Provoked? Humiliated? or Learned?

Story behind those 15 minutes..

As I was coming out of the cabin cum test lab of a reputed medical diagnostic imaging centre in Delhi, NCR, I was scratching my head and was thinking why did I have to listen to that (approximately) 15 minutes lecture on ‘Professionalism’. ‘Diligence’, ‘Reputation’ and all from the doctor?

Afterall, to me, I just asked a question in a requesting tone and was seeking a Yes, No or at the best a thoughtful answer.

Still, I could sense that something went terribly wrong and the question probably offended her to an extent that she chose to educate me for 15 minutes straight on her professional credentials, her due diligence, her methods and a couple of other qualities. She did it just like Shankar Mahadevan’s Breathless style leaving me Speechless 😀

The professional I am talking about was a radiologist who did, twice, abdominal ultrasound on the subject, my mother-in-law. My mother-in-law is a cancer survivor now.

Those 15 minutes were humiliating yet educational. I stayed silent and observed the person taking pride in telling me how professionally she does her job and how the question greatly hurt her feelings. I observed myself too.

What was the context of the Question?

The question (delegated to me to ask)  was originally by an oncology physician (another seasoned and renowned professional) as he was going through ultrasound reports of my mother in law. 

The oncologist suspected that a key measurement was missing from the previous report while it was well mentioned on the latest one. 

I assume that the reports were read and a decision was made in this way

• Quick comparison of the texts on both the reports
  • Observing specific measurement doesn’t exist on old reports but is there on latest ones. Why on the new one?
  • Is it missing ‘somehow’? Why? How?
    • Is it important to know?
      • Yes, to the Oncologist and his assistant
    • Confirmation required?
      • Yes
    • Decision?
      • Ask the patient / attendee to go back to the radiologist and request to compare the films and confirm.

Oncologist’s assistant suspicion, as he told me, was based on the premise that…

1. Investigations may have been performed and the test report was prepared by different people all together.
2. If so, there is a chance that there is a certain level of ‘subjectivity’ in the elimination of the measurement or even insignificance of the measurement such that it was not on the verbatim report.

So, I think he convinced me that it was about the radiologist’s subjectivity in measurement and / or possibly the significance of reporting the measurement. So the Oncologist wanted to confirm which one is the valid one.

Now, I was tasked to go back to the radiologist and ask this question..

‘May you please compare the last two ultrasound films to evaluate if a key organ’s measurement is missing from the old verbatim report or was the measurement not taken or was it not significant enough to report earlier?’

And then…

I went to the radiologist after taking an appointment. I was standing in her cabin and asked the same question, in all my sincere curiosity, polite tone and a healthy respect. I am not sure what mistake I made but it appears that the question itself offended her.

She looked at me as if she was seeing a dumbo and started throwing questions..

• What caused you or the oncologist doubt – question my diagnosis and test report?
• Were the reports (film and verbatim) read carefully by the one who knows how and what to read?
• Was the report data interpreted carefully and understood by the person who knows how is it done?
• What is the intention behind demanding a comparison?
• What if the latest report is the truth?
  • Would it change the further and a superior diagnosis in such case?
    • What is the premise?

She continued by telling (Here is the most interesting and learning part for me). 

She started telling me about herself, her credentials, capabilities, recognitions and also about the structure, data, usability, reliability of the tests and ultrasound reports that her lab produces.

• The Film
  • No one else produces the long lasting quality films that her lab produces.
  • Data points on film is helpful to derive verbatim report
    • Organ
    • Parts of organ
  • The film itself is of a material that lasts long. She told me about Paper printing vs Film printing pros and cons.
  • The film images are uploaded on the Web. Patients can access from anywhere
• The Radiologist Credentials 
• The Lab’s reputation
• The Report
  • Data
  • Target Audience
  • Disclaimer
  • The well known limitation of diagnosis method called Ultrasound
  • The use of words like ‘Approximately’, ‘Variation’ and so on

She didn’t stop here and I am thankful to her. She told me the limited capabilities of the method of diagnosis and what she is doing is the best that one can do. According to her…

• My job is to perform a procedure based on the prescriptions, and take, publish recordings (measurements). 
• Once recorded then provide them in a well readable manner for the target audience with a disclaimer and measurement limitations (possible errors, biases, approximations).
• Measurements from the sample and the subject are approximate and dependent upon
  • Day/Time
  • Environment situations
  • Patient’s physical and psychological situation
  • Breathing patterns 
  • Other factors…

I was speechless but my mind was also listening to her pain as well. The pain when someone’s professional pride is hurt. 

Finally she said to me the following words…

• Sounds like you are provoked.
• No competent radiologist entertain such comparisons. Once the report is out, it is out. I am not obliged to do a comparison.
• Comparison is a different service and it is not done without premium.
• Comparison in this context is nonsense on the grounds of medical conditions and kind of treatment.
• Such demands reflect a backward thinking rather than forward in such disease cases. 
• I can, in the best possible intent and competency, indicate Risk and possible preventive actions like another diagnosis.
• The question is actually a question on my credibility, professional competency, diligence and reputation.
• You hurt my pride in my investigations and reports which are trusted by renowned doctors in India.
• And, Please do not bring such questions without questioning the demand. You seem to be an educated person so…

After all this happened, my questions to myself

The oncologist was suspecting, if the radiologist who did the diagnosis was the same at both times or different. 

• If different, there could be a subjectivity in terms of determining, seeing, measuring and interpreting/reporting the measurements itself.
  • My questions – HOW IS THAT POSSIBLE? 
    • Are there no protocols on what to report under a certain medical test for a deadly disease?
    •  Is it only about test A,B,C only and NOT about holistic observations that matter in such cases?
• Doctor’s statement about the need of a PET-SCAN in such a case? 
  • Was it not on radar earlier? 
  • What if the US reports could have missed the new findings? 
  • Shouldn’t it be on the list of What to Measure in the prescription itself?
  • What might cause a Doctor to NOT to explicitly tell ‘What to measure’ or to determine ‘What seems / could indicate abnormalities?’

In my head, after all this….

• Could these professionals be more empathetic?
• Could they connect directly and talk and get the matter resolved?
• Why did I surrender to both of these professionals?
• Was I playing pure dumb?
• Why was I behaving like a mediator?
• Was I trusting them in a way that my ability to question their demands, counter their arguments and feeling of humiliation was suppressed to a great extent?

In all, the one most important thing I think I learned from the radiologist is this..

As a professional when you do your job with excellence, diligence and integrity, you take pride in the process and the outcome. When this pride is hurt, for whatsoever reasons, you feel bad and sometimes very bad. 

This led me to another learning…

Professionals should learn how to talk to the professionals.

Professionals should also learn how to talk to the people who don’t know about their profession and work intricacies.

I was supposed to be served by both in a manner that I feel no stupid when I am with any of them.

I don’t think I am going to do this with anyone in my life. I will choose either to empathise or sympathise or behave binary in answering such question unless I have solid reasons to believe that it is a deliberate intent and action. 

That’s it.