Share your ideas: Copy-“right” or copy-“left” your idea

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“Everything begins with an idea”, said Earl Nightingale, an American motivational speaker and writer.

Ideas can change the world. All successful organizations or businesses began with an idea that turned out to be great.

If you have had an idea, then chances are that many others would also have had the same idea or a somewhat similar idea and could already be working on it. Ideas arise out of common circumstances or needs. They usually follow the current trends.

Yet we are afraid or reluctant to share our ideas lest they be stolen by others. But it is always better to share your ideas.

Sharing is gathering information. Brainstorming or debating your ideas with others gives you valuable feedback or insight about the viability of your idea, be it your family, friends, or colleagues, right at the very beginning. You can copy-“right” your idea, if you want. The diversity of their knowledge, skills and experience makes you better informed. You learn more about the pros and cons, you can rework your idea and take that first step on the path of converting your idea into reality. This is how innovations come about.

Holding on to your idea, waiting for the right time, may well make your idea outdated.

Anybody and everybody can have ideas. How you execute your idea is what makes the difference. The one who implements his/her idea first gets credit for innovation.

But, if you do not want to work on your idea or implement it, then share it immediately; you can copy-“left” your idea. Put it up on an open forum where anybody can use it or add to it.

Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medalist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

CT follow-up of a solitary pulmonary nodule: New recommendations

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Finding a solitary pulmonary nodule on a chest x-ray is common and once detected, it needs to be evaluated promptly and managed because many such nodules can be malignant in nature. A large majority are picked up as asymptomatic lesions.

A solitary pulmonary nodule has been referred to as “coin” lesion, a nomenclature first devised by John Steel way back in the 60s. Some of its major characteristic features include solitary nature, circumscribed margins, diameter double the cross-sectional diameter of an adjacent blood vessel adjacent (1.5 cm), homogeneous density and completely surrounded by lung with no regional lymph node enlargement or satellite lesions.

There is a long list of conditions that are to be considered in the differential diagnosis of a solitary pulmonary nodule. The most common include lung cancer, benign lung tumor, tuberculoma, fungal granuloma, lung abscess and metastasis.

“Wait and Watch”, biopsy of the nodule or immediate thoracotomy are the management options. A thin slice CT (1 mm) is done to accurately describe the characteristics of the nodule and decision is taken on CT findings.

The updated 2017 Fleischner Society Guidelines for management of incidental pulmonary nodules detected on CT published in the July 2017 issue of the journal Radiology have recommended a range of time for follow-up CT scans, rather than a precise time period based on estimations of the individual risk of malignancy.

According to these guidelines, no routine follow-up is required for patients with a solid or subsolid (pure ground glass or part-solid) solitary pulmonary nodule <6 mm in low risk patients. While, no further diagnostic testing is recommended for patients with solid solitary pulmonary nodules that have remained stable over two years, or subsolid SPNs that have been stable over five years on serial CT scans.

A word of caution here. These recommendations do not apply to patients with known cancers at risk for metastases, immunocompromised patients, who are at risk of infections.

As these guidelines are Level 1 evidence, these recommendations should be followed (Evidence from a systematic review or meta-analysis of all relevant RCTs or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results).

Source

1. Keerat Kaur Sibia et al. Chapter 46. How to manage solitary pulmonary nodule (SPN). Medicine Update. 2017. http://www.apiindia.org/pdf/medicine_update_2017/mu_046.pdf.
2. Gaude GS, et al. Evaluation of solitary pulmonary nodule. J Postgrad Med. 1995;41(2):56-9.
3. MacMahon H, et al. Guidelines for management of incidental pulmonary nodules detected on CT Images: From the Fleischner Society 2017. Radiology. 2017 Jul;284(1):228-243.

Principles of communication

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Communication is the foundation of an effective doctor-patient relationship. It works both ways i.e. it has advantages for both the patient as well as the doctor. Good communication is the key to building trust, patient compliance to the prescribed treatment, patient satisfaction including better clinical outcomes. A good communicator is also a great motivator.

Poor communication has been attributed as a major contributor to litigations against doctors. Hence, good communication skills are therefore very important for the doctor.

There are certain principles of communication that should be followed for effective outcomes.

• Know your target audience. Your audience is made up of diverse group of people, with different cultural backgrounds and health literacy levels. Assess their level of awareness of your audience and tailor your message accordingly. If the level of awareness is low, talk to them at their level and gradually build up the level of your message. Do this even if this is the case with even one member of the audience so that all get the benefit of your message and nobody feels left out. Remember, “One size fits all” messages don’t work always.
• Decide your agenda. You must know what message you want to give. The health information should be field tested and should not create any panic or fear in the society. Communication should be concise and focused.
• Use multiple channels of communication. Decide how you want to deliver the message. There are several channels of communication. Print – newspapers, posters, press releases etc. Audiovideo – radio/TV interviews, press conferences etc. or internet – email, social media, SMS.
• Message should be evidence-based. Your message should be fact-based or evidence-based and not based on opinions or myths. Higher the level of evidence, lesser the chances of your message being contradicted or refuted. While giving a health statement, quote a credible source of information such as meta-analysis, randomized-controlled studies and reviews published in credible journals.
• Strike while the iron is still hot. Timing is of great importance in effective communication for desired outcomes.
• Follow the cycle of Teach, Reason, Summarize and Revise. Pre and post evaluation of the audience is important. Always revise at the end to find out what is understood.
• Word of mouth communication. Involve “community leaders” or “celebrities” people who count in the community, who are considered reliable by the people, who people look up to as role models.

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