Unethical Demand by Ethical People

Many people put their signatures where the administration tells them. The clerical people inculcate this habit in doctors, and the doctors make others do the same when it is their turn to get signatures.
"If your teacher is on leave, get your head of department's signature in his place" the clerks tell our postgraduate students, when they have to send their exam forms to the health university. If I refuse, they say "why not? All department heads do so."
They send me technical specifications of equipment asked for by other institutes, if the cost is above one million rupees. "Please sign the specifications and return the paper" the clerks say. I cannot understand how I can sign that document, when I have not developed it, and the contents of which I do not necessarily agree with. When I express this thought, they say "you just have to sign it. There is nothing more to it." As if the signature is just a part of a ritual which must be carried out, though it has no value in real life.
I have to forward every research proposal to the Ethics Committee of the institute. That includes research proposals of faculty, and proposals of dissertations by the postgraduate students. I used to sign all of those, until I realized that times have changed, and I can be dragged to a court by anyone when anything goes wrong with the proposal.
"Please tell me what my liability is when I sign this document" I asked the secretary of the Ethics Committee.
"You just have to sign it. There is nothing to it."
"What if something goes wrong and someone sues me when I am not connected with the research in any way?" I asked. "If my liability is owing to my administrative position, the civic body should be liable, and pay for any compensation ordered by a court."
"......."
"Will your committee answer my question if I write to it?" I asked. When she said 'yes', I wrote the letter, asking the following. I wrote all possible options, so that they would understand what I wanted.
"Please clarify if my liability is financial, medical, legal, ethical, scientific, moral, and/or any other."
I received an answer after a month and half. It read as follows. "The Ethics Committee deliberated the issue and could not reach any conclusion. So we asked the Boss. The Boss advised as follows. 'The head of the department has to sign all proposals for research by everybody in that department.' The letter with Boss' remarks is attached herewith."
It was a classical example of giving no answer as an answer. I wrote back, thanking for their letter, but asked for clarification on the points I had written about in the my letter. They kept the letter for another month and half, and wrote back "your matter is under consideration, and we will answer your question when a decision is reached. A few months have passed. An answer is awaited. No matter. I have 6 years and 3 months up to retirement. I can wait. In the meantime, I forward all proposals with a remark "forwarded without any financial, medical, legal, ethical, scientific, moral, and/or any other liability. They do not like it, but they take the proposals, because they cannot refuse them without reason, and they cannot decide on a reason. I heard they are thanking God that the heads of other departments have not caught on this idea yet.

Unexpected Justice

Surnames of people in my country differ a lot, though they sound similar to others. I am Parulekar, while there are Parulkar, Paralkar, Parelkar, and a few more which have a greater difference from the original spelling. It should not be difficult for people in my country to remember the differences because they know about it. Perhaps it is lethargy, or lack of application of mind and concentration (both required in minuscule quantities for this purpose) that causes this error.
There was a Dean of Surname Parulkar in my institute, when I was a resident doctor and later a Lecturer. He was famous, and it was natural that people would remember his name. A number of people used to call me by his name, long after he retired. There were people like subsequent Deans, who insisted on calling me Parulkar despite explaining that I was Parulekar. That could have been a manifestation of an attitude. Since I could not do anything about it, I let it be.
I was waiting for a meeting outside the Dean's office the other day, and for want of anything better to do, I looked at the walls and the things hung on them. There was a board with names and working periods of the past Deans there. I had seen the names before, but something made me read all the names again, checking their spellings. All names were accurate, except one. They had put Parulekar in place of Parulkar. Perhaps the painter knew me and did not know the past Dean? Perhaps the person who wrote down the contents for the painter knew me and not the past Dean? I know it was not divine justice, because it does not happen with injustice to another.

Tribute to Victor Bonney

Victor Bonney was truly a genius. His contributions to gynecology are not just numerous, but brilliant. His myoma screw, myomectomy clamp, hood operation for removal of a posterior wall leiomyoma, round ligament forceps, cervical dilator, test to diagnose urinary stress incontinence, record number of myomas (225) removed from a single uterus, method of vault suspension after a vaginal hysterectomy, Berkley-Bonney forceps, and his book on operative gynecology are a few of those contributions. I loved his book 'Operative Gynecology' as a student and have not stopped loving it for 30 more years.
It broke my heart when I looked at the current edition of the book, edited by some people. They have retained some of the original drawings (all of which were wonderful), removed most of the text including many of Bonney's original contributions, and not added much to make it up to date anyway. Perhaps it may appeal to someone who has not read the original book, and to the fan club of current editors (if there is a fan club), but not to those who loved the original. I don't know what Bonney will do if he gets to see the current edition in his grave. I hope that does not happen.
"I saw new edition of Bonney's book, edited by other people. Don't let my publishers take out new editions of my books after I pass away" I told my wife. "No. I am not thinking of passing away soon" I said hurriedly when I saw her troubled brow. "Just making things clear. When they feel the old editions will not do, let the books die rather than get someone to revise them. I am not a fraction as great as Bonney, but I feel about my books as Bonney must have felt about his own book."
Just to somehow make Bonney feel good, in case he can see it, I made a 3D model of his myomectomy clamp, and put it up on the net. At the risk of appearing a sentimental old man, I want to say:

'Sir, making it was tough. I dedicate to you all the efforts that I put in its making. I learned a lot from your book, taught a lot of students what you taught me through your book, and I hope people will see this model and remember the great things that have been removed from your own book.'

Hi Microsoft

I use a free excellent service called StatCounter. It tells me who visits my Blog and Website every day. It helps me know which of my posts interest people. For a few months, I had been getting visits from Microsoft Corporation.They used to be visits to the home page rather than to any particular post or web page. My son, a software specialist, told me it must be web crawling done by Bing, the Microsoft search engine. It is done to index all web pages, so as to yield good results when people search the web for something using that search engine. It made sense because Google has been doing it to my Blog from the beginning of my Blog.
But today I had a pleasant surprise. Microsoft visited a specific post of mine -Dynamic Arrows in PowerPoint. I had written about the use of flashing arrows in PowerPoint presentations, something Microsoft or any other similar presentation software had not included in their available features. The arrows draw attention of the viewer, and can substitute a laser pointer, or help in self playing shows where there is no one to point out anything. I was rather proud of what I had done and posted the technique along with an illustration. You may see it at the following link, if you have missed it.
http://shashankparulekar.blogspot.in/2013/01/dynamic-arrows-in-powerpoint.html
I am quite happy that Microsoft visited my Blog, read what I did with their software that they had not thought of. Perhaps they will include that in their next version of PowerPoint. Most probably they will not give me any royalty for it, since they have just visited my Blog, without making any attempt to contact me. :-)
For those of you who think I am just telling a fictitious story, here is proof. It is the StatCounter report of that visit.

The IP Address: 199.30.18.215 listed is of Microsoft Corporation, as can be found out using any Whois service on the net. Here is what I found today.

OrgName:        Microsoft Corp
OrgId:          MSFT-Z
Address:        One Microsoft Way
City:           Redmond
StateProv:      WA
PostalCode:     98052
Country:        US

Missing Threads of IUD and Us

The art of plain radiography is disappearing fast, with the advent of ultrasonography, CT and MRI. However doctors still continue to ask for and perform these studies. One such study is plain radiograph of the pelvis with a sound in the uterine cavity, to localize missing IUDs. Actually ultrasonography localizes all of these in the uterine cavity and most of these outside it, unless bowel gas shadows obscure the IUD.
One of my old colleagues had a patient who presented with missing threads of an IUD. This patient used to menstruate regularly and had not missed a period. There was no abnormal finding on pelvic examination. Someone had obtained AP and lateral radiographs of her pelvis. They looked as follows.

"Where do you think is the IUD?" she asked.
"If the sound is in the uterine cavity, the IUD has probably perforated the uterus, at least partially" I said. "The lateral view shows the IUD going perpendicular and away from the tip of the sound. But there is no vulsellum on the cervix, which if held together with the sound would have prevented slipping of the sound.
If the sound has slipped out of the uterus when the patient was moved from supine to lateral position, the IUD could still be in the uterine cavity. Did you obtain a pelvic ultrasonogram?"
"Yes. It shows the IUD within the uterine cavity. But we don't believe it. We are going to perform a laparoscopy and hysteroscopy on her and remove the IUD. If it is a partial perforation, the tip could be in the peritoneal cavity and there is no knowing what it might have perforated, say bowel?"
"Let me know what the outcome is" I said.
I scanned the radiographs and took opinions of my staff members and exam-going residents on those images. I showed them only the AP plate and asked their expert opinion, checking various parameters discussed by them, their diagnosis and recommendations for management. The results are in the following table, the figures indicating percentage.

	Residents	Assistant Professors	Senior Faculty
Asked for lateral radiograph	55.56	80	100
Asked for ultrasonogram	7.41	20	0
Comment on absence of Vulsellum on cervix	0	0	0
Perforation by sound	0	0	0
Downward displacement	0	0	0
Correct diagnosis, assuming sound was in the uterine cavity	40.74	30	80

I offer no discussion or conclusion. I leave it for my readers to do.
When they operated on the case, the IUD was found within the uterine cavity. The vulsellum had been removed after placing the sound in place. It just goes to show the importance of holding the vulsellum and sound together.

DNA and iPad Mini

There is a newspaper called 'dna' that is published 4 major cities in India. It is from a group called Bhaskar Group. About 4 days ago they put out an ad asking for creative readers to design a masthead for their Sunday newspaper. The prize for the winner was an iPad Mini.
"I want to participate" I said. "I like to think I am creative."
"Well. go ahead" she said. "You are creative."
"I am not sure they mean to give away the prize" I said. "Their ad says 'the winner stands to win an iPad Mini, not that the winner gets an iPad Mini."
"Perhaps it is bad composition? You should buy an iPad if you want one, anyway."
"I don't want one actually" I said "but I sure would like to be a winner in creative designing competition. I disagree on the issue of bad composition. They are all qualified journalists there. They mean what they say."
I designed a 3D masthead that evening. It looked like this.

"That is the earth down there, with our country seen in green" I told my wife. "The yellow sphere in the circle of 'd' is the sun, which stands for the Bhaskar Group. The two vertical limbs of the 'n' are two pens, the oblique line of the .n. is a microscope depicting scrutiny of the news, and there is a 3D bar diagram in the circle of the 'a' depicting results of the analysis of data by the newspaper. I have painted the letters of 'dna' the same colors as the newspaper's original title."
"It looks good" she said.
They declared the result today. I did not win. I did not make it to the list of some 5 designs they showed in addition to the winning entry. None of them was 3D like mine. They looked more like Photoshop output.
"They evaluated 650 entries from Saturday noon to midnight, when they went to press. You think they even looked at my entry?" I asked my wife.
"I don't know" she said. "Whether they liked it or not does not matter. It was your happiness at creating something that matters."
"Yes, that and also that you thought it was a winner."

Believe It Or Not

We have Resident Doctors who are not necessarily local students. Many of them come from other parts of the state or even another state. They are sort of alone in a different city, away from family and friends. They sometimes have their health problems, sometimes family issues or social issues, which make a few of them do things that have little to do with patient care and their own education.
There was a resident doctor who left her hostel room one morning but did not reach the ward. She was not to be found anywhere and could not be reached on her mobile phone. Her home was not in this city. Her parents did not know her whereabouts. We were worried, knowing what can happen to women sometimes, though this city is considered reasonably safe. When she came back a few days later, she said - "I left my room. I don't remember what happened afterwards. I suddenly realized I was at the airport. So I boarded a plane and went to my brother in Bangalore."
I have no answer how she lost contact with this world until she reached the airport, how she had enough money to get a ticket to Bangalore, how a flight was available at that time, and why she would not tell her colleagues or boss or even parents when she realized what she was doing.
Then there was a resident doctor who went to her home for a couple of days, did not come back for a month, had switched off her phone all the time, while we all were worried. We had reason for worry, because there had been that sexual assault and murder case at Delhi recently, and her home was up north somewhere where it was as safe or unsafe as in Delhi, if not worse.

Then there was a Resident doctor who went away without any notice, came back after a few weeks, said he was not feeling OK and went away again. He is still away.
"Sir, how does the health university allow all this?" someone asked me.
"That is a question only the university officials can answer" I said.
"What about their education?"
"That is a question only the concerned students and the university offiicials can answer" I said. "We cannot teach them while they are away."
"What about the patient care? Don't they feel any responsibility towards their patients?"
"They do what they do because they probably believe that is right. They would probably not be comfortable with themselves if they thought they were doing wrong. Who are we to decide what is right and what is wrong for them?"
"But what about the people they will treat when they practice on their own? If they have this sort of education, experience and attitude, what will happen to their patients?"
"You think too much" I said. "God has made this world the way it is. Since we cannot change it, we have to believe that God will help these doctors and/or their patients."
Addition: 22-04-2013
There was a news item in the newspaper today. One resident doctor in our hospital's orthopedic section went missing. The hostel warden apparently filed a missing person complaint with the police, and a search is on. I wonder why doctors go missing from our department for days, weeks and sometimes more than a month, but the police are not informed by the hostel warden or the hospital administration. I hope someone tells me some day.

Obviously Unobvious

It must be my gray hair that makes some people believe I am old enough not to get the obvious.
There was that first year resident doctor who was shifted to my unit temporarily because there were too many resident doctors in another unit and not enough in mine. There was a big crowd of outpatients waiting for a nonstress test that day. I called the emergency room to find out who was supposed to do their tests. This resident doctor picked up the phone.
"Who is going to do nonstress tests?" I asked.
"Dr. ******" she said.
"Where is she?" I asked.
"She is in the antenatal ward doing nonstress tests of the inpatients" she said.
"Well, then who will do the tests for the outpatients who are waiting here for a long time?" I asked. The patients had been called at a specific time, and they should not have to wait.
"Obviously Dr. ******" she said.
I could have got angry that a first year resident doctor had the cheek and guts to tell the head of the department that he did not get the obvious. I did not show any anger. "Call the Registrar" I said. When the Registrar came on phone, I advised her to send someone urgently to do the tests. She did that without telling me Dr. ****** would do it later. After I gave it some thought, I feel the reason I got such an answer from that resident doctor was, among other reasons, she did not want to do that work. Had she told me there was no one to do the tests, I would have done them myself leaving other work. That was exactly what I did another time, until my Associate Professor saw me, and got the Registrar to take my place on the double.
The other story is of a patient who came looking for me in our outpatient clinic. Some doctor had referred her for a leiomyoma in hr uterus. Unfortunately she came near closing time, long after they stopped issuing case papers to new patients.
"Sir, this patient insists on seeing you, though I explained to her that by hospital rules she has to have our case paper. She says she would like you to at least see all her reports" my Registrar told me.
"I am sorry. You will have to come to my next clinic" I told her. "I cannot see you without a case paper. You cannot get one at this time unless it is an emergency."
She and her relative thought that over. "But it is an emergency" she said. "I have pain in abdomen."
She seemed perfectly fine, without any sign of a pain anywhere. To make sure, I said "the abdomen is a big area. Show me exactly where the pain is."
"Obviously in the leiomyoma" she said without batting an eyelid.
It was obvious that she did not have any pain and did not know where the pain was expected to be. It was also obvious that she did not have the sense not to be rude to the doctor without reason, especially when she wanted a favor. I went back to see the patients who were still waiting to be seen, having reported to the hospital in time, and waited patiently for a long time. She tossed her head and went away in a huff. She did not come back next week or the week following.
I wonder what treatment I would have received from that Resident doctor or this patient, if I had been the person who wanted something from them rather than the other way round.

How To Type in Marathi

I have written this article to spare my readers the efforts I made to search, test, research, retest, test on different machines and different operating systems to find the best answer to this question. If the question had been asked 20 years ago, the answer would have been - 'you need a Marathi typewriter and training on how to use it'. If the question had been asked 5 years ago, the answer would have been - 'you need a Marathi font, Marathi keyboard, and training on how to use it'.
Today there are many answers to that question. The second answer is still valid. A more advanced answer is - 'you need a unicode compliant text editor and a Marathi font'. I have done a lot of search on this subject, and I believe I have a simple solution.
The need is to type emails in Marathi for those who are Marathi speaking ones, and to type in Office software, mainly word processors and spreadsheets. With the circulars from the state government and the civic body, the need for the latter became pressing. My solution is to use a freeware, PramukhIME. It is available today at this address. It works in Notepad in Windows, and in Word processors if you have Java Run Time Environment installed. You may be using Microsoft Office, with which it is compatible. If you want a good free office suite that works too for this purpose, use Kingsoft Office, available today at this address. PramukhIME also has a free plugin for Mozilla Firefox browser. You can switch between English and Marathi with two left mouse clicks when typing an email or writing a blog, like this: अगदी सोपे आहे ना? It needs no training, because the typing is phonetic, i.e. you have to type using a standard English keyboard, spelling Marathi words as you pronounce them. I appreciate the efforts made by developer of PramukhIME, Mr. Vishal Monpara, and his free gift of its use to whoever wants it. Whatever I have written about Marathi is applicable for a host of other Indian languages too.

Update: 19-8-2013
I got a message from the developer that he has brought version 2 of his software. It is still free and has a number of features added to make it more functional.
It is available pn his website at the following address.
http://www.vishalon.net/PramukhIME/Windows.aspx
I liked it as much as the first version.

Delivery rates and Sex ratios

The state government sent us the childbirth related report for the year 2012. I took out figures for three civic and one state run hospitals in the city. All are tertiary level hospitals, and people form each institute believe theirs in the leader of them all. The following graphs show their delivery rates and sex ratios at birth.

I have smudged the names of the institutes so as to maintain their privacy, though I understand it is a public document and is available on the net for anyone who wants to see it.
The state run hospital has all the resources of the state at its disposal, and has famous doctors on its staff. Perhaps the delivery rate there would have been 4 to 5 times what it is. A civic hospital has even poorer delivery rate, though its head of the department of obstetrics and gynecology keeps telling us how busy they all are, how they deliver 20-30 patients a day, and the civic body needs to give them more assistant professors, unless I give them my assistant professors. Well there are people who make statements without checking statistics, or make up statistics to match their statements :-)
It is dismal that the sex ration of them all is poor, none reaching 100 or exceeding it, and one as low as 66%. When I informed my people about ours, one of them said "Sir, now the area surrounding our hospital has been transformed from one time mill land and chawls into posh towers and affluent people are living there. That may the reason of such low sex ratio."
"But the people who deliver in our institute are all poor" I said. "This sex ratio is of our hospital births, not our geographic area." That ended the argument. That all happened long ago, but I am left wondering about it. It implies that even poor people do prenatal sex determination and female fetecide. Our institute has no hand in it, as is evident from the facts that we our MTP rate is very low, and we just deliver all women who come to our hospital. All I can do is educate people and pray that the government somehow controls the prenatal sex determination.

Offer Extraordinaire

They came to my outpatient clinic and met me when I stepped out of the examination room to see someone. There was a man in lead and a woman just behind him.
"Doctor, we have come to request you to send your patients to our laboratory" he said.
"OK" I said.
"We have a new lab dedicated to prenatal care which is birth right of women" he said. I knew about women's rights, but I preferred to let him believe he was the first person to let me know about it. It always saved time. "We offer a package of prenatal tests at a very economical rate."
"What are the tests?" I asked.
"The package includes complete blood count, urinalysis, retrovirus screening, hepatitis B screening, RPR screening, blood grouping, serum iron levels, random blood glucose, thalassemia screen, TSH assay, and hemoglobin S. The actual cost is Rs 2200/-, but we will do it for Rs. 1200/-"
"OK" I said. When some tests were not available in our hospital, we had to send them to other laboratories. This one was one among many such laboratories that had sort of sprouted around our hospital.
"What is your name, doctor?" he asked. I told him my name. "What is your phone number, doctor?" he asked.
"I prefer you do not call me" I said. "So I would not give you my phone number."
He thought it over briefly and said, in a much lowered voice, "Doctor, we give 40% of the patient's charges to the referring doctor."
So that was the reason he wanted my telephone number!
"No, thanks" I said. "My salary is adequate for my survival. You might give that much more discount to the patient."
They went away. Two things struck me as significant. One was that he was offering to do all these tests for rupees 1200-480 i.e. rupees 720/- only, which included his profit too. I could not see how he could do it, unless reports were given without actually performing those tests. The other thing was that he believed a doctor would accept his offer, and since it was unlikely I was the first doctor he had met, some doctors must have accepted his offer. The implications of these two things would be clear to readers and I refrain from putting them down here.

Humor in Counseling?

There was a 55 years old woman with mild acute pelvic inflammatory disease. I asked her to have some blood tests and prescribed a course of antibiotics as per management protocol. Then I advised her to abstain from sexual relations for two weeks, because a rest to the pelvic parts would hasten up clearance of the infection. She looked at me for a couple of seconds as if she could not believe what I was saying.
"We have not had any sex for last six months" she said in a matter of fact voice.
Since she did not ask me for any advice on that point, I decided to take it as a piece of information that would not change my advice to her.
"OK. Please do not have any sex for another two weeks" I said.
She looked at me incredulously for a moment and started laughing. I wonder if she thought that at her age sex was a no-no, and I was just being funny. Since she did not show any sign of letting up and did not seem to want anything more from me, I went to see another patient while she had her laugh. She finished her laughing and left just before I finished examination of the next patient. If laughter is the best medicine, it must have done her a world of good, and perhaps a shorter course of the antibiotic would have done as well, I thought. The thought was superfluous anyway, because it came after she had left.

Saved By Lack Of Blood

In 1983, one of the House Officers woke me up at midnight. I was a Registrar available in campus, and she wanted me to go assist her perform a cesarean section.
"What is the indication?" I asked her.
"Previous two cesarean sections" she said. It was believed then widely that a cesarean section was the only option in such a case. I knew a vaginal delivery could be achieved.
"Is there pelvic contraction or threatened rupture of the uterine scar?" I asked.
"No" she said.
"Is blood available?" I asked.
"Um... no. I have just sent her blood sample to the blood bank" she said.
"OK" I said "call me as soon as bleed is ready". I went back to sleep, ready to go as soon as called. The call never came. When I met her in the morning, I asked her why she did not call me.
"Actually the patient delivered vaginally while I was waiting for her blood" she said with some embarrassment.
There was another patient yesterday, who had had a cesarean section in past, was near term and in labor now. She was anemic. There was no blood available. Finally they got one unit from another hospital's blood bank. She needed more. They were watching her progress, which was quite tardy. The fetal heart rate dropped in between, and they wanted to perform a cesarean section in fetal interest. But there was no blood. The patient's husband was running places to get blood for her. They had to wait. In the meantime the fetal heart rate improved. When they called me at night, the patient's action line on the partogram had already been crossed.
"Perform a cesarean section when you get blood for her" I told them. When I asked about that patient the next morning, the Registrar told me that they shifted the patient to the operation room when the husband came back with blood, but she delivered vaginally there. Her facial expression and tone of voice reminded me of the other House Officer 30 years ago.
Both of these patients were spared cesarean sections by lack of blood. By the grace of God, both mothers and their babies went home fine.

Sopro Camera 'Facility'

We recently purchased an endoscopy camera in donation. We could have got any other one too. But the reseller gave us a reasonable rate, and his specifications included 'facility to record' video of operations performed.
The camera was OK. The display worked fine. The trouble started when we installed the software on a PC for recording operative videos. The software declared that it was good for a month and then we would have to have it activated. We called the company engineer, who told us that the software supplied with the camera was always a one-month version, and that we would have to buy the full version if we wanted it. He pointed out that it was the distributor who had made any promises in that connection, not the manufacturing company.
We were stumped. It did have recording facility, meaning the ability. The thing not said before sale was that we would have to pay extra to have that facility. It reminded me of "Take Note" hardware I had got. It stated it would convert handwritten text into editable text. It supplied software called "MyScript Notes", which did the job. The snag was that it was a demo version, and we would have to buy the full version if we wanted the feature.
"I feel cheated" someone said.
"It is like marrying a good looking girl who can cook well, sing well, paint well, but won't do anything" a male staff member said.
"Or marrying a handsome hunk with loads of money and a mind to match, but who won't let the wife enjoy any of the features" retorted a woman staff member. Well, you get the idea. We talked to the reseller- M/s. Diamond Something. He was co-operative, perhaps the donor had withheld a major part of his payment, until we certified the equipment was OK.
"I will give you the activation code" he said "even if the manufacturer will not."
"We cannot take it from you" I explained to him. "The license for the software should be given by the manufacturer of the hardware."
"Why? You have bought it from us. We will give you service afterwards, not the manufacturer."
 "It is like Microsoft Windows. A person who sells us a computer cannot install Windows on it and give us a license key of his own. That would be piracy. We do not want pirated software."
I wrote to the parent company and asked for its catalogue. There was no response. Finally we realized that we would not get the licensed software. I apprised the donor of the situation and asked him to release the balance payment if he felt like doing so.
Let the lesson we learned the hard way help others. Before you buy this or any other equipment from this or any other vendor, don't fall for the 'facility' word. Confirm that the full facility is a part of the deal.

Metric Confusion

A patient came to us with postmenopausal uterine bleeding. She had no abnormality on pelvic examination. I asked for an ultrasonic scan of her pelvis. A week later she presented with a report. Her uterine description was as follows.
The uterus measures 5.9 X 3.6 cm. Endometrial thickness is 9.7 cm in the fundal region.
The ultrasonography resident doctor must have made a mistake while writing the unit of the endometrial thickness, I thought. It must have been millimeters. I could have corrected it myself, but thought I should talk to him, so that he would be careful in future. After all, when he went into private practice, such errors could prove damaging. I called him.
"This patient's uterus measures 5.9 X 3.6 cm in your report, while the endometrial thickness is 9.7 cm. That cannot be. Endometrium cannot be bigger than the uterus itself."
"I will have to look at it" he said. So I sent the patient to meet him. She came back after half an hour. She had a brand new scan performed by the Assistant Professor of ultrasonography, and the report written by the same resident doctor. This time the uterine measurements were 6.1 X 3.7 cm and the endometrial thickness was 9.6 cm in the fundal region. This seemed to be getting out of hand. I called the Assistant Professor and explained the situation to her.
"I have done the scan myself" she said. "The new dimensions are correct."
"Thanks" I said. "But the endometrial thickness is stated to be 9.6 cm, which is far bigger than the uterus itself. I wanted that part corrected."
"No, no!" she said. "It is not centimeters, it is meters."
I was aghast. She must have heard my catching my breath on the phone. She immediately corrected herself "I mean millimeters."
"Thanks" I said. I did not send the patient back for correction of the report, because the poor woman would be subjected not only to the trouble of another visit to the ultrasonography department, but perhaps their associate professor would perform a third scan on this patient, and the concerned resident doctor would write the endometrial thickness in centimeters again. :-)