My reviewsSetting-up of A Diagnostic Centre : Part I
Last Updated on Friday, 05 December 2008 14:49 Written by Dr. R. J. Yadav Thursday, 27 November 2008 23:48
As a child I heard it many times 'mahnga roye eik baar, susta roye baar baar'. The English translation should go something like this - 'Buy costly, you cry once, buy cheap and cry often' I hear it even today and the message appears as old and true as those in the Vedas. But it is not without a rider. Just before the Gulf war of 1991 I used to watch with amazement AWACS (Airborne warning and control systems) making daily rounds over us looking very elegant as a big Boeing 747 Aircrafts on the back of which was a long pole on top of which was a huge disc. I secretly used to wish India should also have these airplanes. Until one day I read in the news papers that under the pilot's seat there are four rubber washers to prevent any damage to the body of the aircraft by the chair and each washer costs $1000/-and also they get worn-out frequently before long. These aircrafts were manufactured by a private firm and sold to US Airforce. The Airforce got cheesed off paying for these washers through its nose. They made their own and it cost them just 60 pence. A piece and worked as fine.
I can not substantiate what I have just mentioned as it was Newspaper report which are often exaggerated. But as a similar case while I was working in a very large thermal power station where there were 500 MW imported machines and a screw used to cost a thousand rupees as I was told during the beginning of eighties. Again during the same period as of AWACS story, US were flooded with Japanese cars and Honda was the most popular brand. American car manufacturers got jittery and one of them, in utter exasperation asked a Honda company executive "How do you make a profit when you sell your cars so cheap". The executive replied "we don't make profit on the car sale. We make money through the spare parts". Those who own a Honda ask them!
Living in a small place, you will adopt the habit, habitat and the behaviour of the local populace. And with the passing time, even if you have been groomed royally to become a great Radiologist of the future your gradual academic decay is unavoidable.
The preceding paragraph is hinting towards the quality of a thing and its attendant surcharges which can be easily managed as you have seen in AWACS case. While working in a private set up with a 200 MA GE X-Ray machine manufactured in England I got fascinated with GE. To take a forearm AP and Lateral X-rays on the same film we never used a divider. The filter and the collimater were such that exactly the half of the film was exposed without any effect on the other half. I had earlier worked with 500 MA plant but the quality of this machine was remarkable. As I worked for quite a few years with that machine, the room it was installed in and the attached dark room and toilet situations were such that I always wished to have a similar arrangement whenever I started my own practice.
Selection of a place to start the Practice
Though some people have a wide choice about deciding where to settle for a practice from a metro to a big city down to a town but the majority have a limited choice. You may become a very big and popular doctor in a small place but when it comes to being in a crowd of big city doctors you are treated like a small fry. Some years back a lady Radiologist from my northern neighboring district, which is about five times bigger than my own, gave a talk in the main hall during one of the IFUMB conferences held in Hotel Ashoka New Delhi. After the conclusion of the talk, the gentleman chairing the session remarked "It is really commendable that coming from such a remote place she has made some interesting observations." Though she seemed over- joyed having delivered the talk successfully and had become very emotional listening to the chairpersons kind words but I, sitting in the audience, was fuming with disgust.
"You are what you eat" is a well known phrase. Now let me rephrase it "Tell me where you come from and I will tell you what you are"! Living in a small place, you will adopt the habit, habitat and the behaviour of the local populace. And with the passing time, even if you have been groomed royally to become a great Radiologist of the future your gradual academic decay is unavoidable. Though rivalry and competitions are often viewed with disapproval they are as necessary for progress as are the availability of an association of highly educated people, opportunity of taking part in academic activities and interaction with people with interests in medical research and publications.
Though rivalry and competitions are often viewed with disapproval they are as necessary for progress as are the availability of an association of highly educated people, opportunity of taking part in academic activities and interaction with people with interests in medical research and publications.
There is a point of consolation for the conventional Radiologists that suddenly CT has been found to roast the patients with its dose of radiation amounting to the equivalent of 500 Chest X-rays as against one CT chest. During the international IRIA conference in Delhi, a professor of radiation medicine/physics, I don't remember exactly as to from where he was, but I am almost sure he was either from KEM or AIIMS (I am sorry my memory is pitiable!). He gave a very good lecture emphasizing the point that the amount of radiation that we get from our surrounding buildings, from the sky etc is much more than what we get from X-ray exposures, as they are done once in a while when a person becomes sick, and horror stories about the harmful effects of X-rays are not to be taken too seriously. This is what I could understand from his talk. I am certain he did not use these words. I am simply trying to cook it as without a 'Masaala nobody reads anything' But do check about the celestial radiation please. To allay the anxiety about the X-Ray radiations I would like to add further that The ‘Ten Day Rule' about X-Raying a woman during her childbearing age (between 12 and 50) was withdrawn in 1980s. Whenever the examination may irradiate a patients uterus it should be arranged for a time when the patient could net be pregnant --that is, within ten days after the date of the last (or a future) menstrual period. That is the 'ten day rule'. Editorial Br.Med.J. 1975 Dec6; 4(5996); 543. The editorial further states that 'it may be ignored if the patient can affirm that she could not be pregnant because there has been no recent sexual intercourse or she was using a contraceptive pill or she is fitted with an intrauterine contraceptive device proved effective for over more than three months or because she has been sterilised'.
Reception and patient waiting area
I presume you have sufficient funds at your disposal and would be able to construct or make alterations in an existing building to house your centre. To be able to work comfortably I would suggest the following, though I have seen people running X-Ray clinics in just 12' X 12' room and making money. In a similar size room a radiologist had an Ultrasound machine, with table and computer for reporting all cramped up with a stool for the visiting physician. His clinic was situated in a big city that also in the main market.
But if you are able to manage a bigger place see that all the patients entering your centre come to the waiting area that should be able to accommodate at least 30 people. The reception should be just near the main entrance. From this area doors open towards the X-Ray room and ultrasound rooms etc.
The X-Ray room should be of 15' X 25' size with the entrance in the middle and the X-Ray machine table should be in the middle of the room so that any patient that is brought on a stretcher is conveniently placed on the table without disturbing any other thing. Suppose the entrance is on the north side, the chest stand should be fixed on the north wall. In the south side of this room, you should have the X-Ray machine control and also the electrical switch-board. On this side only the rectifier (in old machines) can be placed if required. On this side only a small door opens into a dark room. Towards the chest stand side you should have a door opening into a toilet.
The toilet must be attached to the X-Ray room as a barium enema patient has only a few seconds time after the X-Ray exposure before he will ease himself on the X-Ray table itself.
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Setting-up of A Diagnostic Centre: Part II
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Dr. Vaibhav Jain
said:
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... it is good to have an idea about the details a centre should have, but i would like to read all the parts before giving a final comment. |
Dr.rachita
said:
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... can i know if its necessary to be a radiologist to have a diagnostic centre of your own? or can doctors of toher specialisations also have their diagnostic centre and have a radiologist do the reporting? will be highly obliged to get this answer... |
