trusting relationship with their physicians (1)

How will you disclose unanticipated unfavorable outcomes? To whom will you disclose? How much will you tell?

Mammogram Errors
In “Disclosing Harmful Mammography Errors to Patients” Thomas H. Gallagher et al(2) tried to assess the attitudes about disclosing errors to patients by using a survey with a vignette involving an error interpreting a patient’s mammogram leading to a delayed diagnosis. This study was based on a survey which included items on demographics, practice characteristics, and experience in radiology and breast imaging. A copy of the survey is available online (http://breastscreening.cancer.gov)

To assess radiologists’ attitudes about disclosing errors to patients, the survey contained a vignette involving an error interpreting a patient’s mammogram, leading to a delayed cancer diagnosis:

“A diagnostic mammogram for a new palpable lump shows an obvious malignant lesion. You realize a mistake was made in your prior interpretation of this woman’s last screening mammogram. Prior films had apparently been put up in reverse order, and you mistakenly concluded that the calcifications were decreasing in number when they were actually increasing. Your prior incorrect interpretation has resulted in a delayed diagnosis”(2)
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