iRADiX

How do you deal when you discover ‘Incidentalomas’ while doing a scan …be USG, CT or MRI??

Definition of Incidentaloma:

“An incidentally discovered mass or lesion, detected by CT, MRI, or other imaging modality performed for an unrelated reason.”

From    Free Dictionary

Sometime back a patient came for routine USG study of Abdomen while undergoing Master Check Up. The USG picked up a cystic lesion with internal echoes in the pelvis of the Kidney.

The summer heat had set in and the sun was high in the sky. The clock had just struck noon when the idea to take a quick break flashed across my mind.

I had just finished the morning rush of patients for ultrasound.

Standing up from my chair, I told my secretary of my intention.

Receptionist entered to announce another patient from Germany with renal colic.

Considering his acute problem, I did not deem fit to delay the scan.

As the patient entered ultrasound suite, he glanced at me with a puzzled look.

The nurse draped a sheet on him and I started to take up the transducer when he suddenly sat up.

“Can you do an ultrasound examination?”

I was startled at his question and completely taken aback. Neither did I comprehend the reason for such a question nor could I justify it.

Here I was, having done more than 60,000 scans of all kinds in my career, faced with such a question.

Subtitle: Knowledge management systems and the universal mind

What  knowledge management systems exist in your organisation?

In our explorations and conversations together we try to seek the difference between the individual mind and the universal mind. As the relation between these two (the individual and universal) gains concrete form, and its own proper shape and appearance, one finds a life of the universal individual.

On "Inevitable Attrition"

Addressing the issue of "inevitable attrition" which Dr.Alok Varshney and Dr.Anuj Mishra raised while commenting on the article "A performance agreement'http://www.iradix.in/515-A-Performance-Agreement.html made me reflect on the nature of knowledge management systems which exist within our medical organisations. Employees must have free-flowing lines of communication between one another and need access to sources of knowledge -both inside and outside the organisation. That knowledge is often the raw material of creative thought.

Some companies have developed elaborate knowledge management systems to capture knowledge, store it, and make it easily available to reuse. These systems help ensure that what was learned by someone in Unit A doesn't have to be learned anew by someone in Unit B. Lee Sage has described DaimlerChrysler's Engineering Books of Knowledge (EBOKs), a knowledge management database containing technical data, lessons learned, and best practices that is made available to the company's engineering community. The purpose of the EBOKs, according to Sage, is to capture the expert knowledge of technical employees and use it to improve engineering productivity, speed new product development, and avoid repeating past mistakes. Consulting and tax accounting companies use knowledge management systems in similar ways (1).

What exists appears,

Lets itself be encountered

But you can never deduce it.

Nausea, Pg 188.

Jean Paul Sartre,Existentialist Philosopher

Of the many things we shared, it was the love of the written word that bound us the most.

Every family is a ghost story

In Mitch Albom’s “For one more day” he writes about a story about a family and as there is a ghost involved you might call it a ghost story. But every family is a ghost story. The dead sit at our tables long after they have gone. Ask yourself this-Have you ever lost someone you love and wanted one more conversation, one more chance to make up for the time when you thought they would be here forever?

If so, then you know you can go your whole life collecting days, and none will outweigh the one you wish you had back.

This feeling of “One more chance for a conversation” comes strongly today, as I recall dear LC Uncle.

He taught us many little things about life.

Did you identify any training needs for yourself in this exercise of reflecting on scanning protocols ? In previous entry we saw some issues relating to abdomen imaging.

As we jogged down the different systems we identified other areas where people are hesitant.

In our practice of Radiology, and especially in another country where the radiology services are quite not at par, we are under pressure to teach the fellow colleagues.

A ‘consultant’ is seen as a source of ‘new’ information and fellow medical colleagues are attracted like ‘bees’.

Often the situation becomes difficult to handle as in the case of my friend JS, who was travelling for the first time out of country to work in a new place. The pressure to teach on him was so overbearing that he succumbed to it and resigned from his job.

How should we deal with ‘pressure at work’?

Pressure can come from different quarters. It could just be ‘work pressure’, ‘peer pressure’ or pressure from the boss!

How independent can one be in a modern technology driven specialty branch dependent on referring physicians?

Systems and communities of practice

In the previous blog we had examined some practice options (Part Time?)

As Dr. Sridhar rightly pointed out that we are a referral dependent specialty and in his interact on Forum of Super specialty in Radiology has observed that one really does not often meet radiologists who are practicing as independent super specialists. We meet Neurologists, Cardiologists..but…super specialist radiologists?

In Blog End of Individual Goliaths we had examined how if one has to hold ground one has to be part of some system of practice.

Does the person who is working “For Himself” really work alone or are they part of several practices.

One surgeon friend did not want to initially invest on costly radiology equipment as he had invested in operation theatre and Intensive care units. He asked his radiology friend to invest and set up the radiology department.

“I am a man of limited means and you can use your real estate to become independent any time, once the initial loss making ‘teething’ period is over” the radiologist replied frankly.

When did you hear your teacher last talk good about you?

That set me thinking. Who is your friend? A person who keeps agreeing and praising you whether you are doing right or wrong or a person who will be there as your moral and professional muse, either physically or spiritually, and you can feel his or her presence whenever you are in doubt, crises or facing a challenge.

Maybe a critical guide is a truer friend than all the praising indifferent people put together, who will just go along with you, to please you, but in the end, you will realize who had more contribution to your growth.

One interesting and rewarding way to learn and grasp anatomy is by practicing line diagrams. If one has to draw something, one has to really observe it well. This also makes one more sure of oneself when challenged on our findings and is part of our training and practice as radiologists-who see anatomy in a way no clinician can ever see.

Show me the fracture

"Son, show me the fracture! Let me learn something from you or maybe, you can learn something from me," the Senior Orthopedics surgeon who was also the Director of the Institute called the radiologist to his office and asked him to show where the said fracture was which he was talking about.