Radiology Firing Line

How easy is it for physicians to choose wisely and reject low value care? Who decides what's wise and what's unwise? In this episode Saurabh Jha (aka @RogueRad) speaks with William Sullivan MD JD. Dr. Sullivan is an emergency physician and an attorney specializing in healthcare issues. Dr. Sullivan represents physicians and has published many articles on legal aspects of medicine. He is a past president of the Illinois College of Emergency Physicians and a past chair and current member of the American College of Emergency Physicians' Medical Legal Committee.

In 1999, the Institute of Medicine (IOM) in their landmark report - To Err is Human - estimated that the number of deaths from medical errors is 44 ,000 to 98, 000. The report ushered the Quality and Safety Movement, which became a dominant force in all hospitals. Yet the number of deaths from medical errors climbed. It is now touted to be the 3rd leading cause of death. How easy is it to precisely quantify the number of deaths from medical errors?

Not many physicians challenged the methodologies of the IOM report. Some feared that they'd be accused of "making excuses for doctors." Many simply didn't have a sufficient grip on statistics of measurement sciences. One exception was Rodney Hayward - who was then an early career researcher, a measurement scientist, who studied how sensitive the estimates of medical errors were to a range of assumptions.

Saurabh Jha (aka @RogueRad) speaks with Professor Hayward for the Firing Line Podcast about his reesrach in JAMA published in 2001 - Estimating Hospital Deaths Due to Medical Errors: Preventability Is in the Eye of the Reviewer. It was a landmark publication of the time, and its objective methods have stood the test of time.

Rod Hayward a Professor of Public Health and Internal Medicine at the University of Michigan and Co-Director of the Center for Practice Management and Outcomes Research at the Ann Arbor VA HSR&D. He received his training in health services research as a Robert Wood Johnson Clinical Scholar at UCLA and at the RAND Corporation, Santa Monica. His current and past work includes studies examining measurement of quality, costs and health status, environmental and educational factors affecting physician practice patterns, quality improvement, and physician decision making. His current work focuses on quality measurement and improvement for chronic diseases, such as diabetes, hypertension and heart disease.

Link to paper - https://jamanetwork.com/journals/jama/fullarticle/194039

Can we reduce over diagnosis by re-naming disease to less anxiety-provoking makes? For example, if we call a 4.1 cm ascending aorta “ecstasia” instead of “aneurysm” will there be less over-treatment? Saurabh Jha (aka @RogueRad) discusses over diagnosis with Ian Amber, a musculoskeletal radiologist at Georgetown University, Washington.

What role can radiologists play in shared decision making? C. Matthew Hawkins, MD discusses this important topic with patient advocate Andrea Borondy Kitts.

Saurabh Jha (@RogueRad) speaks with Professor Jeffrey Flier who was the 21st Dean of Harvard Medical School, on wide ranging topics including growing up in the Bronx, reproducibility crisis, research fraud, health policy, and intellectual diversity.

Professor Flier went to Mt. Sinai School of Medicine and completed his training in endocrinology at the National Institutes of Health. He moved north, and became Chief of Diabetes Unit at Beth-Israel Hospital, Boston, spearheading their research. He was Dean of Harvard Medical School between 2007 and 2016.

A prolific scientist, Professor Flier has contributed extensively to metabolic research in diabetes and obesity. He has also written about health policy. He supports intellectual diversity in universities, often leading by example. He has contributed to the literary online magazine, Quillette. He’s also famously known in medical Twitter as the dean who tweets and engages all sorts of tweeps. As one tweep once privately remarked to me “OMG, the dean of Harvard Medical School just responded to my tweet! That’s made my day.”

What does it take to create a decision rule? In this podcast Saurabh Jha (@RogueRad) has a discussion with Robert W. Yeh MD MBA about the deep though and complex statistics involved in creating a decision rules ti guide therapy which have narrow risk-benefit calculus, specifically a rule for how long patients should continue dual anti-platelat therapy after percutaneous coronary intervention (1). They also discuss the motivation behind the legendary, and satirical, parachute RCT published in the recent Christmas edition of the BMJ (2), which delighted satirists all over the world (3).

Dr. Robert W. Yeh is the Director of the Richard and Susan Smith Center for Outcomes Research in Cardiology at the Beth Israel Deaconess Medical Center, and Associate Professor of Medicine at Harvard Medical School. An extremely accomplished scholar whose research transcends many types of methodologies.

(1) https://jamanetwork.com/journals/jama/fullarticle/2508253

(2). https://www.bmj.com/content/363/bmj.k5094

(3). https://thehealthcareblog.com/blog/2018/12/22/evidence-based-satire/

Saurabh Jha (aka @RogueRad) speaks with Bishal Gyawali MD PhD. Dr. Gyawali obtained his medical degree from Kathmandu. He received a scholarship to pursue a PhD in Japan. Dr. Gyawali's work focuses on getting cheap and effective treatment to under developed parts of the world. Dr. Gyawali is an advocate for evidence-based medicine. He has published extensively in many high impact journals. He coined the term "cancer groundshot. He was a research fellow at PORTAL. He is currently a scientist at the Queen's University Cancer Research Institute in Kingston, Ontario.

What is the best way to educate medical students? Richard B. Gunderman, MD, C. Matthew Hawkins, MD and Saurabh Jha MBBS discuss medical education.

What are the challenges of bringing advanced imaging services to India? What motivates an entrepreneur to start build an MRI service? How does the entrepreneur go about building the service? In this episode Saurabh Jha (aka @RogueRad) discusses radiology in India with Dr. Harsh Mahajan, Dr. Vidur Mahajan and Dr. Vasantha Venugopal.

Dr. Harsh Mahajan is the founder of Mahajan Imaging, a leading radiology practice in New Delhi, and now a pioneer in radiology research in India.

http://caring-research.com/

It is easy for armchair activists to bash randomized controlled trials (RCTs) with clever methodological critiques. However, it takes a lot of effort and coordination to pull off an RCT successfully. Saurabh Jha (aka @RogueRad) speaks to Dr. Mark Neuman and Lakisha Gaskins, principal investigator and research project manager of the REGAIN trial, respectively, about the logic, challenges and intricacies of conducting an RCT.

The Regional versus General Anesthesia for Promoting Independence After Hip Surgery (REGAIN) trial is an ongoing pragmatic, multi-center RCT, funded by PCORI, which randomizes patients with hip fractures to regional or general anesthesia.

http://rt5.cceb.med.upenn.edu/public/REGAIN/index.html

Guests:

Mark Neuman MD MSc, is an Associate Professor of Anesthesiology and Critical Care at the University of Pennsylvania. He is a senior fellow at the Leonard Davis Institute of Health Economics. He's a former RWJ Scholar.

Lakisha Gaskins is a research coordinator with extensive experience recruiting patients for RCTs