iRADiX

Leaving a secure and comfortable job was not an easy decision to take. It took me about three years of my residency to constantly think about it and whenever I asked my colleagues and seniors all most all forbade me to quit the job. It was conveyed that it is foolish if you quit the govt. job. Only a few people in government setup asked me to quit the job as early as possible.

The idea of leaving Govt. job struck me when I got a residency in Govt. Medical College, Amritsar. It was a nice and heartening to join in Radiodiagnosis department. As it is known about Amritsar People’s hospitality, I felt at home in the department. But the condition of the medical college and department was pathetic with only few working equipments with very slow replacement. We did not have MRI scanner in our department. Yet our teachers had a large collection of MRI films and interventions. We were sent to P.G.I. Chandigarh for hands on training for a month.

I was posted to Civil Hospital, Amritsar a prestigious place to work. Work was quite impressive, about 100 X-rays/day and Ultrasound about 30 cases/day. The annoying part was that we had to do about 10-15 medico-legal cases/day. There was no Colour Doppler/CT Scanner/ MRI scans. I was missing my days in the medical college and my quest to excel in the field was increasing.

“What are you doing now? Do you keep a journal?” Questions Emerson
Under which Thoreau writes,” So I make my first entry today”


I have been goading some of our more active commentators to write full fledged articles and submit them as Blogs to share their experiences and increase our common pool of knowledge. Some of them start and then…….So I thought of sharing some things more openly and hopefully we will see more rich regular contributions. There are many ways of approaching this subject.

Let me try it with the 4 Ms

• Memories
• Mapping
• Museums
• Motivations

Memories: Keep small notes and pencil sketches

Keeping a diary or journal can serve as a useful source book for writing developed articles. Sticking to Radiology, one can see our field as a branch of natural sciences.

How will you disclose unanticipated unfavorable outcomes? To whom will you disclose? How much will you tell?

Mammogram Errors
In “Disclosing Harmful Mammography Errors to Patients” Thomas H. Gallagher et al(2) tried to assess the attitudes about disclosing errors to patients by using a survey with a vignette involving an error interpreting a patient’s mammogram leading to a delayed diagnosis. This study was based on a survey which included items on demographics, practice characteristics, and experience in radiology and breast imaging. A copy of the survey is available online (http://breastscreening.cancer.gov)

To assess radiologists’ attitudes about disclosing errors to patients, the survey contained a vignette involving an error interpreting a patient’s mammogram, leading to a delayed cancer diagnosis:

“A diagnostic mammogram for a new palpable lump shows an obvious malignant lesion. You realize a mistake was made in your prior interpretation of this woman’s last screening mammogram. Prior films had apparently been put up in reverse order, and you mistakenly concluded that the calcifications were decreasing in number when they were actually increasing. Your prior incorrect interpretation has resulted in a delayed diagnosis”(2)

While examining the “Impartial spectators” one can try to see what other games are being played.

Game Theory
This is a branch of economics useful to study business behavior, concerned with representing economic interactions in a highly stylized form, with players, pay-offs and strategies.

For those esteemed readers who subscribe to “I-follow-Adam-Smith-not-Marx” (money-at-any-cost) Amartya Sen’s recently published book “The Idea of Justice” should be a must read. In this he teases out the confusions arising from the most famous and widely quoted passage from the Adam Smith’s The Wealth of Nations.

It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own self-interest. We address ourselves, not to their humanity but to their self-love, and never talk to them of our own necessities but of their advantages.

So we appointed ourselves as “Impartial Spectators”?!

Open and Closed Impartiality
The editors of the first edition of Harrison’s Principle of Medicine wrote “To the physician, as to the anthropologist, nothing human is strange or repulsive.”

And yet when one examines some of our current trends of practice, one does not feel comfortable at times.

There is a basic distinction of different ways of invoking impartiality, and that contrast needs more investigation. Who will be an impartial spectator in the context of a small child who comes for repeated follow-up CT scans ordered indiscriminately by the referring physician just because the patient is insured?

Complaints about hard work, long hours, low pay and uncertain tenure are the norm amongst Radiologists. The special role a radiologist plays in patient management is discussed ad nauseum from radiologist’s side, but it is a moot point. The question is how other specialists or hospital management perceive a radiologist’s work? Do they think radiologists are valuable team members or just bright technicians? In a bigger picture, how does general public see the role of radiologist in their welfare?

In a free market, the price of a radiologist’s (or any professional’s) services is– whatever a service seeker is willing to pay, which can be a hospital, diagnostic center or a patient. The price is determined by market forces, mainly supply-demand curve and hardly depends on a person’s skill profile as a group.

For example in a region which demands radiology services but has no radiologist for 200 kms, even a bad radiologist can get a premium price for his services. On the other hand a really good radiologist in a big metro may find job seeking very competitive because of many available candidates. So the way to get a job is to ask for lower wages or take up a job which offers lower wages. Since by and large radiologists have similar skill sets, they earn almost the same amount amongst their peer group in a particular region. Only a few exceptional ones can buck these norms.