What is a “Shadow Merchant”?
The emergency room doctor had become a thorn in my side. He was demanding. He was demeaning. He was defensive. It was obvious to me he had suffered a painful experience with radiologists in his past practice. Pleasing the man was almost impossible. Every interpretation I gave him was insufficient. I was taking too long to report his ER cases. I was too vague in my reports. I was wrong with my diagnoses. You name it, he never appreciated my hard work.
As a radiologist, I was used to this kind of treatment. I’ve been in the business for almost 40 years and recall how poorly we were regarded at the beginning of my practice. Times have changed and radiologists are integral partners in patient diagnosis and treatment and we are accepted as equals by our colleagues in other specialities.
But that was not the case years ago with this emergency room physician. He sat in my office while I was going over the findings of a CAT scan of a patient’s abdomen and pelvis. He told me he was leaving our hospital for another practice. I was ecstatic but didn’t show it. In a rare moment of honesty he looked at me and said, “You know, I practiced in a military hospital before I came here. The radiologist there was not that proficient. That’s not a commentary on the military. Just a commentary on the person. Your group has done a good job while I’ve been here and I wanted to thank you before I left.”
I was stunned and he shook my hand. He stood up and before he walked out the door he said, “You’re the best of the shadow merchants in your group.”
“Shadow merchants?” I asked.
“Yeah. That’s what we call radiologists in the military. Shadow merchants. You live in the shadows and make a living by interpreting shadows on your films. Shadow merchants.” He walked out.
There is a suggestion for authors, write what you know.Read the rest of this entry
Seeing Cancer in 3D!
This month is Breast Cancer Awareness month. As a radiologist, I am very tuned in to breast cancer awareness. I read mammograms, breast ultrasounds, and breast MRI every day. It is part of my overall job as a radiologist.
In May 2013 I attended a breast imaging conference in Tampa Bay, Florida. During that conference, there was much discussion of a new technology known as tomosynthesis. This alternate form of mammography had just been approved by the FDA. As I watched the images stream before my eyes I was astonished!
Trying to read mammograms is a huge challenge. We have performing mammography, or Xray images of the breast since the 1960’s. In the past fifty years radiologists have tried and tried to come up with newer technology. You see, regular mammograms are the best test we have to detect early breast cancer. But, mammograms are not 100% accurate. In fact, most radiologists would gladly trade reading mammograms for anything that would give better results. The problems is, we just haven’t been able to find anything.
Tomosynthesis is also known as 3D breast imaging. The technology is astonishingly simple but only now possible due to technological advances in computer processing. In this new form of imaging of the breast, the Xray tube moves through a 15 degree arc above the patient’s breast over 4 seconds. The series of exposures is then processed to produce “slices” through the breast. It’s like leafing through the pages of a book.
Did you get that? The amount of imaging time is the same as 2D mammography we have been performing for years. In fact, the radiation dosage is less than twice that of a normal mammogram. But, the results are astonishing!
Look back at my previous posts and you can watch my videos regarding this new technology. But, let me tell you that 3D breast imaging is allowing us to pick up to 50% more early invasive breast cancers than before. And, these early forms of breast cancer are small enough to actually allow us to decrease the death rate from breast cancer!
I am part of the Willis Knighton Health Care System here in the Shreveport – Bossier City area and I am proud to be a part of the launch of this new kind of mammography beginning last week on October 1. We are now performing 3D breast imaging at our Willis Knighton Pierremont outpatient breast clinic. Soon, Willis Knighton Bossier will have this technology and then, before the end of the year, Willis Knighton South will come on line. Already, we are seeing amazing results from this new technology just in one week!
Women, pay attention. If you have put off having your first mammogram or having that yearly followup mammogram, contact your doctor and see if it is time for you to have your first 3D mammogram. Let’s put an end to breast cancer!
A Baby Named Galley!
There is a moment in a published author’s life that is akin to seeing your unborn child for the first time by ultrasound. As a radiologist, I am fully aware of the excitement parents feel when they see that gray and white blob moving on the ultrasound screen and begin to catch glimpses of what the finished “product” will look like. They gasp when they see fingers. They laugh when they see arms and legs. And, they cry when they see the face even though it is such a poor reflection of the beautiful child they will hold in their hands in just a few months.
Friday, I had such an experience. A package waited for me by my front door when I got home from a long, hard day at the hospital. To say I was tired and frustrated and disillusioned by the direction health care is going is to say the least. Soon, I will weigh in on this issue because I can no longer keep my silence after the horrific events with the VA scandal. But, for today, I want to share something bright and happy and encouraging. I picked up the package and noted it was quite heavy for such a small box. When I got the thing inside and ripped off the tab, guess what I found inside?
What? What are galley proofs, you ask? In the days before electronic media prevailed, an upcoming book was printed out on rough sheets of paper to approximate what the final product would look like. Since 2006, I’ve been involved in the publishing of five of my books and each galley proof was presented to me as a PDF. My excitement was no less at receiving these electronic documents. But, here was a throw back to old school publishing. Why? Because this book required a careful review of the actual printed appearance, not just an electronic approximation. For, this book would have illustrations and break out text boxes and Lifefilters. . .
What is a Lifefilter? More on that later.
In the summer of 2012, as I have shared in the past, God did something truly miraculous and literally dropped a book project into the laps of yours truly and my co-author and best friend (and former pastor) Mark Sutton. We wrote a book on depression in 2001 (which is still an excellent book, by the way!) But, over the intervening years, things changed and we wanted to update the book. Our publisher was not interested. But, a new team took over the editorial direction at B&H Publishing and they wanted us to write a new updated version of the book.
Mark and I went to work immediately in the fall of 2012 and now, before me was the galley proofs of a book we are hoping will help millions. Did you see that word? Millions! Not because we want money. No, it is because we are in the midst of an epidemic of depression unprecedented in American history since the Great Depression.
So, I will grab a cup of coffee. I wish I could teleport myself to New Zealand and have one of those luscious “flat whites” as you can see my friend Alex drinking. Yes, that is a cup as big as a cereal bowl! They love their coffee in New Zealand. So, I will hunker down with my galley proofs and drinks lots of coffee and check this manuscript out.
When will you be able to get your hands on “Hope Again: A 30 Day Plan for Conquering Depression”? Stay connected to my site as Mark and I will be launching a new website this summer to keep you informed of the arrival of this important tool. For now, you can check out our rather static site for information on the current book here. And, don’t forget to pick up some copies of “The Chronicles of Jonathan Steel” for your summer reading!
Got to get to work!
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