General, Doppler and small parts ultrasound

I have been in some remote areas where people have purchased Doppler machines just to advertise that they produce color pictures. and the patients are impressed and ask for it though the physicians in those areas have not yet felt the need for a Doppler study ‘In contrast there are areas where the physicians are so much aware of Doppler that you have to do one or two vascular Doppler daily. I have worked with a physician who asked for renal Doppler in every case where he wanted to start an ACE inhibitor in a hypertensive patient. He had a good justification for it. In a reasonably good centre a radiologist has to perform at least one of the Doppler study in the areas such as thyroid, carotid, peripheral vessels and at times breast and scrotum. etc. Pediatricians will invariably send a few cases for cranial ultrasound  once in a while. In centers of remote areas ultrasound is the main revenue earner and CT takes the back seat...

Selection of a Centre to work in

Most of these centers require their radiologist to be available 24 hours. Many of them don’t want to give even a day’s off. They may call you for a simple case to do USG even on a Sunday making it as emergency case... On week days you have to work for almost 12 hours Though the salary is good around one lac or more with free accommodation and even free food at times but freedom to move around without informing them is a hurdle and even a great irritant at times. In the beginning as I did not have the experience I worked in 3 centers for two to 3 months but ultimately got fed up and left them as I did not like too much of a disturbance even during night hours A young man may work for a year or two and collect some money so that he can establish his own centre later or until he gets a better job but I had no such compulsions. I would always advise you to go and see the location and working of the centre for a few days and then negotiate and then join if you like.

An editorial in The British journal of radiology in the late eighties had rightly predicted that by the   year 2000 there would be a world wide shortage of radiologists by 50 percent. And perhaps this presumption had been the concern of only the radiology community and the clinicians who depended, on radiology services to what extent only they knew or perhaps know now, never gave radiology the respect due to it inspite of the awe -inspiring entry of Ultrasound, CT and MRI enhancing the status of radiology to the present level that the brightest of the medical students are getting attracted towards the field.

About 10 years back a very senior American radiologist remarked during an IRIA conference that the imaging technology about to come will astound you and a time will come when clinicians won’t be able to write a prescription without our help. Since then and now I am not aware what changes have taken place in the minds of the clinicians as I still perceive their usual arrogance but when they come to the point of shaking hands their attitude does softens a bit. It is not our ability to handle an advanced imaging equipment that has earned their closeness but the money associated with it as they pay the same or even more attention to a rich patient of theirs oblivious of the radiologist’s presence at times...

I visited my Mecca that is Mumbai this January. You may get out of Mumbai but Mumbai never gets out of you. My love of Mumbai is not entirely one sided. I went to Jankharia Imaging as an observer. Personally I didn't know any body over there and they didn't know me either but a few minutes were more than enough to be friends. Mumbai is so used to seeing people of different cultures that an instant mixing, like milk and water, is but natural to it. And so it was at Jankharia's. There is a work culture there, a methodology combined with meticulous details of a technique and a very carefully planned routine with a discipline of a very high order. They all know their work very well and carry themselves smartly. I could easily visualize that if you really want your centre to excel then you have to have these settings in place and enforce it strictly.

      I went into service soon after graduation. Though I find life quite hard without some reading material I lost contact with the medical books. Every service has problems peculiar to it. Certain problems are common to all. Formulating new strategies to solve and avoid them are always on the menu. You may get a nasty boss. There are some colleagues who are always on the look out for creating trouble for others and revel in it. You may find it impossible to avoid by-pass or ignore them. They are a constant drain on your mental peace. After a days work you are so exhausted that you want to leave every thing back and just relax with your family. There is hardly any time for books. This is more so if regular brushing up of your professional knowledge is not very necessary to keep you in the job.

Ultrasound Machines

While I was a resident in Radiology Ultrasound was just in news. We didn't realize that the Ultrasound machines will also appear soon in the market just as it happened in the case of the discovery of X-Rays. Since the beginning of eighties some people started doing Ultrasound in India. They were so few in number that I can say I knew only one each in Bombay, Chennai, Calcutta and Delhi. There were some others but since I had no personal knowledge of them, I am finding it difficult to recall. These pioneers today are the star speakers in our conferences on Ultrasound and though I have not mentioned any name you should not find it difficult to know, whom I am talking about. They are the enterprising, inquisitive, and daring people with a very strong drive to learn a new technology. They taught us the very basics of Ultrasound in the CMEs. How a gall bladder looks like, how not to miss a GB calculus, what is gall bladder sludge, how will you differentiate it from GB malignancy, why not to measure the GB wall which is in contact with the duodenum for thickness, what is the importance of always reporting the post void residue in case of BPH and so on. They even told us about the mistakes they had committed so that we could become careful, for example one consultant admitted having reported malignancies in liver and after investigations in Tata Memorial hospital they came out to be tubercular as during that period Ultrasound appearance of tuberculosis of liver was not described in the text books.

Choice of an X-ray machine

X-Ray machines that were once so hazardous have all got the approval from the BARC. The Vendors proudly display this approval in the brochure. I don't say these machines are not safe as there has been a quantum leap in technology and all required safety measures must have been taken in their manufacture well within the perimeter of our safety standards. But do not be carried away by the frequent claims that our equipments now measure up well with the international standards and that we have now even started exporting them.

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.

for every student, where ever he may be, his teachers and his alma mater are the best in the world just like for every child his or her papa is the best papa in the world

^Not long ago there were few medical colleges. The doctors who came out of those colleges either went to private practice or joined state services. It was mostly the financial condition of the family that was a major guiding force. Few of them stayed back for post graduation. The admissions to PG courses were done on merit basis there was not much competition. If one did not get Medicine, Surgery and Gynecology then he went to Eye, ENT or Radiology. Though, even some bright students went for Pharmacology and Pathology and other non-clinical subjects. In which speciality you will earn more money was not the consideration. It was perhaps the respect and status and the peaceful life that they went for.