Directions...

Wow. It's been three months since I last checked in with you, my loyal readers. All 3 of you. As you might guess from reading my ranting over the past 11-plus years, I've been in the midst of a dilemma,  in this case trying to figure out what my future should hold. There are many directions to go, many options to consider, and many needs to satisfy. But I think I've got it. Finally.

To be totally honest, my basic instinct was to retire completely at the end of the year. Which was my intention last year, but somehow I stayed on. And I will indeed continue to work for another year, although I'll cut back my weeks even more; in 2016, I will have worked 26 weeks, but in 2017, I'm planning on being in the saddle for only 22 weeks. That's enough, I think. Rest assured, however, I'll have my phone on and operational 24/7, so no one need worry about reaching me. No, I don't charge for that extra service...

So why was this decision so hard? Do it or don't, right? Well, it's complicated, and there are many factors involved. Of all of them, the financial aspects are the most straight forward. Continuing to work keeps my (markedly lowered) salary coming in, and my health insurance is provided. Since Dalai, Jr. has a $36,000/year drug habit, that drug being Remicade, insurance is quite nice to have, and even our rather high-deductible plan would set me back almost as much as the Remicade if I were paying for it directly out of my pocket. No brainers, there.

Then there's the mental stimulation. Being at the PACS station does keep me on my toes, with little time to squander on foolishness like blogs. Hopefully, with the downsized work-year, I'll be a bit better. A three month hiatus is inexcusable.

And I must add that Mrs. Dalai was quite encouraging...of me getting my saffron-robed backside out of the house. "For better or worse, but not for lunch!" as she says. Quite often, in fact.

There were some negatives, of course. Here, I must be careful in my wording. If you choose to read between the lines, I cannot be responsible for what you assume I'm saying. Capisce? Much of my hesitation revolved around numbers. Mainly numbers of exams, read and unread, daily variance in consumptions of the numbers, numbers of things on exams I did not find, numbers of times I could not complete my interpretation of an exam all at once due numbers of others coming in my office, numbers of patients reading their own reports, etc., etc. Some of these problematic numbers could be cured by throwing greater numbers at them, but greater numbers come with greater costs, and in essence, this is not an option for the for the foreseeable future. So, I could either embrace the numbers or reject them. For one more (reduced) year, I'll suck it up. After that...we'll see.

You might recall my earlier post about Rad-Aid wherein I mentioned a chance to go to Ghana. I couldn't make that trip, but I was given another chance to go, and so I shall! Watch this space for updates from Africa. My task (as team leader, no less, being the only physician on this particular expedition) is multifold. First and foremost, I will try to help with the local PACS, which thanks to a generous donation by IBM/Merge, is the same as our system. Actually, it's a version ahead of ours, so I've had to try to learn that one a bit sooner than I had planned. Fortunately, the viewer component is pretty similar, but the worklist page is much more complex, allowing construction of some rather amazing worklists. I'll still declare Merge PACS to be one of the more usable out there, and I'm sure the physicians in Accra can by now use it about as well as I can. But their system lacks one element, a RIS. As luck would have it, I gave this problem some thought when we put in our AMICAS PACS years ago, in this post from January, 2006, 10 (yes, TEN) years ago. My solution was to use PACSGear to scan a paper report and send the image to PACS as another series in the particular exam. One could also use one of several software apps out there (I cited Print2PACS back then) that would do the same thing with a digital document. Those ideas might work. It seems though that the residents in Ghana actually type their reports into a different computer, so I'm wondering if they could instead type into the PACS comment field. Much will become apparent when I'm on site. In the meantime, any ideas on this are welcome.

Task #2 involves integrating the Nuclear Medicine Department into PACS. Which means setting up DICOM link from the gamma camera to the PACS. This should be straight-forward, but somehow with PACS, nothing is ever easy. As with most places outside of the United States, Nucs is completely separate from Radiology, with all the complexity that entails.

Last, but certainly not least, I am going to share some of my limited knowledge with the rads and residents. I'll concentrate on things nuclear, since that is my area of expertise, and I've prepared a good number of lectures in that realm over the years.

I'm hoping to make a difference with this trip, both on the ground in Accra, and within my own soul. This seems to be a wonderful way to give back, and I'm hoping my efforts will be found worthy.

By the way, Rad-Aid is exploring a flying hospital concept, using not a 747, but an airship!

Sign me up for the first flight...

Let me end on a happy note. I had the opportunity to speak with a bunch of pre-meds at a local event last week. Yes, that's a good thing! These particular pre-meds were members of a pre-med honor-society, and they definitely were the cream of the crop. Based on some of my past experiences, remote and recent, I had expected a bunch of arrogant, socially-inept snowflakes, bleary-eyed from 20-hour days of study, the sort that would sell their soul, or at least a kidney, to get into medical school. I couldn't have been more wrong about this bunch. These kids (indulge me, I'm old) were enthusiastic, yes, but they were curious and introspective, well-informed, and interested in just what it is radiologists do. They had the proper balance of intelligence and humility. Their MCAT scores are no doubt high, but they maintain their humanity and their humility. In other words, they GET it. They have the instinct to be fine physicians, those to whom I would send my family and friends.

I feel more optimistic about the future of medicine than I have in a very long time.

One of those kids might become my doctor some day soon. Hopefully, one of them will go into gerontology.