They always tell you the first thing you should always do when looking at an imaging study is verify the patient’s name and date of study.

Today I got nice and burned by it, but luckily the attending caught it. Nothing deathly serious, just a stupid, stupid mistake, which I will not do again.

As I’ve always said, I’d much rather make stupid mistakes as a med student than as a doctor.

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So I had this great idea to writeup all these practical tips for patients, not just medical professionals, but the devil’s always in the details. (The details being that I forgot to actually write them.) Better late than never.

Radiology. This is most “imaging” you get: x-rays, CT (aka CAT) scans, MRI scans, ultrasounds. All that jazz. Most radiologists don’t see patients, unless they’re doing some sort of procedure (swallowing contrast or barium, putting contrast or barium up your butt, etc.); there are interventional radiologists, who see patients, but that’s more specialized.

• There are many different imaging studies, and they’re good for different things, so don’t get too concerned if you “only” get an ultrasound to look at your gallbladder.
• I think the main concern most people have about radiology is the radiation they get from a test. While high doses of radiation can be concerning for the risks of new cancers (breast, thyroid, and blood cancers come to mind), your average CT scan or x-ray is a relatively low dose of radiation (and ultrasound and MRIs don’t use radiation, they use sound and magnets, respectively). The fact is (sit down, take a deep breath), you’re getting radiation every day. Seriously! About 360 millirem per year. Do the math, and that’s about 1 mrem per day. A chest x-ray is about 2-4 days’ worth more of radiation ( here’s a full list ). So that’s 364 mrem per year instead of 360. While there’s no “safe” radiation dosage, as all radiation breaks up DNA and creates free radicals, everything in medicine is a risk-benefit ratio. Everything has a risk, everything has a benefit. The equivalent of getting an abdominal x-ray is like traveling 2500 miles by car (pdf) if you compare risk activities. And if you’re getting an x-ray or scan, we’re concerned you probably have something far more painful or life-threatening going on inside your body, something that’s much more likely to hurt you than the radiation will.
• I should also clear up some confusion about the effects of radiation. There’s two types of effects: linear and threshold. Linear is the cancer–the more radiation you get, the more likely you are to develop cancer. Threshold means that below a certain dose of radiation, you don’t have any side effects, and above it, you start to have effects. These threshold effects are the skin damage, GI tract damage, hair falling out, etc.

I hope that clears things up about radiology, or at least some of the fears and concerns. If you really want a primer on radiation, try this .

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I haven’t written much about radiology, namely because there isn’t much to write. Our clerkship has, unfortunately, been less than productive. I don’t know if it’s just poor scheduling plus lots of conferences and flus, but we’ve had a number of classes cancelled, and the morning readout sessions seem more focused on getting through the images than teaching about them. A number of us think it would have been better to just get a textbook, some websites, and take the month off to study. Most of the other clerkships I’ve had so far at least had some component of teaching during the physicians’ work day.

I’ve also become pretty frustrated with the constant radiologist obsession with income. It’s definitely more prominent in the younger docs and residents than the older physicians, but more than anyone else so far our lecturers have expounded the virtues of radiology for the amount of money one can make. Maybe I’ll feel the same way in one year’s time–I’m not above saying that I won’t–but as a third-year student, still fairly new to clinics and not-so-jaded, it was really unattractive.

I spent 45 minutes one day waiting for a fellow and an attending to start reading films while the attending whispered to the fellow about his new job, how much money he can make a month, and how much time he gets off per year. After being told “we’re about to start reading” 5 or 6 times, I finally got up and walked out of the room, feeling so frustrated. Had I spent another second in the room I felt like I would have started to turn jaded and bitter down to my core. (This was in addition to the fact that the radiologists in the room had described clinicians as “annoying” when they ask the radiologist for help reading a film.)

We must, of course, remind ourselves that this is not all radiologists, and maybe it’s not even a fair representation of the radiologists about which I write; maybe they had a bad morning, or didn’t get any sleep last night, or who knows what. But their effect on me was the same. Just another personal reminder that my behavior, attitude, and actions do affect the way other people see the world.

In light of the lack of time spent in the classroom, I have come up with a great list of radiology online resources, which are truly excellent:

LearningRadiology – My favorite, by far. Talks specifically for medical students, quizes, cases of the week, all in really easy to understand format. I thank this website for helping me to get a general understanding of the chest radiograph.

Yale Cardiothoracic Imaging – A beautifully-designed website, easy to use, with great images and illustrations, all annotated. Has normal anatomy plus a number of basic diseases.

Radiologyeducation.com and medicalstudent.com have a huge number of links; the UCSF Radiology website also has a great number as well.

I’ll be adding more as the week goes by; I have a number that are bookmarked, but I’m not ready to give the full Over My Med Body stamp of approval.

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I wanted to solve a problem I’ve seen on the wards and in clinics, as well as mess around with some new web technologies, and thus Medslist was born. Simply, it’s a way patients can store their list of medications online, email a copy to themselves, update them later, print a copy out for their physicians, etc. Sometimes people come in with lists of medications, which is great, but often they’re illegible or hard to follow.
Medslist allows people to list a good number of facts about their medications–including the reason they’re taking it–and perhaps this may encourage some patients to learn why they’re taking it, and have a more active role in their treatment, management, and health.

For now, it’s only working on PC Firefox, Mac Firefox and Safari. I’m having trouble reproducing a bug where the login feature doesn’t work in PC Firefox; if you have this problem, try reloading the site a couple times, and it should work.

How did I have time for this? I’m on Radiology right now, which provides a certain amount of free time (I think they’re trying to get us to be radiologists based on the radiologist lifestyle.)

Please post your criticisms, comments, and suggestions here. If you have bugs, post’em. Feature ideas? Post’em. Right now the feature set is limited, I know: No way to get your password if you lost it, no way to edit medications, etc. But please brainstorm and go wild; what would you like to see on a medication list that your patient carries into the clinic for you?

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