Patients-not just Images
Devoted to Education and Practice in Patient-centered Radiology
Chairman's Corner
Chairman's Corner
I was wrong!
I was wrong!
Ravi Ramakantan
Ravi Ramakantan
It was one of our routine Thursday afternoon chest radiology meetings...only this one was web based ,,. COVID times. There were about 20 people - both faculty and residents from chest medicine and radiology.
It was one of our routine Thursday afternoon chest radiology meetings...only this one was web based ,,. COVID times. There were about 20 people - both faculty and residents from chest medicine and radiology.
A chest physician narrated the story of this young patient who would had been having fever and intractable cough; the cough exacerbated by lying down.
A chest physician narrated the story of this young patient who would had been having fever and intractable cough; the cough exacerbated by lying down.
One of our bright young first year residents was presenting the radiology workup. The chest radiograph had a large, symmetrically placed midline soft tissue shadow in the region of the superior mediastinum, Applying the cervicothoracic sign, she concluded that the lesion was posteriorly placed - in effect in the paravertebral region and that the most common etiology was a tuberculous paravertebral abscess. To my questions, she replied completely and correctly about the cervicothoracic sign.
One of our bright young first year residents was presenting the radiology workup. The chest radiograph had a large, symmetrically placed midline soft tissue shadow in the region of the superior mediastinum, Applying the cervicothoracic sign, she concluded that the lesion was posteriorly placed - in effect in the paravertebral region and that the most common etiology was a tuberculous paravertebral abscess. To my questions, she replied completely and correctly about the cervicothoracic sign.
I then give my opinion on this lesion. It totally contradicted her interpretation of the cervicothoracic sign.I said this was an anterior mediastinal mass and that I would wonder if this was an aneurysm of the the arch of the aorta involving the neck vessels, I waxed eloquent about how with a paravertebral abscess, the patient would have had an upper dorsal backache - which she did not.
I then give my opinion on this lesion. It totally contradicted her interpretation of the cervicothoracic sign.I said this was an anterior mediastinal mass and that I would wonder if this was an aneurysm of the the arch of the aorta involving the neck vessels, I waxed eloquent about how with a paravertebral abscess, the patient would have had an upper dorsal backache - which she did not.
The resident then discussed this patient’s CT scan - and ..... she was right - it was indeed a large paravertebral abscess in the upper dorsal region with vertebral destruction.
The resident then discussed this patient’s CT scan - and ..... she was right - it was indeed a large paravertebral abscess in the upper dorsal region with vertebral destruction.
My diagnosis was way off the mark.. . 40 something years of radiology and all...
My diagnosis was way off the mark.. . 40 something years of radiology and all...
This is not something unusual. Off and on in case discussions - either in teaching meetings or in routine reporting sessions, a resident’s interpretation turns out right and mine wrong.
This is not something unusual. Off and on in case discussions - either in teaching meetings or in routine reporting sessions, a resident’s interpretation turns out right and mine wrong.
It is based on these numerous experiences that I make it a point to ask residents who seek my opinion on a case “What do YOU think?” .. before I share my thought.
It is based on these numerous experiences that I make it a point to ask residents who seek my opinion on a case “What do YOU think?” .. before I share my thought.
In such happenings, there is something extremely important - both for the teacher and the taught . It underlies the fact that you as the teacher have to own up your mistakes and give credit where it is due. It is in this same vein, that I have written up earlier on how, when the situation demands, it is important for faculty to own up and say "I don't know "
In such happenings, there is something extremely important - both for the teacher and the taught . It underlies the fact that you as the teacher have to own up your mistakes and give credit where it is due. It is in this same vein, that I have written up earlier on how, when the situation demands, it is important for faculty to own up and say "I don't know "
That resident, I am sure, would have been mighty pleased that she had been right.
That resident, I am sure, would have been mighty pleased that she had been right.
This is such a good thing. It is way to reinforce residents' courage to disagree with their seniors. For me, this is an important part of any education.
This is such a good thing. It is way to reinforce residents' courage to disagree with their seniors. For me, this is an important part of any education.
When you are a teacher - a medical teacher at that; you do not just teach the subject ; you 'teach' a way of life.. leading by example.
When you are a teacher - a medical teacher at that; you do not just teach the subject ; you 'teach' a way of life.. leading by example.
Even as I write these lines, a play of words of Felson’s original lines take shape in my mind..
Even as I write these lines, a play of words of Felson’s original lines take shape in my mind..
Is it more important to be right for the wrong reason or to be wrong for the right reason.
Is it more important to be right for the wrong reason or to be wrong for the right reason.
In this episode, of course, my resident was right for the right reasons!
In this episode, of course, my resident was right for the right reasons!
And, I was wrong!
And, I was wrong!
October 2020
October 2020