Sad story
Sad story
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Giving dual board (diagnostic/therapeutic rads) lifetime certification to the septuagenarians who badly needed them
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Anything is possible. Our "regular" jobs, dealing with biology - many of the things we'd like to do are literally impossible, given the limitations of knowledge and technology.
But rules, laws, regulations? All of that was made by people. Cancer is "real", some dusty state regulation "prohibiting" unions or whatever else the Good Ole Boys say we "can't" do is not real.
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Definitely, it takes a certain personality to exist over the long haul in large departments where you are less valued/with less input than the nurse manager/dept manager/chief tech etc. Tweets from certain residents imply they relish the coming 40 yrs of brown nosing.
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deleted1116990
I'm a physician, not a provider
It is time to take back what belongs to us. It is ours. It is time to rise and start the revolution. Our title will not be taken away. You would never accept being called Laura when your name is Sarah. Our title has power. It is our healers' birthright. Start the revolution. It starts with your...
www.kevinmd.com
If this article speaks to you, then employment in a large organization probably isn't for you.
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deleted1116990
Looks like he triggered a bunch of nurses by making fun of the way they use an alphabet soup of credentials after their names and either got booted off Twitter or self-deleted. Typical. See post above.
Even sadder that it had to get deleted
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deleted1111261
Mediators of Racial Disparities in Heart Dose Among Whole Breast Radiotherapy Patients - PubMed
Depending on laterality and fractionation, Asian women and Black women experience higher cardiac doses than White women. This may translate into excess radiation-associated ischemic cardiac events and deaths. Solutions include addressing inequities in baseline cardiac risk factors and...
pubmed.ncbi.nlm.nih.gov
I tried to engage with this on Twitter and just deleted it - I have a troll! So difficult to have nuanced discussion.
It says 20-30% may be do to clustering around certain facilities. Meaning, there are probably a few low quality centers that provide low quality RT to people of all races, but those centers tend to have more non-white patients.
What makes up the residual 70-80%? Are people sincerely thinking that ROs are intentionally giving higher doses to Black and Asian patients? I have no idea of what would motivate this. I have met so many of the Detroit-area ROs. I cannot fathom that they are considering race when treatment planning for breast. It is very odd thing to even consider.
This is the second publication from the group that showed a race based disparity and after further investigation, it was mostly due to a few facilities.
Serious question - what good does this publication do for oncology, radiation oncology and society as a whole? Are there any solutions that come out of this? What does a practicing RO get out of this? I use the exact same scorecard for all breast patients. I do nothing different. Why would a modern trained RO treat breast cancer differently in different races?
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Many rad oncs “George Bush” the blacks???Mediators of Racial Disparities in Heart Dose Among Whole Breast Radiotherapy Patients - PubMed
Depending on laterality and fractionation, Asian women and Black women experience higher cardiac doses than White women. This may translate into excess radiation-associated ischemic cardiac events and deaths. Solutions include addressing inequities in baseline cardiac risk factors and...
I tried to engage with this on Twitter and just deleted it - I have a troll! So difficult to have nuanced discussion.
It says 20-30% may be do to clustering around certain facilities. Meaning, there are probably a few low quality centers that provide low quality RT to people of all races, but those centers tend to have more non-white patients.
What makes up the residual 70-80%? Are people sincerely thinking that ROs are intentionally giving higher doses to Black and Asian patients? I have no idea of what would motivate this. I have met so many of the Detroit-area ROs. I cannot fathom that they are considering race when treatment planning for breast. It is very odd thing to even consider.
This is the second publication from the group that showed a race based disparity and after further investigation, it was mostly due to a few facilities.
Serious question - what good does this publication do for oncology, radiation oncology and society as a whole? Are there any solutions that come out of this? What does a practicing RO get out of this? I use the exact same scorecard for all breast patients. I do nothing different. Why would a modern trained RO treat breast cancer differently in different races?
Also we should nickname this study…
Heart of Darkness
Mediators of Racial Disparities in Heart Dose Among Whole Breast Radiotherapy Patients - PubMed
Depending on laterality and fractionation, Asian women and Black women experience higher cardiac doses than White women. This may translate into excess radiation-associated ischemic cardiac events and deaths. Solutions include addressing inequities in baseline cardiac risk factors and...
I tried to engage with this on Twitter and just deleted it - I have a troll! So difficult to have nuanced discussion.
It says 20-30% may be do to clustering around certain facilities. Meaning, there are probably a few low quality centers that provide low quality RT to people of all races, but those centers tend to have more non-white patients.
What makes up the residual 70-80%? Are people sincerely thinking that ROs are intentionally giving higher doses to Black and Asian patients? I have no idea of what would motivate this. I have met so many of the Detroit-area ROs. I cannot fathom that they are considering race when treatment planning for breast. It is very odd thing to even consider.
This is the second publication from the group that showed a race based disparity and after further investigation, it was mostly due to a few facilities.
Serious question - what good does this publication do for oncology, radiation oncology and society as a whole? Are there any solutions that come out of this? What does a practicing RO get out of this? I use the exact same scorecard for all breast patients. I do nothing different. Why would a modern trained RO treat breast cancer differently in different races?
Did they even try to look at differences in mean heart size between the two groups?
If not, seems to me like they're missing a rather large potential confounding variable.
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deleted1116990
Come on. You already know the answer to this.
The purpose of this publication is to advance a narrative.
If you find a disparity, any disparity, between outcomes of people with different skin tones, it can only ever be due to one thing.
Who knows, but it's a pretty clear suggestion that doctors either consciously or subconsciously change the quality of their care based on skin color alone. It's pretty annoying for those of us who have worked in predominantly poor and white communities (with high rates of obesity and substance abuse) and seen the substandard care these patients receive as well. It's also interesting to note that many specialists in these communities are foreign trained as nobody else will go there.
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Mediators of Racial Disparities in Heart Dose Among Whole Breast Radiotherapy Patients - PubMed
Depending on laterality and fractionation, Asian women and Black women experience higher cardiac doses than White women. This may translate into excess radiation-associated ischemic cardiac events and deaths. Solutions include addressing inequities in baseline cardiac risk factors and...
I tried to engage with this on Twitter and just deleted it - I have a troll! So difficult to have nuanced discussion.
It says 20-30% may be do to clustering around certain facilities. Meaning, there are probably a few low quality centers that provide low quality RT to people of all races, but those centers tend to have more non-white patients.
What makes up the residual 70-80%? Are people sincerely thinking that ROs are intentionally giving higher doses to Black and Asian patients? I have no idea of what would motivate this. I have met so many of the Detroit-area ROs. I cannot fathom that they are considering race when treatment planning for breast. It is very odd thing to even consider.
This is the second publication from the group that showed a race based disparity and after further investigation, it was mostly due to a few facilities.
Serious question - what good does this publication do for oncology, radiation oncology and society as a whole? Are there any solutions that come out of this? What does a practicing RO get out of this? I use the exact same scorecard for all breast patients. I do nothing different. Why would a modern trained RO treat breast cancer differently in different races?
I count 12 total people that benefit from publishing this type of oncology "research."
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Cant get it published it unless it concludes that radoncs go for the heart when a black woman walks through the door. Probably also true when treating pelvic cancers as well. Given that most inner city hospitals are almost never doc-in-the-box, but large programs/part of large programs, there is probably a conspiracy. Diff dvh criteria for black/Asians vs everyone else?
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White women have smaller, colder hearts
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I agree. I haven't read the whole paper, but I see no mention of racist docs in the abstract. It seems reactionary to claim that as their conclusion or motivation.
But, I see no way to come up with meaningful conclusions from work like this. There are disparities in outcomes regarding breast CA, but I'm certain that availability of breast cancer technique is very low on the factors driving these disparities. More importantly, it is impossible to make meaningful inferences from dosimetric data alone.
I'll file it away with the other "we did this cause we could and we could publish it" papers.
That it is published in a pretty reputable cancer journal is telling.
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You’re a very reasonable person but this is not a reasonable take GIVEN what we “know” about structural racism, inherent bias, white privilege etc
Expert alert: What a formula change may mean for Black patients who need kidney transplants
"This is an essential step toward reducing racial inequity in access to kidney transplantation."
www.postbulletin.com
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Well, THAT is a big deal. In an era where the average Black American in California is about 50% Caucasian, these race based formula's are almost certainly more hurtful than helpful.You’re a very reasonable person but this is not a reasonable take GIVEN what we “know” about structural racism, inherent bias, white privilege etc
Expert alert: What a formula change may mean for Black patients who need kidney transplants
"This is an essential step toward reducing racial inequity in access to kidney transplantation."
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Racism is where you find it. Twenty years ago no one was thinking race adjustment for kidney function was harmful; in fact, you had to do the adjustment on Step 1. Playing devils advocate, it seems there is a “formula” that rad oncs are unconsciously applying to breast patients where black patients get more heart dose; maybe we are not as dosimetrically persnickety for black patients, maybe we use standard fractionation more often due to larger breast size because we are paternalistic toward black patients, etc etc. There COULD be racism at play, there could not be. The authors don’t have to be explicit…
Any time you do a study in medicine where the variable is race and the variable is associated with a worse outcome, and you publish the study, there is a statement (of sorts) being made. And any time a statement is made, there is always a “motivation” behind the statement.
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I'm not opposed to disparity research. Disparities are what drive poor US health outcomes overall in a country with massive expenditure and good outcomes for wealthy folks.
The kidney thing is almost the definition of systemic racism. People shouldn't feel bad about this. It is the outcome that is important. It is systemic racism because no individual is being racist. If someone applies a sliding scale on kidney function based on designation of race, based on data from god know when, in a population of god knows what level of racial admixture, it is going to discriminate against a significant amount of black people reaching threshold for transplant.
That is simple. That is systemically racist. We all should feel good about moving on from the calculation.
When we have molecular medicine, we need less race based medicine. Low renin hypertension? Do the test.
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I guess I don't see... if you calibrate your viewpoint, admittedly... an outright immediate intellectual difference between exploring heart dose from RT across race and the race/kidney function calculation brouhaha. Your statement "It is systemic racism because no individual is being racist" actually being my point about the heart dose study. Not that I agree with it, in fact I think there is no systemic racism or overt racism about this, but if no one ever had done this analysis, I had 0% feelings about it. Now I have 0.01% feelings about it.
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But that is the definition of racism vs. structural racism. Not giving a black patient a kidney because they're black is outright racism, and while we can never say that is gone, it is improving and not considered acceptable. Not giving a black patient a kidney because they don't meet "objective" criteria based on EGFR when that EGFR calculation explicitly includes race is a great example of structural or systemic racism.
Putting the racism issue aside, isn't there an inherent problem with overpowering studies. 8000+ patients, and 0.1% difference in mortality. NNH = 769.
While this may be a "statistically significant" difference, is it "clinically meaningful"? If such a survival 0.1% "disadvantage" was noted in examining 8000+ patients who started on Monday vs. Tuesday, would we all move our starts to Tuesdays?
If you look at enough patients, it will becoming increasingly unlikely that ANY p value will be >0.05
While this may be a "statistically significant" difference, is it "clinically meaningful"? If such a survival 0.1% "disadvantage" was noted in examining 8000+ patients who started on Monday vs. Tuesday, would we all move our starts to Tuesdays?
If you look at enough patients, it will becoming increasingly unlikely that ANY p value will be >0.05
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I can't read it as I don't have access, but I didn't see any cancer outcome data. Strange to have a paper looking at heart dose, which is likely related to target coverage, and say nothing about local recurrence. Was it in there? I presume this was meant to suggest breathhold is used less frequently in minorities. If so, sure, that's a bad thing. Make breath hold soc/never in need of p2p.
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Unless the true mean and distributions of both groups studied are exactly the same (which should not be our null hypothesis), one can claim statistical significance for the smallest difference in groups as you move toward an n of infinity.
Here, it's worse than this. There is no mortality data. There is dosimetric data alone with modeling estimating a 0.1% incurred mortality excess. I don't think any radonc should take a number like this seriously.
Imagine if there was a prospective non-inferiority study (please no-one do this) where patients are randomized to docs who are either aware of or blind to patient race and overall mortality was the end-point in question. These would clearly be non-inferior results. (A dumb idea all around).
The best concluding sentence for this study IMO would be, "dosimetric differences in left sided breast cancer patient's by race are small and unlikely to contribute to known disparities in breast cancer mortality". Hope that's in the paper.
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deleted1116990
Full transparency of all charges and collections from patients' payors for all services performed under my name and license but billed on my behalf.
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same reason that fractionation schedules often have x3 or x8 fractions
less than or equal to five is a popular number of fractions as well
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In the old days of RT (like.... pre-2010)... almost all RT fractionations were either
5X
or
5X+3
fractions in duration (where 'X' was a positive integer)
You NEVER saw 5X+2, or 5X+4, fractions. (And, strangely IMHO, never saw 1.9 Gy fraction sizes).
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WW JD P?
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I don't want my therapists to not work on Fri. Is anyone really open just 4 days/week?
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I don't get it... is he saying therapists don't want to work, or MDs don't want to work?
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Both I think
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I am sure radiobiologically you could make 4 days work for vast majority of cases. (16 fraction breast was given 4 days a week in canada), but the optics would be terrible.
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Optics would be awful
However. This is not a joke…
I worked at a hospital 2013 to 2017. Did my own billing. I was told by initial CEO that coverage was by med onc and radiology when I was out of town so I would take a 3 day work week once a month. The old CEO got replaced. At some point in time the new CEO became “supervision woke.” Prior to that time, he just assumed when I was out that cancer patients were not treated. (I know seems improbable, but these were the words from his mouth.)
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If radiobiologically radiation can only be given 5 days/week I’m sure it can be made to work with 4.
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The only time in a randomized trial radiation by itself gave a survival advantage in advanced lung cancer, it was given continuously 7 days a week. After that trial, such a schedule was never tested again
4 days a week but every patient gets one BID treatment weekly. See how that flies with machine staff…
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I've yet to find a scenario where the machine staff won't complain. I spent 30 mins last friday at 3pm after the patients were done being treated fielding a complaint about the way I have things scheduled not being "fair" as it allowed one therapist who wasn't treating to leave at 2:45, which didn't allow either of the other therapists to leave "early." I'm still confused about this.
edit: I work 5 days a week despite not wanting to. I also don't want to work 6 days a week on those weeks that I do. I don't ever work 7 days a week, though. Sorry Jordan.
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Are we working in the same clinic? lol
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deleted1116990
Come on guys, they have kids that will literally die if they cannot leave by 4 PM. Have they not informed you of this?
Starting at 6AM? No problem. Why can't the lazy rad onc get there that early so we can get out early? Have to stay past 4? Blood on your hands.
Starting at 6AM? No problem. Why can't the lazy rad onc get there that early so we can get out early? Have to stay past 4? Blood on your hands.
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Man I love that radiology techs are totally ok with staggered shifts.
7am to 3
9 am to 5
11-7
Etc
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deleted1116990
I have never met an RTT that would voluntarily work a late/2nd shift. Literally, of the ~100 RTTs I have encountered in my life I have never met a single one who would have preferred to come in later and stay later or even stay later for additional $$. In your above scenario, they would fight to death over the 7AM-3PM slot.
