Re: Forthcoming discussion : announcement

[Guest guest]

Dear NetRUM Members

Thanks Dr. Vijay for both the invitation and for allowing to moderate a new but very important topic " Rational use of investigations for diagnosis " . I am right now sitting in Ludhiana. Two important members of NetRUM viz Dr. Chetna Desai and Dr. Anupama are also with me in Ludhiana. I will be back tomorrow to my place of work. Since I am going to moderate the forum first time, hence I would like to introduce myself first. I work as lecturer for the last 7 years at Jawaharlal Nehru Medical College, AMU, Aligarh and working basically on pharmacovigilance and indigenous drugs. As per advice of two active members here with me, I request all members to please post their valuable views and try to invite clinicians also so that we may have their views on the above topic as well.

S. Ziaur Rahman

Aligarh

On 1/20/08, Vijay <drvijaythawani@...> wrote:

Hi,

The next discussion on NetRUM will run from 26 through 31 Jan 2008 on " Rational use of investigations for diagnosis "

which will be moderated by young Dr. S. Ziaur Rahman, Senior Lecturer from Department of Pharmacology of Jawaharlal Nehru Medical College, AMU, Aligarh.

Dr Zia is requested to kindly introduce himself in the meantime to NetRUM members and take over NetRUM WEF eve of 25th Jan 2008.

New members are guided to view the moderator in photos option and see the topics in database.

Vijay

Groupie

[Guest guest]

Dear NetRum Colleagues, The main and core objectives of rational use of investigations are: Activities are wanted to trim down the frequently quite irrational overuse of diagnostic tests Existing facts favors using mixtures of techniques to sway doctors' behavior In routine practice doctors' judgments are often exaggerated by force from patients General practitioners possibly need more assistance in putting across the justification for using, or not using, tests A patient who changed my practice Case Study was worried about three pea sized lumps on her

anterior chest wall. She had noticed them about three weeks before and felt embarrassed about coming with something so trivial. As I examined her, we chatted about the children. She was six months younger than me, with a son six days younger than my daughter (aged 8) and a daughter two years older. Blond and vivacious, was always a pleasant patient to have on the morning list. Like any intelligent parent, she had her anxieties about her children, and I knew them well. The lumps she showed me was so small and insignificant that I reassured her confidently, adding my usual advice to “Come back if things change.” Three weeks later, the day the children went back to school after Christmas, came back. The lumps had grown, and I felt a horrible sense of dread. To “save her worrying” I removed one of the lumps at the end of the morning surgery. As I did so, I found the usual chitchat drying up. The specimen I held in the forceps was unmistakably jet black. I did not need the histologist's report to tell me the diagnosis. Her future swam before me—this was very nasty, she would be dead by Easter. How could I carry on discussing books we had both enjoyed and the tribulations of

family life? In fact lived until May and died just before her 40th birthday. It was not an easy passing. She already had hepatic involvement, and the subcutaneous nodules spread over the whole of her trunk. Fortunately, before she had too many symptoms from her cerebral metastases, she was overwhelmed by sheer tumour load. At the funeral 's husband defiantly asked many of the friends and family to wear bright clothes, and their daughter played the

flute superbly to a packed church. What did I learn from , and how has this changed my practice? Eighteen months earlier, she had had a 7 mmmole on her back. Seen by another doctor, she had been asked to come back in two months. The mole disappeared, and she did not return. I had not realised that spontaneous “resolution” is a well recognised feature of primary melanoma. I still confidently reassure the owners of undisputedly benign lesions, but when there is uncertainty I take steps to reach a definitive diagnosis. With guidance from the local dermatologist, I have bought a digital camera and a dermatoscope, which I am slowly learning to use. I do not tend to review patients with doubtful lesions but instead try to come to a decision there and then whether to refer or to excise so that I do not have patients default. My experience so far is limited, and my threshold for referral is low at present while I build up my knowledge. Above all, I am constantly suspicious and would far rather be safe than sorry. From a personal point of view, seeing someone my own age dying so quickly and so inevitably made me step back and look at my own family, reminding me that time spent together is very precious. Oliver Penney general practitioner,Weobley,

Herefordshire Source: BMJ VOLUME 324 30 MARCH 2002, Page No 785 Thanks and best regards Mohammad Bashaar Ibn Sina Academy <ibnsinaacademy@...> wrote: Dear NetRUM Members Thanks Dr. Vijay for both the invitation and for allowing to moderate a new but very important topic "Rational use of investigations for diagnosis". I am right now sitting in Ludhiana. Two important members of NetRUM viz Dr. Chetna Desai and Dr. Anupama are also with me in Ludhiana. I will be back tomorrow to my place of work. Since I am going to moderate the forum first time, hence I would like to introduce myself first. I work as lecturer for the last 7 years at Jawaharlal Nehru Medical College, AMU, Aligarh and working basically on pharmacovigilance and indigenous drugs. As per advice of two active members here with me, I request all members to please post their valuable views and try to invite clinicians also so that we may have their views on the above topic as well. S. Ziaur Rahman Aligarh On 1/20/08, Vijay <drvijaythawani (DOT) co.in> wrote: Hi, The next discussion on NetRUM will run from 26 through 31 Jan 2008 on "Rational use of investigations for diagnosis" which will be moderated by young Dr. S. Ziaur Rahman, Senior Lecturer from Department of Pharmacology of Jawaharlal Nehru Medical College, AMU, Aligarh. Dr Zia is requested to kindly introduce himself in the meantime to NetRUM members and take over NetRUM WEF eve of 25th Jan 2008. New members are guided to view the moderator in photos option and see the topics in database. Vijay Groupie

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[Guest guest]

Hi Zia,

You are in august company of trained moderators of NetRUM. Please do

take valuable tips from them.

Vijay

> >

> > Hi,

> >

> > The next discussion on NetRUM will run from 26 through 31 Jan

2008 on * " Rational

> > use of investigations for diagnosis " * which will be moderated

by young *Dr.

> > S. Ziaur Rahman*, Senior Lecturer from Department of

Pharmacology of

> > Jawaharlal Nehru Medical College, AMU, Aligarh.

> >

> > Dr Zia is requested to kindly introduce himself in the meantime

to NetRUM

> > members and take over NetRUM WEF eve of 25th Jan 2008.

> >

> > New members are guided to view the moderator in photos option

and see the

> > topics in database.

> >

> > Vijay

> >

> > Groupie

> >

> >

> >

> >

> >

>