The House of Medicine: A Resident’s Perspective on Organized Medicine

I recently returned from the American Medical Association Annual 2014 Meeting in Chicago and was asked to reflect on my experience as a resident involved in organized medicine.

Organized medicine is the forum for change on a very large scale and functions as the legislative branch of medicine. It is a democratic infrastructure that allows physicians from all walks of life to advocate for their patients, practices, and the health of all Americans and international visitors who receive care in the United States. My decision to become involved was made as a first year medical student; my medical school was extraordinarily supportive, both with scheduling and financing, of trips to MSSNY and AMA meetings. My focus has been broad and I have written and/or advocated for policies ranging from childhood obesity, graduate medical education funding, and timelier program responses to resident and fellow applications to maintenance of certification regulations, SGR repeal, and mandated insurance coverage for lung cancer screening. These policies will directly impact public health, postgraduate education, access to medicine, and reimbursement for essential services.

We choose to practice medicine to help patients, solve a diagnostic mystery, treat illness, and save lives. However, when we become physicians, we also have a duty, which I believe we should all embrace, to improve the delivery of medicine over time. We can accomplish this through a variety of ways including research, education, administration, and organized medicine. How will you affect change?

Gayle Salama, MD, is a radiology resident at Weill Cornell Medical College

Teaching the New Interns About Imaging Appropriateness

We asked Dr. Jeffrey Hogg to share his strategy for making sure the interns at WVU are “Imaging Wisely” and hope many of you will be inspired to do the same.

Kendo and Swerdlow identified seven radiology skills as “essential” for beginning interns. In orientation at WVU Healthcare I review and identify resources to master these:

  1. Choose most appropriate radiologic study for workup of common clinical situations
  2. Communicate relevant clinical history when ordering a radiologic study
  3. Knowledge of limitations of radiologic studies
  4. Recognize common abnormal findings on CXR
  5. Recognize common abnormal findings on AXR
  6. Systematic approach to viewing CXR
  7. Systematic approach to viewing AXR

ACR Appropriateness Criteria (AC) are central to the message. I emphasize that the criteria are free decision support guidelines that optimize safety, diagnostic efficiency, and cost. I appeal to interns’ “Professionalism” to do the best for their patients, using only appropriate studies to avoid wasted time, resources, and excess patient radiation. I list the Medical Specialty Organizations active on ACR AC Expert panels. I demonstrate the ACR AC site organization by “Category”, “Clinical Topic”, and “Variant” to show how they can find imaging guidelines specific to their patient. I show the embedded link to the ACR AC in our electronic medical record. This addresses skill 1.

Hogg Blog Post

Use of ACR AC for communicating clinical history for radiologic studies promotes “Professional Communication”. This addresses skill 2.

Each ACR AC “Clinical Topic” “Summary” teaches epidemiology, natural history, treatment approach, roles and limitations of radiologic studies, addressing skill 3.

The remaining 4 skills are addressed by providing links to tutorials teaching systematic approaches for abdominal and chest radiographs with common abnormal findings.

Reference: Kondo KL, Swerdlow M. Medical student radiology curriculum: what skills do residency program directors believe are essential for medical students to attain? Acad Radiol. 2013 Mar;20(3):263-71.

Jeffrey P. Hogg, MD, professor, neuroradiology, Robert C. Byrd Health Sciences Center, West Virginia University