iRADiX

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).

For it matters not how small the beginning may seem to be:

what is once well done is done forever.

Henry Thoreau, Civil Disobedience

The G7-G8 group of countries named “Lifelong learning” as a main strategy against unemployment. Having worked in the international “Global-work place” in a private corporate set-up and seen many “corporate-cruelties” in the name of “nothing-personal-just-business” one of the survival strategies is to have dedicated working groups.

A performance agreement

I will try to make you a technologist, and not remain a technician all your life.

Do you do Level 5 sonography?

Society can be analyzed in different ways. One of the ways to do that is to see how technology has affected the ways of living.

Levels

In an Editorial written in 1989, Dr. Roy A. Filly told about Level 5 Ultrasound. (1) He wrote about a call from a clinician asking whether he performed Level 4 Ultrasound. He had never heard of Level 4 sonography, but the request itself struck an unusual chord within him. He recognized this request itself as part of a growing problem in obstetric sonography. Uncharacteristically for him, he shot back

“I only perform Level 5 sonography”.

Rather than chastise him for this cavalier statement, the clinician thanked him and the patient dutifully reported the next day with a request for a Level 5 Sonogram.

In some IRADIX interacts –readers have said that the problem of regulation of Imaging equipment is unique to India where norms are not followed. This is not true.

The Editorial clearly talks about this issue in an advanced country and goes on to state

Doppler traces and Technical Thresholds

In previous entries we examined some issues arising from X-ray (Please Repeat), CT scan (high resolution), and Ultrasound (Snowstorms). Let us examine some other quality issues using the tool of “Technical Review Meeting” in the web world. Hopefully these will be applied practically. Feedback from readers regarding their experiences, pitfalls and lessons learnt will help improve the common pool of knowledge.

A fresh understanding of particulars

If a source is emitting sound waves, the frequency of reflected sound from an object in its path increases or decreases if the object is moving towards or away from the source respectively. This is the Doppler Effect (Christian Andreas Doppler-1803-1863), an Austrian mathematician) and the change in frequency is the Doppler Shift. (1)

In one of the forum discussions of IRADIX a question was asked, whether you use the Doppler mode while doing a routine ultrasound. In previous blog we had seen some Snowstorm-PRF issues. As told earlier, many vendors have targeted clinical departments as their market to sell them imaging equipments. This has led to increase in Quackery and some erosion of ‘Radiologists’ ground.

The positive outcome of this could be that we have to raise our bar so that they will still require us. It also made me reflect on the nature of sensation (Vico), reflection, education (Rousseau’s Emile) and remember the words of Francis Bacon

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.

“Is there anything known as ‘Part Time’?”

Déjà vu

As I saw my friend debate into having one’s own equipment soon after having joined a private hospital, I had a sense of Déjà vu.

They say, hindsight is a wonderful thing. Here I present some of the private practice options, overlaps and paths.

These are not meant to be an advocacy of any one path, but an attempt to show the different trends; and as an enquiry into what could possibly suit us and hopefully will get refined after contributions from our commentators.

A Fort

The senior surgeon called up the young radiologist and asked him to join the ‘fort’.

“There are many such diagnostic centres. Many more will open up in the next few years. This hospital is like a fort. And once you are within it, it is up to you, to see how you fit in, whether you are in the back room or in the centre of things.”

This Fort analogy to private medical institutions, given by the surgeon, serves as a reference to measure up which type of practice one does and how being part of these institutions will shape future choices and horizons.

“With all our limitations, we are an institution” the surgeon continued.

The state of our medical practice as has been illustrated in the previous blogs and the comments following speaks for itself.

Can there be Science without conscience? How do we work towards preservation of the patient-physician relationship in this milieu?

Indiscrete Jewels

There could be no better hook upon which to hang a contemplation of our milieu of practice than the fictional dream recounted by Denis Diderot (1) in his novel Les bijoux Indiscrets (1748;The Indiscrete Jewels). In this work Diderot describes a building without foundations, whose pillars, among which deformed and crippled men loiter about, soar upwards into swirling mists. The building is the Palace of Hypothesis and the old men are theologians and metaphysicians. Then an energetic little child appears, and as he approaches the building he grows into a giant; his name is Experiment, and when he arrives at the Palace of Hypothesis he gives it a mighty blow which smashes it into ruins. Thus science shatters the systems of Theology.

Evidence based work

A search for common values in a rational scientific context centered on preserving the patient-physician relationship can be found in the approach of “Evidence Based Radiology”(EBR).Why this debate and discussion, some friends may ask. It is in ‘enlightened self-interest’ to prevent burn-out, lack of interest in work as one finds the key decisions relating to one’s practice slipping out of one’s hands. Evidence based Radiology is a method inspired from the analytic process. It emphasizes autonomous reflection, systematic identification of roles, motives, and consequences of current actions and organizations, clarification of aims and means; selection of principles and values, and equilibrium, application and validation. This method entails constant vigilance and repeated revisions, but the allowance of time to think about ethical matters and decrease confusion and moral perplexity. The result is a stronger moral personal identity and a brighter horizon for a satisfying professional life. ”. (2, 3)

In acquiring one’s conception of the world one

always belongs to a particular grouping which

is that of all the social elements which share

the same mode of thinking and acting. We are

all conformists of some conformism or other,

always man-in-the-mass or collective man

Letters from Prison

Antonio Gramsci (1)

In developing a language and discourse of the possibility of a “Radiology Utilization Committee” there were some interesting thought provoking comments and links. From the link provided by

Dr.V.Sridhar(http://www.sfrnet.org/data/upload/files/a7e7222e420ac736c1256b6c0044cb07/euratom-anglais.pdf) it is clear that there has been a lot of detailed scientific discussion on these aspects.

And still I find myself bowing in front of the Urologist who is indiscriminately ordering follow-up CT scans. As was briefly mentioned in the previous blog-whatever happened to the patient’s right to information. How much Fairness and Justice is there in the milieu of our medical practice?

Having introduced the topic in previous article, we shall try to examine specific situations and try to evolve a common body of knowledge. In this I will deal with some specific situations which are within our direct “Circle of Influence” in our departmental settings and also try to name possible areas of concern which require wider inputs.