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rstanley{at}uabmc.edu
Recently I picked up our local newspaper only to read yet another article about medical errors. My first reaction was to wonder why it seems that the media often report what is "bad" in health care and seldom (it seems) report what is "good." I made this comment to a colleague and her response was that news is what is out of the ordinary. If "good" health care were unexpected, the headlines would read "No Medical Errors Today" rather than "Medical Errors? Patients May Be the Last to Know" (New York Times, August 29, 2006) [1].
It's a "no brainer" that good medicine is expected by our patients as well as our colleagues, but what exactly does good medicine mean?
One definition can be found in the Accreditation Council for Graduate Medical Education's six competencies as outlined below:
You probably recognize these competencies from medical school and from the American Board of Radiology's (ABR) program for Maintenance of Certification, but these six concepts should not and in fact do not end there. While looking through this month's table of contents, it occurred to me that we address many of these competencies each month.
The practical clinical articles featured this month, such as Dr. Zagoria's commentary, "Percutaneous RF Interstitial Thermal Ablation in the Treatment of Hepatic Cancer" [2] and the original research study by Dr. Hoffman et al., "MDCT in Early Triage of Patients with Acute Chest Pain,"[3], keep readers abreast of evolving knowledge.
Effective information exchange with other health professionals is addressed in the commentaries "Radiology Reporting: Returning to our Image-Centric Roots" [4] and "Replacing Traditional Text Radiology Reports with Image-Centric Reports: A Shift from Epiphany to Enigma?" [5]. This point and counterpoint combination of articles was of particular interest to me. As a great believer in the power of the word, I must say that I come out on Lenny Berlin's side of the debate. Although it may not be necessary on a routine screening chest radiograph, I have always taught residents that it is important for the referring clinician to know that you are aware of what he or she specifically is looking for, what the precise pathologic morphology consists of, how the current findings compare with any prior radiologic examinations, and what the most likely diagnosis is. Alternative diagnoses also must be included, if such a discussion is relevant. And, finally, the report should include the best way of pursuing such a diagnosis from an imaging standpoint, if further imaging studies are indicated. In my opinion, it seems unlikely that an image with markings on it could convey all of what a radiologist should be thinking and communicating.
Patient safety is specifically addressed in two Web exclusive articles, "Lower Tube Voltage Reduces Contrast Material and Radiation Doses on 16-MDCT Aortography" [6] and "Comparison of MDCT Radiation Exposure: A Phantom Study" [7]. One of the ongoing goals of the AJR has been to promote the dissemination of radiation dose reduction strategies whenever possible.
Finally, patient care evaluation is discussed in the Web exclusive article "Survey of the Use of Quality Indicators in Academic Radiology" [8]. Thus, the content of this month's issue is very much consistent with the goals of the Maintenance of Certification program of the ABR and the promotion of the six competencies defined by the Accreditation Council for Graduate Medical Education.
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