iRADiX

Of all the things in life, it is the uncertainty of the future that is the most perplexing to the human beings. We try to gauge the future though scientific and non-scientific means and hedge our forecasts using the terms probability or likelihood or some other jargon. Still, it is the wait that gnaws our heart, doesn’t let us sleep peacefully and makes us prone to panic attacks.

As Radiologists we are the masters of forecasting. A look at a scan and we decide how much longer a person may live, whether he can be cured or what are his chances of having a normal life. We use our imperfect knowledge and imperfect tests to determine someone’s fate. But imperfect tests are all we have, however might a layperson clamor for simple yes-no answers from us.

So often the anticipation of joy turns into fear of unknown, because of our imperfect ways to predict future.

It starts with a phone call

Doc, we want to get a pregnancy scan. Do you do it?

Yes, we do ultrasounds. Its our specialty…

Good, but we need to do it fast, cos’ we have a flight to catch.

Let me see what I can do, my schedule is a bit busy right now. You will have to wait a bit. Or you can take another appointment…

No it’s URGENT.. we need to get it done right away. You see we are going to America. We need to get these tests done before we leave.

Okay, let’s see… Yes I think I can squeeze you between two of the appointments. But you need to come with in 15 minutes.

No problem…

Two hours later, a couple turns up at reception...

Breastlight showing a shadow in 61 year lady with mass

The recent Telegraph edition has been talking about the need for screening all men above 50 for Prostatic cancer ¹

I asked this experienced surgeon who specializes in breast regarding the issues of Critical Point.

In his question, he summarized the different nuances of this debate, which he has heard in different fora over the years. He has been part of a breast team which uses the triple assessment scheme of clinical examination, radiological assessment and cytological assessment. He talked about the role of mammography particularly over age 35 years and how ultrasound sometimes is particular useful under 35 years because increased tissue density reduces the sensitivity and specificity of mammography.

The commoditization of Radiology practice has led to several trends.

In a few years

"In a few years there will be many trained persons in the market" one celebrated radiologist who was also a financial partner in the centre would repeatedly tell the junior consultant during their lunch sojourn.

After several such repetitions, which were silently heard by the junior consultant (he had to pay the school fees of his children-you never know how vindictive people can become) he asked another radiologist who was much more experienced in this circuit about these lunch-time 'sermons'.

Another Professor left and then re-joined as he could not adjust to the milieu of work in the private sector.

It never ever occurred to me that I should do private practice – not as an intern - when I was deciding on a specialty to choose as a career – not today when it appears that private practice will be ‘legalized’ for us.

Why? Many have asked me off and on. Those who are close to me and know me well have sort of written me off – “He is slightly off…” they would say and some of you, I am sure, will readily agree- perhaps increasing the “slightly” scale!

Over the years, I have easily adjusted to a lifestyle that suits my pocket. I have few wants though one of them is an expensive hobby; but, mostly I make my ends meet with my handsome BMC pay – cuts and all - and my wife supports me when the well runs dry.

^Fifteen or twenty years ago - things at our hospital were not as bad. We had more people around, material was more easily available; the hospital was run by the administration and not by the unions and politicians as it probably is now. Even then, many of us strongly felt that there was a need to change the system of medical staffing so as to retain people. At that time, some of us spear-headed a movement -one of the many thus far- to allow full timers private practice.

All supported it - we swore by it. However, one man - one of the most respected in the campus - Sunil Pandya - the Chief of Neurosurgery - strongly opposed it. We adored "SKP"; he liked us a lot; he knew we were the future of KEM; he supported us in all our endeavors. But this time around it was a firm "NO".

While a resident you are well protected by an armour of your professor, other departmental consultants and your colleagues. You are doing every thing automatically, almost in a carefree manner unmindful of any untoward events which may startle you at times when you are totally unprepared. When you leave this environment, join some hospital or a private practice you are on your own. Totally vulnerable, you imagine contrast reactions occurring, getting sued for wrong reports and derogatory comments of your rivals in the profession.

Little they realise that a trainee paratrooper is often to be pushed from the air craft and rest of the journey to the ground is effortless. Perhaps in US if you dont write articles in medical journals you wont get promotions. We, here, have discovered lots of excuses. When we read some known person's good article we say oh! he is in a medical college with all facilities; there are residents to write for him etc. Yes ,the residents are those paratroopers who in some / most of the cases do most of the work of collecting, investigating the cases, and the literature search but they are all the time guided (pushed) by the boss, who often gives 'the first sentence'?

During the literature search you will come across many well written articles and you will be tempted to copy their sentences in your writings. Appreciating a good writing is a good beginning, collect those good sentences, good words in a diary read them ones in a while to inculcate the habit of good writing. But for God's sake do not use those sentences or paragraphs verbatim, in your article without quoting the original author other wise you may be held guilty of plagiarism.