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Table of contents :
Title Page
Copyright
Dedicated to
Contents
Preface
Foreword
Part I: Inspiration
1. Journey to a Professional Career in Medicine: How to Prepare Yourself for the Medical World
2. Indian Doctors and Healthcare in India: Pathway to become a Global Leader
3. Eye for the Sky: My Journey from a Dusty Village to Being a Doctorpreneur
Part II: Flight
4. How to Make the Best of Your Time at Medical College
5. How to do a Successful Internship and Manage Your Time between Internship and NEET PG Preparation
6. Super-Specialty: How to Select the Most Appropriate Branch after MBBS
7. How to Survive Residency
8. How to Obtain a Clinical Fellowship “When a man goes through years of training to be a doctor, he will never be the same. He knows too much.” - Enid Bagnold
9. Thriving the Fellowship Duration “The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires.” - William Arthur Ward
Part III: Glide
10. Career Opportunities for Doctors in the Medical World
11. Secrets to Become the Best Doctor and Building the Best Medical Practice “The Art is long, Life is Short.” - Hippocrates
12. The Hospital Space versus Private Practice “As to diseases, make a habit of two things - to help, or at least, to do no harm.” - Hippocrates
13. Medical Professionalism and Qualities of the Best Doctor
14. How to Become the Perfect Surgeon
15. Interacting with the Patients and the Art of Patient Satisfaction
16. How to Deal with VIP Patients
17. Sharpening the Saw: Role of Medical Conferences to Upgrade the Knowledge and Skills
18. Stress Management: Work-life Balance “It is neither wealth nor splendor, but tranquility and occupation which give you happiness.” - Thomas Jefferson
19. Managing Marriage with Your Medical Profession “The family is the test of freedom; because the family is the only thing that the free man makes for himself and by himself.” - Gilbert K. Chesterton
20. Women and Medicine: How to Achieve Balance in Career and Family
21. Doctors and Time Management: How to Achieve More in Less Time
22. Ethical Obligations and Medicine “Primum non nocere—first, do no harm.” - Hippocrates
23. Law and Medical Practice
24. Webutation: How to Build Your Online Reputation “It takes many good deeds to build a good reputation, and only one bad one to lose it.” - Benjamin Franklin
25. Doctor, Heal Thyself
Part IV: Soar
26. Wealth Management for Doctors: How to do Financial Planning
27. Spirituality, Power of Faith, Prayers, and Their Role in Healthcare and Healing
28. Leadership for Doctors
29. How to Lead and Manage a Team of Doctors and Staff-Members
30. Negotiation Strategies for Doctors
31. Violence against Doctors: How to Overcome Confronting Situations
32. Multi-Professional Teamwork
33. Why Doctors are Losing Public’s Trust and How to Regain Trust in Patient-Doctor Relationship
34. International Health Careers: Opportunity for Medical Professionals
35. Global Medical Trends and Challenges: The Changing Health Environment
36. Pharmaceutical Industry and the Medical Profession
37. Future of Healthcare in India and Worldwide
38. The Final Word: Your Journey as a Medical Student to Become a Successful Doctor
Acknowledgements
References
Praise from the Medical Pioneers
About the Author
Back Cover

Citation preview

An Imprint of Maple Press Private Limited

Maple Press Private Limited sales office A 63, Sector 58, Noida 201 301, U.P., India phone +91 120 455 3581, 455 3583 email [email protected] website www.maplepress.co.in, www.maplelibrary.com Secrets of Successful Doctors: A Complete Guide to a Fulfilling Medical Career by Dr. Suresh K. Pandey Copyright © Dr. Suresh K. Pandey 2019 Dr. Suresh K. Pandey asserts the moral right to be identified as the author of this book. No reproduction without permission. ALL RIGHTS RESERVED. No part of this book may be reproduced or transmitted in any form by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, except as may be expressly permitted in writing by the publisher.

Dedicated to

All respected teachers of Advance Eye Center, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Prof. Amod Gupta, Prof. Jagat Ram, Prof. M. R. Dogra, Late Dr. J.S. Saini, Prof. S. S. Pandav, Dr. Ashok Sharma, Dr. Kanwar Mohan, Prof. Arun K. Jain, Prof. Usha Singh In the walk of every student’s life, you are the motivation. When we struggle through the darkness, you shine upon us as an eternal source of light. You are oceans of knowledge whose depth is immeasurably profound, always making learning a fun-filled, joyful, beneficial and memorable experience for us. You are the creativity behind our ideas, the cornerstones of our lives, the source of our knowledge, and the melody in our sounds.

Contents Preface Foreword Part I: Inspiration 1. Journey to a Professional Career in Medicine: How to Prepare Yourself for the Medical World 2. Indian Doctors and Healthcare in India: Pathway to become a Global Leader 3. Eye for the Sky: My Journey from a Dusty Village to Being a Doctorpreneur Part II: Flight 4. How to Make the Best of Your Time at Medical College 5. How to do a Successful Internship and Manage Your Time between Internship and NEET PG Preparation 6. Super-Specialty: How to Select the Most Appropriate Branch after MBBS 7. How to Survive Residency 8. How to Obtain a Clinical Fellowship 9. Thriving the Fellowship Duration Part III: Glide 10. Career Opportunities for Doctors in the Medical World

11. Secrets to Become the Best Doctor and Building the Best Medical Practice 12. The Hospital Space versus Private Practice 13. Medical Professionalism and Qualities of the Best Doctor 14. How to Become the Perfect Surgeon 15. Interacting with the Patients and the Art of Patient Satisfaction 16. How to Deal with VIP Patients 17. Sharpening the Saw: Role of Medical Conferences to Upgrade the Knowledge and Skills 18. Stress Management: Work-life Balance 19. Managing Marriage with Your Medical Profession 20. Women and Medicine: How to Achieve Balance in Career and Family 21. Doctors and Time Management: How to Achieve More in Less Time 22. Ethical Obligations and Medicine 23. Law and Medical Practice 24. Webutation: How to Build Your Online Reputation 25. Doctor, Heal Thyself Part IV: Soar 26. Wealth Management for Doctors: How to do Financial Planning

27. Spirituality, Power of Faith, Prayers, and Their Role in Healthcare and Healing 28. Leadership for Doctors 29. How to Lead and Manage a Team of Doctors and StaffMembers 30. Negotiation Strategies for Doctors 31. Violence against Doctors: How to Overcome Confronting Situations 32. Multi-Professional Teamwork 33. Why Doctors are Losing Public’s Trust and How to Regain Trust in Patient-Doctor Relationship 34.

International

Health

Careers:

Opportunity

for

Medical

Professionals 35. Global Medical Trends and Challenges: The Changing Health Environment 36. Pharmaceutical Industry and the Medical Profession 37. Future of Healthcare in India and Worldwide 38. The Final Word: Your Journey as a Medical Student to Become a Successful Doctor References Praise from the Medical Pioneers Acknowledgements

Preface

“May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.” - The Hippocratic Oath

What is this Book About? Secrets of Successful Doctors: A Complete Guide to a Fulfilling Medical Career is an attempt to offer readers in-depth insight into the professional world of doctors and the medical career. This book is written with the intention of providing complete guidance to medical professionals, including students in medical colleges, medical graduates, residents, and young doctors on how to get through the challenges they might face at various stages of their medical career. Considering the struggles that I faced as a medical student, I felt essential to contribute my inputs in making the process easier for those who have just stepped into this eternally noble profession. A vast majority of medical students do not get the right counseling during and after medical college, which ultimately leads them to

having a tough time and some end up taking the wrong decisions. This impacts their entire professional work and personal life. This book is a small effort to make a difference to the life of young doctors who want to pursue a successful career in medicine. Studying in a medical college is a long and challenging journey. From the NEET (National Eligibility-cum-Entrance Test, the medical college entry test) through the first year MBBS professional exams and third-year clinical rotations to the final year viva, it is a bumpy roller-coaster ride. Life after medical college is no piece of cake either. It continues to get tougher at every stage. Preparing for Pre-PG Examination, getting into the right residency program, and choosing the right specialty or sub-specialty are the decisions and processes that lay the foundation of the advanced medical career ahead. Medical graduates may not get the right advice, which results in poor decision-making. Consequently, doctors suffer from dissatisfaction, burnout, and slackened professional career growth. This book endeavors to make this entire process smoother and more efficient for medical graduates. Why Have I Written this Book? Time has changed considerably since I joined medical college 30 years ago, at the age of 17. Back then, there were few coaching centers, and the competition to become a doctor was tough but not fierce. We relied on our teachers, our notes, and available textbooks to prepare for our medical entrance examination.

At present, excellent books, and educational resources, as well as coaching centers are available to help the medical aspirants. We are living in a digital era, and with the widespread availability of high-tech smartphones and with high-speed 4G Internet connections, most of the information is provided by “Dr. Google” in fractions of seconds. The ease of availability of smartphone and widespread use of social media (WhatsApp, Facebook, Instagram, etc.) consume significant amount of time allowing lesser time to read books. Nonetheless, books have their own charm and significance and remain a source of inspiration for everyone. While working as an eye doctor in Kota (Rajasthan), I came in contact with thousands of medical aspirants who were visiting Kota to prepare for the NEET (The National Eligibility-cum-Entrance Test, the medical college entry test). I was motivated to write this book after talking to these students, and, their parents. Even several patients who visited us for eye checkups have requested us to share the secrets to becoming a successful doctor. My wife, Dr. Vidushi Sharma, and I have also had the opportunity to visit Kota’s famous coaching classes and have interacted with several of these students. Due to the excellent results provided by these institutes, Kota attracts thousands of students who come to this city for fulfilling their dream of becoming a doctor. As a result, every year more than 100,000 students come to Kota to enroll themselves in famous coaching institutes such as Allen, Resonance, Bansal, Career Point, Sarvottam, Motion, Btrix, Rao Academy, Achiever Institute, etc. In the last 13 years while working as a doctor in Kota, I have come across not only students but their parents and relatives as well, who

sought me out for my opinions, and tips and suggestions to get selected in NEET. These parents told us specifically that their sons or daughters would like to become successful doctors like us and asked us to share some advice on the process. This book is my attempt at guiding young medical students to utilize their time in medical college in most effective manner. It is an attempt to tell such medical students to learn to deal with patients in a compassionate way. Throughout this book, I shall tell how to achieve work-life balance while studying in medical college, and how to deal with the pressure of study, patient-care and workload of more than 70 hours per week. Why is this Book Unique? Divided into four major parts - Inspiration, Soar, Flight, and Glide this book addresses the journey you will take as a medical student to become a successful doctor. Starting from the first year MBBS at the medical college, it outlines the challenges faced by medical students in adjusting to their new life and getting into the right residency programs successfully. The first part of the book consists of success stories of a few famous doctors to inspire you to become the best in the medical profession. The second part of the book offers an insight into the core elements that medical graduates have to encounter as they enter into the professional world of medicine. Focusing on ethical obligations to legislative settings, the third part will give you a glimpse of medical entrepreneurship, and the challenges that

doctors encounter while working in a hospital setting and running a private medical practice. The final part entails a detailed analysis of the challenges that the medical profession is faces globally. This includes the time management and leadership mantras for young doctors, global health opportunities, changed managerial and leadership roles, the consistently changing medical trends across the world, and increasing incidences of violence against doctors. To lead a promising and successful medical career, you have to try hard and learn from your mistakes. No challenge is big enough if you believe in yourself and choose to face your fears with courage. Choosing to become a successful doctor is certainly a bold decision. I hope this book will augment the decision you have made for yourself. My Long-term Vision through this Book- Can India Become a Global Leader in Healthcare? India

is

well-known

for

its

talented

doctors,

its

capable

pharmaceutical/medical device industry as well as highly dedicated nurses and medical technicians. Our country has great potential to become a global leader in the field of healthcare and medical tourism. A total of 529 medical colleges of India, produce 70,878 allopathic medical graduates every year, a number among the highest in the world. The need of the hour is that every medical student, doctor and medical professional should recognize their potential, and work at best of his/her capability to contribute, so our country can move on the pathway of becoming one of the best in the world of medicine and healthcare. The role of government, health

policymakers, health planners, and key opinion leaders is very important to overcome challenges and to create the best possible opportunities for medical professionals. I hope the book serves as a source of motivation and inspiration to each and every aspiring medical student/professional and helps them through their struggles to establish successful medical careers. While writing this book, I have endeavored to keep in mind every aspect of medical life and the challenges that I faced along the way. Hopefully, you will enjoy going through Secrets of Successful Doctors: A Complete Guide to a Fulfilling Medical Career. I will sincerely appreciate your suggestions to improve the contents in the next edition.

- Dr. Suresh K. Pandey

Foreword I

Professor Frank Billson, AO MBBS, DMedSc, FRANZCO, FRACS, FRCS, FACS University of Sydney, Sydney, Australia Patient-physician relationship plays a major role in the process of healing. The relationship between doctors and their patients has received philosophical, sociological, and literary attention since the time of Hippocrates, and is also the subject of several articles, monographs, chapters, and books in the modern medical literature. As doctors, we must never betray the trust that patients have in us and should always deal honestly with them. Secrets of Successful Doctors: A Complete Guide to a Fulfilling Medical Career is an excellent book that offers the readers an indepth insight to the professional world of doctors and medical career. This book is written with the intent to provide a complete guidance to all medical professionals on how to get through the challenges they might face during various stages in their medical career. This book is divided into four parts and each part is deserving of special attention and careful study by the medical students and doctors because of

the valuable advice and wisdom each of them contains. The author, Dr. Suresh K. Pandey, has also discussed several important issues related to art and science of medical practice, changing trends of medical practice, doctor-patient relationship, violence against doctors and tips to heal the healers. I congratulate Dr. Suresh K. Pandey for bringing out the pertinent book. I am sure that the medical students, young doctors and medical professionals will be benefitted by this book tremendously. - Professor Frank Billson, AO MBBS, DMedSc, FRANZCO, FRACS, FRCS, FACS University of Sydney, Sydney, Australia

II

Padma Shri Professor Jagat Ram Director, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India It gives me immense pleasure to read the book “Secrets of Successful Doctors: A Complete Guide to a Fulfilling Medical Career”, written by my student who trained under me in Ophthalmology, Dr. Suresh K. Pandey. In this book, the author describe success mantras for medical students to become a successful doctor. Dr. Pandey also discussed leadership mantras for doctors,

tips

to

strengthen

doctor-patient

relationship,

time

management tips and strategies to prevent violence against doctors. Dr. Suresh K. Pandey shares his empowering journey from a poverty-stricken background which began in a village, to medical training from India and overseas, and lessons of entrepreneurship essential for establishing and running a successful medical practice, together with his colleague and life-partner, Dr. Vidushi Sharma. This treatise aims to inspire, motivate and uplift medical aspirants, medical students, young doctors and practicing clinicians alike. The book also gives practical tips on overcoming every obstacle and further aims to help young doctors who are starting up a medical

entrepreneurship. I extend my heartiest congratulations to the author, Dr. Suresh K. Pandey, for sharing these most valuable pearls of wisdom with medical students and young doctors. I am sure medical aspirants, medical students and young doctors, and medical professionals will find a wealth of information and wisdom in this book. - Padma Shri Professor Jagat Ram Director, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

III

Padma Bhushan Dr. Devi Prasad Shetty Chairman, Narayana Health, Bengaluru, India The healthcare industry is currently undergoing major changes in India and there are many positives in India’s favor. Indians are born healers. The younger generation is very studious. India has more than 529 medical colleges and produces the largest number of doctors, nurses, and medical technicians. We have a very mature pharmaceutical industry. India has all it takes to emerge as a major healthcare provider for the world. Doctors serve as the backbone of any society. They ensure that people are healthy and strong so that they can make a meaningful contribution to the progress of the country. Doctors, are a major roleplayers in the building of the economy, spreading a positive image of the country, and improving the life-quality of the nation. They carry a huge responsibility toward their patients. From the right diagnosis to effective after care planning, doctors are responsible for the optimum functioning of the entire country. The healthier the people are, the better the institutional operations will be.

My congratulations to Dr. Suresh K. Pandey for this wonderful book Secrets of Successful Doctors: A Complete Guide to a Fulfilling Medical Career. It is a crucial subject to understand that the healthcare framework is evolving globally. The demands of the medical profession and the roles of doctors and patients are changing with the changing trends in medical practice. The entire field is transforming with the modernization in technology and extensive research being conducted in various medical fields. I am positive that this book will become an inspiration for medical aspirants and young doctors who are preparing for medical entrance examination or studying the medical curriculum. - Padma Bhushan Dr. Devi Prasad Shetty Chairman, Narayana Health, Bengaluru, India

IV

Padma Bhushan Dr. Naresh Trehan CMD, Medanta, The Medicity, Gurgaon, India When it comes to revenue and employment in India, healthcare has indeed become one of the largest sectors. Maximized coverage, diverse services, and increased expenditure by the public and private sector have allowed it to grow immensely. India has the largest pool of doctors and paramedics in South Asia and the worldclass technology is complemented by skilled world-class doctors and medical personnel. The public holds doctors to a higher moral standard than other people, and the expectations from doctors are very high, as patients are often disturbed and look up to doctors to provide them not only with the cure but compassionate care as well as comfort. Secrets of Successful Doctors: A Complete Guide to a Fulfilling Medical Career endeavors to offer an in-depth analysis of the hurdles that are faced by medical students, young and practicing doctors at various stages of their medical career and how they can effectively make through it.

I would like to congratulate Dr. Suresh K. Pandey for his excellent treatise on this subject. The author has discussed the doctor-patient relationship, violence against doctors, stress, and burnout among medical professionals and several other challenges faced by the medical students, young doctors while they work and has offered solutions. Despite all the hurdles, the medical profession is still considered as the noblest profession by the young generation and the society at large. The young doctors of India have bright prospects as the number of medical aspirants is increasing tremendously and the Indian healthcare industry has a promising future. The numbers of seats in various medical schools are being increased and many new medical colleges are also being set up. I am sure this book will serve as a guiding light to motivate and inspire young medical aspirants and struggling doctors through their long struggle to become successful doctors. - Padma Bhushan Dr. Naresh Trehan CMD, Medanta, The Medicity, Gurgaon, India

V

Padma Shri Professor Randeep Guleria Director, All India Institute of Medical Sciences (AIIMS) New Delhi, India Doctors play a significant role to ensure the welfare of our society. They make a massive difference in the lives of their patients by reducing their pain, helping them heal from illness and disease faster, and even saving their lives. They can truly transform the life of an individual with their care and treatment. Their empathy and compassion for helping others is what makes them an integral part of society. The way they listen to their patients, understand them, and offer the right treatment builds trust and confidence of the patients toward their doctors. This book, Secrets of Successful Doctors: A Complete Guide to a Fulfilling Medical Career, is an excellent and timely text written by Dr. Suresh K Pandey. Dr. Pandey has touched on several aspects to enhance the public image of doctors including doctor-patient trust and relationship. This doctor-patient bond is so important that hospitals and medical institutions should train their staff, especially new doctors, to communicate and interact with their patients more

effectively, and truly understand their patients to build a good rapport. Healthcare needs to be more compassionate and emphatic. This treatise will be an excellent resource for medical aspirants, medical students, new doctors and professional healthcare workers alike. Not only does it highlight what it takes to start a medical practice, i.e. medical entrepreneurship, but it also focuses on the importance of compassion and better communication. - Padma Shri Professor Randeep Guleria, Director, All India Institute of Medical Sciences (AIIMS) New Delhi, India

Part I: Inspiration

1. Journey to a Professional Career in Medicine: How to Prepare Yourself for the Medical World

“There is no career nobler than that of the physician. The progress and welfare of society is more intimately bound with the prevailing tone and influence of the medical profession that with the status of any other class...” - Elizabeth Blackwell, MD, 1821-1910 Dear Medical Student and Doctor-in-training, Congratulations on starting your journey to become a successful medical professional! Medicine is the noblest profession in the world and you are about to embark upon an exciting life-altering journey. You are about to join an elite group of people who will now be your peers going forward. To become a successful doctor, a medical student or a doctor-intraining like yourself has to go through many difficulties and challenges. You have to study day and night to achieve your daily targets and assignments. Be it the first year MBBS at the medical college, deciding your speciality, or choosing a clinical medical practice, you are bound to stagger at some stage. This is all but part

of the professional medical career that you have chosen for yourself. Besides the personal choices you make, as a clinician, you are responsible for those patients who come to you with medical needs and trust you to improve their life quality. This certainly puts tremendous pressure on you to meet the expectations of your patients and the organization you are associated with. Being a doctor is a huge responsibility, and unfortunately, shouldering that responsibility will sometimes take a personal toll on you. But it is worth it all, because you have the chance every day to make a positive difference in the lives of your patients and their families. You can develop healthy doctor-patient relationships and provide compassionate care to your patients. Try not to let the tough times burn you out or turn you off. As I hope you already know, not everyone has had the advantages in life that you have. Some people just have plain bad luck. Considering the nature of your profession, there are several stress points that can impact you negatively. You must learn to take these stressors positively, and that can boost your performance professionally and improve the quality of your own life. Becoming a doctor and part of the medical profession has never been perceived as easy. It is complicated, intimidating, and exhausting. You have to learn to manage it effectively, if you hope to excel. In the present era, medicine has become high-tech, but it all really harkens back to a basic principle: Do no harm to your patients. Do not conduct any tests or procedures if they are not needed. Do not experiment on your patients. Do not be callous or rude to your patients, because this can harm their spirit. When medical

technology fails to give us the tools needed to provide the cure that patients are seeking, what you have left to give is your time. The most important thing you can do is pledge to accompany your patients on their journeys, wherever it may lead them, even if it is to their grave. Do not be afraid. You can handle it. It takes time and practice, but you will grow into it. You are a professional, and your major assets are your medical knowledge and skills. You need to keep building on these if you want to stay successful. The Japanese call this kaizen, which means constant improvement. Whether you choose to pursue private medical practice or get associated with a government hospital or work with the trust hospital or corporate medical organization, you have to hold on to the elements of professionalism, ethics, and code of practice. How you interact with patients and maintain professional relationships within the hospital space determines your zeal to maintain a professional stance. As a medical professional, your priority should always be the patient, but you must overlook your personal and family life in the process. It is important that you maintain a good work-life balance and address your health, and personal and social needs effectually. This is mandatory for your optimum performance. Remember that you have to heal yourself before you can heal others. Considering the contemporary setting of the healthcare industry, you are destined to encounter several challenges on the go. From new research results achieved on daily basis to advanced medical technologies, and frequently changing medical laws and the

transforming attitude of patients toward health and healthcare professionals, it requires a certain amount of resilience and determination to sail through the challenges. As doctors, if the challenges have made us learn anything it is to stick through with determination and perseverance. Nothing can make you falter but yourself. No challenge is big enough if you choose to face it with all your abilities. To keep up with the contemporary challenges, it is crucial that you modify yourself with the growing needs and changes. Make yourself adaptable to the change. Upgrade yourself with time and stay abreast with the progression. This is all you need to make your mark. You should aim to become a happy and successful doctor. The following is the ABC of a good doctor as beautifully elaborated by Malvinder S. Parmar and published alongside the research of Rizo, Jadad and Enkin in BMJ 2002. A: attentive (to patient’s needs), analytical (of self), authoritative, accommodating, adviser, approachable, assuring B: balanced, believer, bold (yet soft), brave C: caring, concerned, competent, compassionate, confident, creative, communicative, calm, comforter, conscientious, compliant, cooperative, cultivated D: detective (a good doctor is like a good detective), a good discussion partner, decisive, delicate (do not play 'God') E: ethical, empathy, effective, efficient, enduring, energetic, enthusiastic

F: friendly, faithful to patients, flexible G: a 'good person,' gracious H: a 'human being,' honest, humorous, humanistic, humble, hopeful I: intellectual, investigative, impartial, informative J: wise in judgment, jovial, just K: knowledgeable, kind L: learner, good listener, loyal M: mature, modest N: noble, nurturing O: open-minded, open-hearted, optimistic, objective, observant P:

professional,

passionate,

patient,

positive,

persuasive,

philosopher Q: qualified, questions self (thoughts, beliefs, decisions, and actions) R: realistic, respectful (of autonomy), responsible, reliever (of pain and anxiety), reassuring S: sensitive, selfless, scholarly, skilful, speaker, sympathetic T: trustworthy, a great thinker (especially lateral thinking), teacher, thorough, thoughtful U: understanding, unequivocal, up to date (with literature) V: vigilant, veracious

W: warm, wise, watchful, willingness to listen, learn, and experiment Y: yearning, yielding Z: zestful. Wishing you the very best, with much admiration for your courage in choosing medical career, to become a happy and successful doctor. Dr. Suresh K. Pandey

2. Indian Doctors and Healthcare in India: Pathway to become a Global Leader

“We have to really educate ourselves in a way about who we are, what our real identity is.” - Dr. Deepak Chopra Inspired by great success in the field of Information Technology (IT), India has all the ingredients to become a global leader in the medical field and can become one of the top destinations in medical tourism. A total of 529 medical colleges of India, produce 70,878 allopathic medical graduates every year, a number among the highest in the world. India is also very well known for its pharmaceutical/medical device industry as well as highly qualified doctors, surgeons, nurses and medical technicians. Indian Doctors - Potential to Become one of the Best in the World To understand why Indian doctors have potential to become one of the best in the world, you should know their background. The ambition of vast majority of school kid in India is to become a doctor. Hundreds of thousands of students apply for admission to Medical

Colleges through NEET (National Eligibility-cum-Entrance Test). At present the number of NEET aspirants is increasing constantly (Total 12,69,922 in 2018 to 15,19,375 in 2019). Because of this rush, NEET is tough and only the top rankers, or only the brightest of the brightest, get admission in medical colleges. So from the start, the raw material for making an Indian doctor is the best. There are about 529 medical colleges in India, strictly controlled by the Government, to keep a good standard of education. Medical Institutes like All India Institutes of Medical Sciences (AIIMS), Post Graduate Institute of Medical Education and Research (PGIMER), provide world-class teaching facility at a fraction of cost compared to the western world. These premier institutes have a huge number of patients, because these are mostly government-run hospitals and treatment is highly discounted for our population. Thus, there is a tremendous number of patients in these hospitals, and the doctors in training get a lot of hands-on clinical experience. The old saying 'practice makes perfect' is so true in the case of medical trainee of India. India with more than a billion people, provides ample practice to the physicians and surgeons. Few decades ago, medical institution, corporate hospitals providing cutting-edge technology were not established in India leading to migration of many qualified medical professionals to countries like USA, UK and Europe for better job prospects and life style. Many of these doctors (of Indian origin) played a key role in the world of medicine in western countries. Serving a successful service in the west, some of these physicians and surgeons have returned to India and have set up top-class hospitals fulfilling the international

standards with most modern medical equipments and patient-care facilities. Examples of a few inspiring global medical leaders from India include Dr. Devi Prasad Shetty, Dr. Naresh Trehan, Dr. Pratap C. Reddy, Dr. G. Venkataswamy, Dr. Gullapalli N. Rao, Dr. S. S. Badrinath and many others. Inspiring Stories of Selected Doyens of Medical Field (Visualize and Aspire to Become like One of Them!) Visualization is of the most important tools for motivation in any field, and that includes the medical profession. If you look beyond the medical field, there are several examples to understand the significance of visualization. The boxing legend, Mohammad Ali, for instance, emphasized on how important seeing yourself as victorious is before the actual fight. Jim Carrey, in his days of struggling in the acting career, used to see himself as the most top-class actor in the world. Michael Jordan is another example of having excellent visualization capabilities. He took the last shot mentally before taking it in real life. This is all about using positive visualization to your benefit and crediting it as your success strategy. The following are brief stories of a few highly respected medical professionals, who have contributed a lot in their field and made India proud by their achievements. The remarkable journeys of world-renowned doctors will inspire and motivate you during your own journey as a medical professional. You can also visualize that you are a successful medical professional and learn from these medical pioneers.

Bharat Ratna-Late Dr. Bidhan C. Roy

Born on July 1, 1882, Bidhan Chandra Roy was a renowned physician,

educationalist,

philanthropist,

freedom-fighter

and

politician. He served as the Chief Minister of West Bengal from 1948 to 1962. Considered as the founder of modern West Bengal, Dr. Roy is one of the few doctors in the history of India to obtain the degrees of FRCP and MRCP simultaneously from St. Bartholomew’s Hospital, London, England. The long career span of Dr. Roy began with working in the Provincial Health Service before going to England. He worked as a doctor as well as a nurse whenever the time called for it. He also carried out a private practice at a nominal fee. After returning from England, Dr. Roy joined the Calcutta Medical College and subsequently the Campbell Medical College and the Carmichael Medical College (currently knowns as R. G. Kar Medical College and Hospital, Kolkata) as a lecturer. He made tremendous contributions to raising health awareness among the common people. He imparted medical education and founded several specialized hospitals and healthcare centers across the state to support his

initiative. Chittaranjan Seva Sadan, established by Dr. Roy in 1926, was founded especially for women and children. Dr. Roy played an immense role in encouraging women to visit hospitals for their treatment. In 1928, he played an instrumental role in establishing the Indian Medical Association (IMA) and was nominated as the National President of the association for two terms. When associated with Calcutta Corporation (1930-31 and 1933), he encouraged the Corporation to make extensive progress in the public sectors of education, medical facilities and services, and infrastructure. The Medical Council of India was also an initiative of Dr. B. C. Roy. For his substantial contribution to the medical field of India, Dr. Roy, was awarded the country’s highest civilian award, the Bharat Ratna, on February 4, 1961.

Doctorpreneur, Dr. Naresh Trehan

Born on August 12, 1946, Dr. Naresh Trehan is a renowned and celebrated cardiovascular and cardiothoracic surgeon of India. Dr. Trehan, despite having a successful medical career in the United States, returned to India in 1988 with the ambition of serving in the medical field back home. Since then, he has achieved phenomenal success with respect to the quality of treatment, training of doctors, and medical research. Having studied from King George Medical College, Lucknow, India, Dr. Trehan went to the New York University Medical Center Manhattan, USA in 1971. Upon his return in 1988, he founded the Escorts Heart Institute and Research Center in Delhi. Dr. Trehan is the Founder Chairman of Medanta – The MediCity at Gurgaon, Haryana, India. This is one of the largest multispecialty hospitals in India. The project of MediCity is spread across 43 acres and intends to combine traditional medicines with holistic medical therapies. For his splendid achievements in the field of healthcare, Dr. Trehan has been awarded significant honors. He was presented the Padma Shri Award in 1991 for his work in the field of cardiac surgery. In 2001, he was honored with the Padma Bhushan Award by the

President of India for his distinguished service in the Indian medical field. In 2002, Dr. Trehan was awarded the Dr. B. C. Roy Award from the Medical Council of India for his marvelous contribution. Dr. Trehan earned Honorary Fellowship from the Royal Australasian College of Surgeons in 2002. He was given the title of EY (Entrepreneur of the Year) in 2012 for his setup of Medanta.

Henry Ford of Heart Surgery, Dr. Devi P. Shetty

Born in Dakshina Kannada, Karnataka, on May 8, 1953, Dr. Devi P. Shetty is a famous cardiac surgeon and philanthropist of India. Known for conducting over 15,000 heart operations till date, Dr. Shetty is an inspiration for numerous young aspirants for the medical profession. He pursued his medical education and then postgraduate study from Kasturba Medical College, Mangalore. Following this, he went to the United Kingdom, for training in cardiac surgery at Guy’s Hospital, UK. Dr. Shetty’s utmost intention was to make healthcare affordable and within reach for the people in India. This determination came from the situation he had witnessed back home where poor people would die only because they were not able to afford treatment. This dedication compelled Dr. Shetty to establish the Manipal Heart Foundation at Manipal Hospital in Bengaluru. In 2001, he laid the foundation of a multi-specialty hospital, Narayana Hrudayalaya in Bommasandra, Bengaluru. He also established the Rabindranath Tagore International Institute of Cardiac Sciences in Kolkata with the intention of making healthcare accessible and affordable for all. Dr.

Shetty is known for using innovation in running his hospitals. He has managed to bring down the operating costs by using simple yet highly efficient measures. Given his experience, the Government of Gujarat has requested Dr. Shetty’s service to set up a 5000-bed hospital in Ahmedabad. Dr. Shetty also holds the honor of completing heart surgeries at one-tenth of the cost as compared to the heart institutes in the United States of America. This has earned him the title of the Henry Ford of Heart Surgery.

The Medical Entrepreneur, Dr. Prathap C. Reddy

A medical entrepreneur and cardiologist from Aragonda (Chittoor, Andhra Pradesh), Prathap Chandra Reddy was born on February 5, 1933. Known for establishing the first corporate chain of hospitals in India, the Apollo Hospitals, Dr. Reddy is considered to be the person who revolutionized the healthcare system of the country. Having international medical experience, Dr. Reddy worked at the Missouri State Hospital in the United States of America. He led multiple research programs before returning to India with the mission of providing high-quality healthcare in the country. In 1983, Dr. Reddy established the first Apollo Hospital in Chennai. Around the same time, he also started Indian Hospitals Corporation, India’s first hospital consultancy body. Dr. Reddy has played an integral role in bringing top Indian doctors, working abroad as expatriates in UK and USA, back to India. The Apollo Hospitals chain is recognized as one of the finest healthcare providing organizations. Dr. Reddy is proactive in trying to amend government regulations pertaining to medical trends in India and has helped to ensure that the government is taking a more liberal view toward aspects like organ transplantation. Dr. Reddy was awarded the Padma Bhushan

in 1991 and the Padma Vibhushan in 2010 for his outstanding performance and service in the field of healthcare in India. He was ranked 48th in the India Today’s list of 50 most powerful people in 2017.

Elimination of Avoidable Blindness by Emulating the Service Efficiency of McDonald’s Fast Food: Late Dr. Govindappa Venkataswamy

Popularly known as Dr. V, Govindappa Venkataswamy was born on October 1, 1918, and died on July 7, 2006. A pioneer in the field of ophthalmology, Dr. Venkataswamy dedicated his entire life in his mission of eliminating avoidable blindness for the masses. He was the founder of the enigmatic Aravind Eye Hospitals and strived to provide high-quality and affordable ophthalmologic treatment. Dr. Venkataswamy’s Aravind Eye Care System, Madurai (Tamil Nadu) is a

registered

non-profit

organization

that

is

acknowledged

internationally. Till date, it has catered to over 55 million patients and performed 6.8 million eye surgeries. The service delivery model developed and applied by Dr. Venkataswamy is widely appreciated for its scale and selfsustainability. The Aravind Model of Dr. Venkataswamy was even made a subject of Harvard Business Case Study in 1993. Dr. Venkataswamy, despite being crippled by rheumatoid arthritis at the raw age of 30, performed over 100,000 eye surgeries personally. He was the mastermind behind the concept of eye camps

instigated by the Indian Government. In 1992, he co-founded Aurolab with his partners with the aim of making it an internationallycertified manufacturing facility for the production of an intraocular lens (IOL) at a reasonable price. Dr. Venkataswamy led the Lions Aravind Institute for Community Ophthalmology in 1996 for training and counseling of administrators to replicate the Aravind Model in hospitals across the country and internationally. In 1973, the Government of India awarded Dr. Venkataswamy a Padma Shri for his remarkable service in the field of eye-care.

The Visionary, Dr. Sengamedu S. Badrinath

Sengamedu Srinivasa Badrinath was born in Chennai, India on February 24, 1940. He is the founder and chairman of Sankara Nethralaya, Chennai, which is one of the leading eye hospitals of India. After graduating from the Madras Medical College, Chennai, in 1963, Dr. Badrinath completed his internship and residency at the Glasslands Hospital, New York. He went to the New York University Medical College to pursue Basic Sciences in Ophthalmology. In 1969, Dr. Badrinath became a Fellow of the Royal College of Surgeons of Canada. Later on, in 1970, he became a Diplomate of the American Board of Ophthalmology. Dr. Badrinath returned to India in 1970 and served at the Voluntary Health Services before setting up his private practice in ophthalmology and vitreo-retinal surgery at the H.M. Hospital, and subsequently at the Vijaya Hospital, Chennai. He has over 60 peer-reviewed publications to his credit. In 1978, Dr. Badrinath founded the Medical and Vision Research

Foundations

in

Chennai

along

with

a

group

of

philanthropists. In 1983, Dr. Badrinath was awarded the Padma Shri by the Government of India, and then Padma Bhushan in 1999. He was

presented the Dr. B. C. Roy National Award in 1991. The Hall of Fame Award in 2005, the Ernst and Young Entrepreneur of the Year Award (2005), and the Lifetime Achievement Award by ICFAI in 2005 are some of the much reputed accolades awarded to Dr. Badrinath for his outstanding service in the medical field.

The Power of Vision, Dr. Gullapalli N. Rao

Born in Chodavaram, Krishna district, Andhra Pradesh, Dr. Gullapalli Nageswara Rao is a world-renowned ophthalmologist and founder of the L. V. Prasad Eye Institute at Hyderabad. Dr. Rao completed his graduation from the Guntur Medical College, Andhra Pradesh. For his post-graduate study and residency training in ophthalmology, he joined the All India Institute for Medical Sciences (AIIMS), New Delhi. Currently serving as the chairman of Academia Ophthalmological Internationalis, Dr. Rao has gained significant popularity in the field of medical research and has several research papers to his credit. He is a fellow of the National Academy of Medical Sciences, India. After leading a successful career in USA, Dr. Rao returned to India in 1987 to establish the L. V. Prasad Eye Institute at Hyderabad. He has over 300 publications to date. His specialization areas include diseases of the cornea, eye-banking, corneal transplantation, and community eye health. He also has expertise in eye-care policy and planning. Honored with a degree of Doctor of Science from the University of Melbourne, Dr. Rao has received several awards and accolades

from

the

medical

institutions.

The

American

Academy

of

Ophthalmology presented him the International Blindness Prevention Award, and the Association of Eye Bank of Asia awarded him the AEBA Award for his contribution to the field of ophthalmology. The Government of India awarded the Padma Shri to Dr. Rao for his remarkable achievements. He was selected in 2017 to the Ophthalmology Hall of Fame instituted by the American Society of Cataract and Refractive Surgery (ASCRS).

World’s Youngest Doctor, Dr. Balamurali Ambati

Born on 29 July 1977, in Vellore, Tamil Nadu, Balamurli Ambati holds the title of the world’s youngest doctor in the Guinness Book of World Records. An ophthalmologist, educationist, and researcher by profession, Dr. Ambati graduated from Mount Sinai School of Medicine, USA, in 1995, at the young age of 17 years. After his residency in ophthalmology at Harvard University, Dr. Ambati worked fervently on strategies to reverse corneal angiogenesis. He did his fellowship in cornea and refractive surgery at the Duke University in 2002 and became a faculty member of the Medical College of Georgia to practice clinical ophthalmology and to pursue research in the field of corneal angiogenesis. Dr. Ambati is associated with the ORBIS Flying Eye Hospital, which enables him to travel to underprivileged countries and practice and teach ophthalmic surgeries. He received the 2010 Utah Innovation

Award

for

his

outstanding

contribution

to

the

advancement of the ophthalmic devices and research. Dr. Ambati was presented the Raja Lakshmi Award in 1995 by the Sri Raja Lakshmi Foundation, Chennai. In 2014, the ARVO Foundation

presented him with the Ludwig von Sallmann Clinician-Scientist Award. He also won the Troutman-Véronneau Prize from the PanAmerican Association of Ophthalmology in 2013. Indian Doctors as Global Leaders: How can Indian Doctors Improve their Standing in the International Fraternity? As mentioned in the beginning of the chapter, we Indians have made a commendable mark on the international ground in the medical field. Our organizations and establishments are gaining international acclamations and initiatives being endorsed worldwide. While this is a positive sign, we still need to do a lot more to ensure that a positive image of the country is portrayed in the international medical community. India’s image may be overshadowed by national dilemmas such as poverty and overpopulation, but we, the medical professionals, can indeed serve as the ambassadors of positivity and a bright side of our country. Leadership plays a tremendous role in this particular regime. If we show a more positive and contributive stance toward not just our practice and career interest but toward the national health interest, too, and integrate it in our overall objectives, we shall be able to combat the health issues faced across the country. We need to embrace the role of leadership in all aspects and modify our stance accordingly to improve our standing in the global community of medical leaders. Here are few ways how we can transform ourselves in the best possible manner and attain success.

1. Participation in International Conferences and Publication in Medical Journals Attending medical conferences provide you a unique way of networking and instigating innovation. It help propagate relevant and newly-discovered information to a larger audience. Publication in peer-reviewed international medical journals will help you to enhance image of Indian doctors among international medical fraternity. Always document unique case by taking clinical photo and present them in the national and intentional conferences. 2. Be Open to Learning New Things The first thing you need to realize is that you are never going to know everything there is to know about your field, and that is okay! Medicine is a field that is always evolving and there are always new ways to practice that are being introduced. As a practitioner, you should never be content with the amount of knowledge that you have. You should always be looking into new research being done and the impact that it is having on the medical community. 3. Never Let Go of your Discipline and Passion Discipline and passion are two characteristics that might seem to be at odds with one another if looked at logically. However, in the field of medicine, it is only a hybrid of these two traits that will set you aside from everyone else practicing. Set high standards for yourself and show commitment to achieving those standards each and every single day.

Being respected as a global medical leader means that you need to put in the same amount of dedication and effort every single day. As a doctor, your work should speak for itself. Your brilliance should shine through your innovations and the dedication that you show towards your patients and your practice. Consistency is the key to achieving your goals and if you constantly keep on innovating and sharing with medical fraternity. Applaud others for the work that they are doing in your field but also be keenly aware of your own accomplishments. Stick to the standards that you have set for yourself and do not let anyone sway you! 4. Build a Strong Team and Delegate Important Tasks The next thing on the list is the teamwork. One cannot expect to achieve anything big unless they have a strong team to back them up. Our performance is hugely dependent on the performance of the team we have. If members are working diligently and competently, it would ultimately reflect in our performance. To become successful, we need to back our health practices and organizations with excellent team- coordination, consistent flow of information, and excessive discipline across the team. Build a strong and capable team and delegate all important non-clinical work to them. The successful people we read about today and take inspiration from acquired success not because they did everything singlehandedly, but because they had strong supporting teams, big visions, strict values, and organizing and managing skills. If we choose to take a similar stance, we will be able to become the ultimate best at what we do.

Healthcare System in India: How to Overcome Challenges and Improve the Delivery Being a predominantly rural and agrarian economy, one cannot expect the country to reach its optimum potential unless Govt. take care of the rural regions and rural population. As India is moving toward rapid urbanization, there are over 70 percent (about 1.2 billion) people who still reside in the rural areas and there are almost 400 million people in the country who are surviving on less than US $1.25 (Rs. 100) per day. Approximately 44% of the children are malnourished and infant and mother mortality rate is unacceptably high. With such alarming statistics, Govt. has to devise an action plan that improves and strengthens our existing healthcare delivery system with the specific focus on the rural regions and impoverished population. The Indian healthcare sector will be able to flourish only if Govt. acknowledges challenges head-on and make concerted efforts to overcome them. Here are some ways through which, the challenges of healthcare system of India can be addressed: 1. Smart Use of Information Technology Information technology (IT) has taken over the world in almost every manner. There is barely any field that is functioning without the integration of IT. It has become a necessary element in ensuring the efficiency of the organizations and respective frameworks. Like the most other sectors, IT has been integrated into the medical field as well and is continuing to prove as a highly productive initiative. While several potentials of IT in healthcare are recognized and well-

implemented, there are still substantial areas where IT can be used. With the integration of smart technology, we can promote, regulate, and handle several social-sector schemes on a large scale. This is especially beneficial for the rural regions prevailing in the remote areas. Using smart technology, the health organizations in the major cities can stay connected to the remote districts and offer them health support and guidance through means such as telemedicine. Several initiatives have been taken by the government in this context, namely the Swastha Bharat Mobile application for information on diseases, symptoms, treatment, health alerts, and tips; ANMOL-ANM online tablet application for health workers, eRaktKosh (a blood-bank management information system) and India Fights Dengue. If such initiatives are successful in producing the intended outcomes, the day is not far when India will have one of the best healthcare systems in the world. 2. Improved Health Insurance India lacks substantially in the area of health insurance. With just 32% contribution made in the health insurance and that, too, to only 24% of the country’s population, we need to address this issue at the earliest possible. The system can be strengthened if healthcare services are equally provided across the country. Considering the abundance of rural population and areas, IT can be integrated into this particular regime as well where the beneficiaries are offered the smart card to allow them access to the healthcare services from the empanelled hospitals. 3. Collaborative Startups

One of the reasons for healthcare inequity is the poor infrastructure and lack of facilities in the majority of government run hospitals leading the patients to visit private healthcare sector. In India the total expenditure on healthcare as percentage of GDP is just 1.15%, while in the USA it is 8.5%. About 70% of the Indian population pays out of their own pocket for medical expenditures which is a staggering number compared to USA, where the out of the pocket expenditure is much lower at 10-12%. Lack of allocation of significant GDP on healthcare facilities compels the doctors as well as professional resources to serve for private organizations. This leaves the public sector lagging further. Ultimately, this results in inefficiency and dearth of medical professional resources in government-run health institutions. So, to overcome this challenge and make the overall system better, we suggest collaborative startups (public-private collaboration) that can improve the quality of care in the country at an affordable cost. This will ultimately strengthen the system as a whole. 4. Adoption of a Broader Healthcare Approach To make the system stronger and the best in international ranking, it is imperative that all the perspectives are taken into consideration. All aspects need to be taken care of and addressed adequately to ensure no loopholes are left behind. We have to focus on individual issues from fertility rate to malnourishment among children and maternal (mother) mortality rate to clean drinking water. Health is associated with the biggest and the smallest and every other social issue in between. Is there an economic recession in the country following demonetization? More cases of mental health illnesses will

emerge. Are residential areas lacking clean drinking water? Cases of water-borne diseases will prevail. The trend of early marriages is increasing? Mother and infant morbidity and mortality rate will elevate. To ensure India as a healthy nation, we need to address the social, environmental and economic, cultural issues and embrace a more holistic approach that can help improve the overall situation. This particular solution demands collaboration of not just the health sector but the social and human welfare, economic organizations, media houses, religious and spiritual organizations need to come together to contribute India's health. This can curb several preventable health conditions merely by spreading adequate awareness. We need short-term as well as long-term plans to bring improvements. These plans

need

to

be

made

with

the

collaborative

efforts

of

representatives from various government departments, healthcare policy makers, NGOs, medical professionals, leaders from pharmaceutical industries, and healthcare workers contribute in the endeavor to make the healthcare system of India one of the best in the world. Take-Home Message ➢ To strengthen our healthcare system, we need to address our weaknesses and find ways to turn them into our strengths. ➢ If healthcare providers are adequately educated and trained, they can identify and address the shortcoming that contribute a weakening of the system.

➢ Research is very important in healthcare to analyze the situation and develop logical and productive solutions. ➢ Using smart technology, we can promote, regulate and handle several social-sector health schemes at a larger scale. ➢ Information technology can be used for beneficiaries from the rural areas to use a smart card that can allow them access to the healthcare services from the empanelled hospitals. ➢ Collaborative startups can improve the quality of healthcare in the country at an affordable cost. All aspects need to be taken care of and addressed adequately to ensure no loopholes are left behind. ➢ The success of a doctor is directly proportional to the health of the patient. The healthier the society around us is, the better our performance will be. ➢ If the allocation of resources is executed wisely and used smartly, substantial productive outcomes can be achieved. ➢ To become successful medical professional, we need to back our health practices and organizations with innovation, consistent outcome for our patients, following protocol/check list to minimize mistakes, excellent team coordination, consistent flow of information, and discipline across the team members.

3. Eye for the Sky: My Journey from a Dusty Village to Being a Doctorpreneur

“I am a self-made man and I rose from humble beginnings to receive the best possible surgical training in India and overseas, and I am happy that I could come back to my own land and people to do good work among them. I want to encourage and inspire young doctors to come back to their roots and provide good services in areas where they are needed and valued.” - Dr. Suresh K. Pandey The purpose of this chapter is not to be self-laudatory, but to convince readers (medical students and doctors) that if I can do it, so can you. This chapter is written to inspire medical students, young doctors of India to dream big, and then chase your dream to make it successful. As a successful entrepreneur in the medical field, I want to continue to provide good services, and also want to train and inspire more and more young doctors to excel in their work and provide services where they are needed and valued. My city, Kota is famous for education and it is my dream to see it famous in the field of medicine and healthcare. In addition to work related to eye surgery, I would like to continue my passion to motivate aspiring

students to make their best efforts to get success and also to live positively. Dare to Dream I was born in a village called Mohna, district Chittorgarh in Rajasthan. My father, Shri Kameshwar Prasad Pandey was a school-teacher and my mother, Smt. Maya Pandey, was a housewife. The financial condition of our family was not too well-off, and my village lacked basic infrastructure like electricity and roads, but I found solace in my studies with dream to become a doctor. I completed primary school education at my school in Mohna and secondary school education from a nearby village school Eklingpura. I also obtained an NTSE (National Talent Search Exam) scholarship for a year in 1980. At age of 12, I joined the Government Higher Secondary School in Rawatbhata, which was 30 km away from my village Mohna. I completed the first year of Bachelor of Science (B.Sc) from Government College, Rampura, with first rank in the Vikram University, Ujjain, MP. I had to live in a rented accommodation, surviving on whatever I could cook myself. I was motivated by reading inspiring stories of famous people. Inspiration to Become a Doctor I was inspired by my grandfather (Late Dr. Kamta Prasad Pandey) to become a doctor. My grandfather was a freedom-fighter, who had migrated from Ballia (UP) to Rajasthan in 1943 after the 'Rebel Ballia (Bagi Ballia) Movement'. Before that, he had learned basic eye treatment and the art of cataract surgery from Dr. P. D. Giridhar at Kishan Lal Jalan Eye Hospital, Bhiwani, (Haryana) in 1937. Cataract

Surgery was not very advanced in my childhood days and patients needed thick (aphakic) glasses. Still, the visually-impaired patients used to express gratitude to my grandfather for curing their eye problems. So, I had my eyes set on becoming a doctor and, specifically, an ophthalmologist. I was always fascinated by a doctor’s ability to make a difference in patients’ lives through medical or surgical treatment.

Freedom-fighter and renowned eye surgeon Dr. Kamta Prasad Pandey (grandfather of Dr. Suresh K. Pandey) with Dr. P. D. Giridhar (chief eye surgeon) and other eye surgeons at Kishan Lal Jalan Eye Hospital, Bhiwani (Haryana, India), 1937. Admission in Medical College and How I Overcame Challenges Despite all odds, I prepared for the MBBS entrance exam (PreMedical Test) with borrowed books, visits to the library, reading inspirational life-stories to keep myself motivated. I managed to get selected in the MBBS course at the Netaji Subhash Chandra Medical

College at Jabalpur, MP, in the first attempt (at the age of 17) and that too without the help of any coaching institute. I had learned from the beginning: "Success does not come and find you; you have to go out and get it." Studying MBBS was not easy for me as the medium of education was English and I had studied in Hindi-medium schools. I stayed at my hostel, and hostel life contributed enormously to convert me from an introvert, shy individual to an extrovert person. The maximum interaction I had with my classmates and seniors was during group discussions

on

various

medical

topics

that

helped

me

in

understanding complex areas and clarified my confusions and doubts. Fortunately, I met helpful and supportive seniors who helped me in understanding English and medical terms during the first few months of the MBBS course. They even lent me notes and books to help me study. The process of adjusting in a completely different environment, understanding a new language, and going through financial stress was hard to say the least. I faced the toughest time of my life during the MBBS course. With only Rs. 600-800 sent by my parents every month, I had to stretch every rupee. Sometimes, I had to survive on just one meal each day. Surviving on a shoestring budget was not easy. I even cooked myself just to save money. All these problems and financial difficulties were not bigger than my dreams, and I never let them bother or distract me from my main goal. I was a step closer to becoming a doctor and I focused whatever energy I had on that one goal. Studies were a way for me to keep myself distracted from my worries. I stayed away from partying and students who wasted time

having endless fun. I had no option other than focusing all my money, effort, and energy on my studies if I really wanted to turn my dream of being an ophthalmologist into a reality. Medical Training in India, USA, and Australia I successfully passed MBBS with first division with 7th rank in the class of 140 students. With the help of my seniors and sheer willpower, I secured a very good rank in the state pre-post graduate (Pre-PG) examination and also selected in PG entrance examination of PGIMER, Chandigarh. I pursued my Post-Graduation in Ophthalmology from the prestigious Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. After completing PG in ophthalmology in December 1997, I was selected for advanced training in USA where I worked as a Fellow and later as an Instructor at the John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA and Sydney Eye Hospital, Save Sight Institute, Sydney, Australia for five and two years respectively. Return to India - Journey to Medical Entrepreneurship My wife (Dr. Vidushi Sharma, MD, FRCS, UK) and I then returned to India in January 2006, and with our insignificant savings, we started the SuVi Eye Institute and Lasik Laser Center in Kota on February 6, 2006. Word about our good work spread quickly and within three years, the institute expanded remarkably. We started our clinical practice seeing 8 to 10 patients per day. Now, we see approximately 250 patients every day and perform 8 to 10 laser, major or minor eye surgeries per day. So far, I have done more than 60,000 successful cataract surgeries with a very high success rate

and about 2000 eye surgeries free of cost for the needy patients. SuVi Eye Hospital, Kota has world class eye surgery facilities, including Rajasthan’s first DORC Eva Phaco-vitrectomy machine for vitreo-retinal surgery, Zepto-nano pulse technology for refractive cataract surgery, and several other valuable diagnostic and surgical equipment to treat all routine and complex eye ailments. I credit my late father-in-law (Late Group Capt. K.M. Sharma) as the force behind this vision. He inspired me to return to India and supported me in setting up the hospital. My wife, Dr. Vidushi Sharma, has been the biggest supporter in my professional and personal journey like a friend, philosopher and guide. My Mentors, My Passion I had the good fortune to come across many inspiring teachers and mentors who inspired me to become a successful doctor. I am grateful to my mentors, Prof. Jagat Ram, Prof. Amod Gupta, Prof. Mangat Dogra, Late Dr. J. S. Saini, Dr. Ashok Sharma, Prof. S. S. Pandav, Dr. Kanwar Mohan, Prof. A. K. Jain, Prof. Usha Singh at PGIMER, Chandigarh, Prof. David J. Apple in USA, Dr. Anthony J. Maloof, and Dr. E. John Milverton in Australia, who were instrumental in shaping and refining the surgeon in me as they taught me the art of eye microsurgery using both the right and the left hand. I am also thankful to my friends Dr. Somesh Gupta, Dr. Man Singh Chandel. I also get inspiration from books written by Shriram Sharma Acharya of Gayatri Pariwar. My passion is to motivate young students to become better citizens of India and to excel in their field.

Awards and Recognition I was felicitated with the Achievement Award by the American Academy of Ophthalmology. I was awarded the Gold Medal by the Indian Intraocular Implant and Refractive Surgery Society twice. I was invited to perform ‘Live Surgery’ at the international meeting at Milan, Italy, as well as at several Indian cities such as New Delhi, Mumbai, Pune, Hyderabad, Chennai, Vishakhapatnam, etc. I was also awarded for the Best Surgical Videos by the American Society of Cataract and Refractive Surgery, USA. Dr. Vidushi and I were honored by the National President of IMA for Outstanding Community Service Awards and Government of Rajasthan awarded us for our outstanding work in the field of ophthalmic teaching and the elimination of preventable blindness. More than 25 eye surgeons from India and overseas (USA, UK, Middle East and Europe) have visited our facility at Kota to witness our cutting-edge work in the field of ophthalmology.

Dr. Suresh K. Pandey receiving an award at the European Society of Cataract and Refractive Surgeons (ESCRS) Conference at Vienna, Austria

Dr. Suresh K. Pandey receiving an award at the ASCRS Conference at San Diego, USA

Dr. Suresh K. Pandey receiving a Best Video Award at the ASCRS Conference at Boston, USA

Dr. Suresh K. Pandey and co-authors receiving the Best- of-Show award at the Annual Conference of the American Academy of Ophthalmology at New Orleans, USA

Dr. Suresh K. Pandey receiving Video Award during the ASCRS conference at San Francisco, USA

Dr. Suresh K. Pandey and co-authors receiving the Best- of-Show award at the Annual Conference of the American Academy of Ophthalmology at Chicago, USA

Dr. Suresh K. Pandey receiving Award during the SAARC Conference held at Karachi, Pakistan

Dr. Suresh K. Pandey receiving the Gold Medal during the IIRSI Conference held at Chennai, India

Dr. Suresh K. Pandey receiving the Gold Medal from the Governor and Health Minister of Tamil Nadu during the IIRSI Conference at Chennai, India

Dr. Vidushi and Dr. Suresh K. Pandey were awarded for their remarkable work to eliminate blindness by Rajasthan Home Minister and District Collector, Kota, India

Opportunity to Meet Two Inventors in USA Late Sir Harold Ridley (Inventor of the Intraocular lens) and Late Dr. Charles D. Kelman (Inventor of Phaco) I was fortunate to meet late Sir Harold Ridley (inventor of artificial lens) and Dr. Charles Kelman (inventor of small incision cataract surgery known as phacoemulsification) few times while working in the USA. I have also contributed about their invention in the medical books and journals, which is briefly mentioned here. World War II Discovery that led to Modern Cataract- IOL Surgery: Today, cataract surgery, using the implantation of intraocular lens (IOL) is the most common form of surgery in the world. Most of the doctors (except eye surgeons) do not know the amazing World War II discovery that led to modern cataract-IOL surgery. While war has a dreadful impact on lives, it does occasionally introduce new technology that can improve lives too. During the World War II, Sir Nicholas Harold Ridley, while operating on wounded pilots at St Thomas’ Hospital, London (UK), made an important discovery. During his treatment experience, Sir Harold Ridley realized that the acrylic plastic splinters did not face rejection from wounded pilots’ eyes. This led Ridley to discover the prospect

further and he tried using an artificial lens to correct the vision of the patients with cataracts. In 1949, Ridley partnered with ICI, the manufacturers of the Perspex acrylic plastic material, to produce first intraocular lens (IOL) and in the following year, he carried out the first artificial lens implantation in an eye on February 8, 1950. The first IOL was manufactured by the Rayner Company of UK. Following this successful cataract- IOL surgery, Ridley committed himself to work on a comprehensive development program that was eventually accepted worldwide and received the approval of the US FDA in 1981. This discovery of an Intraocular Lens made by Sir Harold Ridley continues to make a tremendous difference in the life of millions of people to date. Discovery of Phacoemulsification by Dr. Charles D. Kelman The technique of phacoemulsification was introduced by Dr. Charles D. Kelman in 1967, and remains one of the most essential discoveries in the field of ophthalmology and outpatient cataract- IOL surgery. The phacoemulsification procedure entails using a small ultrasonic tip that vibrates to break the cataract-affected lens within the capsule and aspirates it out using a small needle. Since its discovery, over a million cataract surgeries have been performed in the United States alone. In 1975, Dr. Kelman started working on designing lens implants to use simultaneously with cataract surgery. Since then numerous companies have started manufacturing IOLs, including Alcon Laboratories, Johnson and Johnson Vision, Bausch and Lomb, Zeiss Medical Technology, Hoya

Surgical Optics, Rayner Intraocular Lenses Limited, Hanita Lenses, and the leading Indian manufacturers such as Appasamy, Care Group, Biotech Vision Care, Aurolab, etc. Neurosurgeons have adopted the Kelman phacoemulsification machine for use in dissecting tumors from delicate brain and spinal cord tissue in children. In this way, the device has saved hundreds of young lives. Authors' Message and Pearls to Become Successful Doctor ➢ Complete your medical studies and specialization training at the right age, before you plunge into family responsibilities and get the requisite qualifications, training and exposure. Do not worry if it takes more time, involves getting less money or going overseas for short training or observer-ship. You will later on realize its worth in terms of providing you a competitive edge over others. ➢ Do not compromise on your medical training. Get the best possible training that you can get and empower yourself. This will give you a firm foundation to build a sound professional career on. ➢ It depends on you how much knowledge you can gather from your teachers or mentors. If you are receptive, obedient, hardworking and eager to learn there is no end to how much you can learn from them. ➢ Be totally focused during your training period and learn as much as possible. Concentrate on your clinical and surgical expertise so that at the end of your training, you are confident of your surgical skills. There will be many other things in life that will threaten to shake your confidence. Do not let surgical competence be one of them.

➢ Be humble. Do not let success go to your head. ➢ Work with sincerity and dedication. ➢ Always keep patient welfare topmost in mind even if you are in private practice. Follow ethical practice. ➢ Learn patient-dealing and cultivate good communication skills. ➢ Be approachable and accessible to your patients. ➢ Document everything properly. This is very important especially if you are in private medical practice. ➢ Aspire to better yourself. To secure an edge over others, improve your knowledge, skills and expertise. ➢ Keep yourself updated by visiting medical educational websites, medical e-learning platforms and health-related social media. Besides other advantages, it will help you be in touch with others in your field and keep abreast with the latest. ➢ Be determined and thick-skinned. Setbacks are bound to come in life. In the end the one who succeeds is the one who does not allow setbacks to affect him. As Churchill famously said, “Success is not final, failure is not fatal.” ➢ The medical profession is looking up in the non-metro cities now, with greater mobility of funds, more disposable incomes and easier financing options for doctors. The word-of-mouth publicity also works faster in smaller cities, if you can provide good services to your patients. So, it is a good idea for young doctors to explore the opportunities in Grade B cities in India.

Part II: Flight

4. How to Make the Best of Your Time at Medical College “Studying medicine is like true love. You suffer, fail, learn and fall again, fight and grow but you never want to let go. - Anonymous Congratulations on being enrolled to a medical college. Most of you have always dreamed of becoming doctors. I am sure your parents and family members must be quite proud of you and your achievements. Medical career may start with enthusiastic vibes and plenty of excitement, but soon all that excitement dies down, and the enthusiasm vanishes away when you are subjected to a tremendous load of study material and the constant worry of exams. It is easy to get overwhelmed right at the beginning of this massive journey. Hence, it is important that you get into the right frame of mind from day one. This book will help you throughout. A good start makes the journey ahead smoother. Admission in the medical college changes your life drastically. The definition of normal life changes and your days get distanced from the 24-hour clock. Being burdened under piles of books, and extensive information to study, the hectic routine can make your life miserable. The concepts of sleeping, eating, meeting and greeting people all go for the toss. However, you must know that medical college has the potential to change the meaning of your life. The

medical profession you have chosen for yourself is the profession of serving the humanity. Medicine is a tough field and a medical student needs to learn and master several skills. It requires you to strengthen your drive and gear yourself up for what lies ahead of you. While the beginning of the medical college can give you a tough time through extensive studying, the professional life will subject you to pressures such as odd

hospital

timings,

unpredictable

patients,

life-threatening

situations, and complicated surgeries. It is important that you learn to sustain pressure from the beginning. The earlier you stabilize your foot, the better it will be for you. Learn to meet the challenges headon. What you become skilled at today is going to stay with you throughout, and it is a long way ahead. It is a part of human nature that whenever we survive through one phase and enter another, the previous one appears too easy and the present too difficult. Entering medical college at first seems like an unachievable milestone, but once you enter it, you realize that the nightmare has only just begun. During your medical college, you are bound to face clinical and non-clinical challenges. To begin with, the first thing that you will encounter as the biggest hurdle in your way is studying from a large volume of medical books and learning new medical terminology. The size of medical books, medical dictionary, and combined learning about human anatomy through cadaveric dissection are all enough to scare a new entrant. But neither the size nor the complexity is something you will be able to get rid of. It is that crucial part of the medical college that you have to swallow no matter how bitter it is. Medical terminologies are your survival component in the medical

field. To survive through the terminologies, the best you can do is utilize its rules to your benefit. Start with breaking down the terminologies and understanding the building blocks. Emphasize on understanding rather than memorizing. The second integral challenge that can stagger you substantially at the beginning of medical college is the immense workload that you suddenly get bombarded with. The studying material that is both complex and long that can be terrifying to even look at, let alone actually

studying

it.

Accompanied

by

complex

and

long

terminologies, the information related to subjects like anatomy, physiology, pharmacology, pathology, and microbiology, can be an intimidating job that can demoralize you right from the beginning. It may take a long time to understand the new study requirements, and by the time you do, it is usually already time for clinical and written exams. And then if you get cleared, the cycle starts again – same workload, same toughness. Studying as a medical student in medical college requires you to limit most social activities that were once a significant part of your life. Hanging out with friends, family members, spending nights watching movies, late-night sleep-ins, and leisure, will all begin to seem, alien once you are enrolled into a medical college. Sleep deprivation and skipping food becomes a constant in life, and this serves as one of the big challenges. Your motivation starts to burn out and what you feel is exertion, anxiety, and demoralization. This can severely impact your mental health negatively. The balance of your life gets disturbed and you are bound to your books and studies 24/7. The stress of work is too much and the fact that there is not

enough time to complete the tasks, and it starts to reflect on your appearance. While almost all of the medical students survive through this initial phase one way or another, they still remain lost internally with the pressure, which only aggravates with time. The lack of guidance for young medical students in this context heightens the possibility of producing doctors who remain unsure about how to handle the pressure effectively, which is a mandatory part of the field. The one and half years during the MBBS course present you with the challenges related to the memorization of study material, which can be over thousand pages per subject, or dealing with the lack of study-life balance. The real hardship starts from third-year MBBS onward when the clinical learning process starts and the medical students are given the taste of the real life of clinicians. This is a huge transitional phase in a medical student’s life which was till now confined to the limitations of classroom and the theory of the books. Once you step in the real-life setting of healthcare where their future resides, you are subjected to a whole new range of challenges, starting from communication skills to the requirements of the professional stance. It requires you to spend an extensive amount of time with senior professionals who are way older than you in age and experience. I would recommend that you prepare a group of like-minded friends and take full advantage of different learning methods. Try to teach complex topic to your friend, engage in group discussion or watch online videos, to learn and master the subjects.

Challenges in the medical college are only the beginning of what you have to face ahead – a glimpse of the future, as they say. These challenges are, however, more related to your psychology than anything else. It does appear intimidating but if tackled sensibly, you can easily overcome these challenges and learn to cope with the tough life that accompanies your chosen profession. The following section entails how you can effectively establish yourself at the beginning of your medical graduate studies and guide you on how to manage the medical college time efficiently. Time Management This is the first thing you need to work on if you want to get through medical college successfully, and in order to tackle its challenges effectively, you need to improve your managerial skills. If you acquire the skill of time management, it will be one of your best skills that will help you throughout your life, clinically and otherwise. With the work burden you have in college pertaining to extensive study, time management skills can help you through all. To manage your time better, here are a few tips that can help you. Plan, Plan, and Plan Planning is the key to management. The better you plan, the better you will be able to manage the tasks you are provided. Planning ahead of your schedule allows you to be proactive and makes you ready to withstand whatever is sent your way. Use a planner is a smart way to start with. It lays it all down whatever is needed to be done so that you know how much work you have and how you are going to manage it all in a limited time period. Your planner does not

necessarily have to be a traditional diary. You can maintain your planning anywhere that is feasible for you– computer, notebook or your phone. What matters is that you have everything aligned appropriately according to priority. Plan weekly so that you know what lies ahead in one quick glance, and then you can adjust other smaller tasks accordingly. When planning, you need to be careful about how you schedule your tasks. Know that you cannot plan each minute exactly. That is unrealistic. You need to be more considerate about the bigger tasks, and the ones that are of top priority. Make sure that you have a flexible schedule. It does not have to be completely oriented around your study activities. Make some time for personal activities as well. You need to understand that your time at the medical college is precious. You have to do your best with the hours you have. Certain things will have a permanent place in your schedule, and others will have to be accommodated accordingly. What you need to be careful about is that you do not over-exhaust yourself. Your personal well-being should be a priority. Make a practice of getting involved in campus activities and engage in recreational facilities provided on-campus. Allocate few hours of study and few minutes at the gym, and the rest of your activities can be scheduled around it. Consistency is Essential The medical profession requires you to build consistency in your attitude and your way of doing things. Well, not just the medical profession, but any field requires you to have a certain consistency

to thrive in your life. Consistency can play a tremendous role in making you a successful person. Generating constancy in your routine activities like a sleeping pattern, study schedule, working out, and eating at the same time every day helps your body to follow the biological clock. Following the fixed routine assists you in becoming punctual, which can be highly beneficial for you not only in the medical college but also in your entire medical professional and personal life. Though it may appear difficult in the beginning, especially during your student life, a little effort can strengthen this habit, and result in improving your focus and productivity. Aside from consistency, to make the best of your medical college, you need to have as much of a distractionfree life as you can. The MBBS course and studies are tough to keep up with and require keeping up with extensive studying material for every course. In such circumstance, the last thing you want is continuously getting distracted with message alerts and email notifications. Developing consistency requires you to focus on the task that you have planned. If the two hours that you have dedicated to studying in your

planner,

you

keep

responding

to

E-mails

and

Facebook/WhatsApp messages, your planned schedules are destined to prolonged. If you cut down all distractions, you are likely to achieve more in less time. This will allow you to have time to involve in other activities. Have a Study Pattern

Being a medical student, you must know that studying everyday is a must. Therefore, it is important that you have study blocks and fix time to study every day. When you maintain a study pattern, it gets easier to cope with the daily studying requirement in a more timeeffective manner. Along with establishing a definite study pattern, you should also know how to study. Studying medical books can put you into stress where you have to absorb a lot of information in relatively no time. You need to determine which study method suits you best. Study methods can vary; what works for someone else may not necessarily work for you. To tackle this, you can set your own limits based on how much you can take at a time. Overburdening yourself will only increase your mental pressure and stress you out. It is okay to study relatively fewer hours but important to study regularly. Study in Groups and use Online Resources to Learn Faster Medicine is all about teamwork and sharing information. You have to be able to cooperate with others. Even when you apply for residency/fellowship, it is important to keep this concept in mind. The moment the residency/fellowship directors feel you will not be a good team player or that you might have 'issues' with your colleagues, your application can be rejected. Find a small group of like-minded colleagues who are interested for mastering the subjects by group discussion. Each one of you can learn a difficult topic and teach other members of the group. Once you form the right group, arrange to meet weekly for few hours to ask each other questions about concepts you do not understand. Even better, ask each other questions on little details you think your friends might have

understood. You can also arrange a review session the day before the exam. This can help you refine your last minute knowledge and reinforce all that you’ve studied so far. Use online resources to master the subject. Organizational Skills are Lifesaver Organizing is crucial for you as a medical student. When you are organized, things do not appear as colossal as they may otherwise appear. When you maintain an organized and regular study pattern and tackle study challenges on a daily basis, you are likely to get subjected to lesser stress closer to the MBBS examination. To get more organized in your study, you can segregate your study load into smaller manageable chunks. Have weekly study goals, and split these goals into further daily targets. This will help you get through more work rather comfortably. You do not have to worry about getting the context of everything and understanding all of it at once. It is nearly impossible to understand everything right away. You will get there but gradually. Medical college has a relatively longer academic term for a reason. Things are going to repeat, and you will keep revisiting them. Therefore, avoid overspending time in striving to understand everything. Study smartly. You should focus on other things in your life as well. Medical college does not mean you cut yourself off from the rest of the world. You need to have a reasonably good social life to cope with the academic life. This is mandatory for your behavioral health. Maintain a Balance between your Academic and Personal Life

Apart from time management, another essential thing you need to consider during your medical college is to take care of yourself. Know that nothing can be achieved unless you are healthy inside out. To utilize your time as a medical student in optimum manner, you need to maintain a balance between your academic and personal life. This is going to go far with you. Most medical students ignore their health while striving to accomplish their study goals. This should not be the way. Your health and personal well-being should be your top priority. If you are not healthy physically and mentally, nothing else will matter. You have immense responsibility of future healthcare on you, and that demands you to prepare yourself to perform optimally, to your best potential. For this, you need to gear yourself up not just academically and professionally, but also physically, mentally, and emotionally. You need to prioritize yourself so that you can have more productive functioning. Here are a few tips that can help you take care of yourself in medical college. Seek Motivation Repeatedly Medical college has the tendency to make you lose your perspective and exert you to a level where you are on the brink of getting frustrated. It could be the extensive study pressure or abnormal hours of clinical rotations, failing a test, or missing a rotation these are norms in medical college. You do not have to sweat over it. Hard times are bound to come during your study in the medical college. There is no getting away from them. What you can do to stay positive throughout. Instead of stressing over an experience that

goes wrong, you can utilize the incident for your personal development. Reflect on the event, learn why the problem occurred, analyze how you can handle a similar situation better in future, and move on. If you are struggling with a topic and you flunk the test, acquire your mentor’s guidance and relay your concerns to them. Get their feedback on how you can perform better in the subject. Take their advice and work on improving yourself for the next test. The key to surviving the challenges is to believe that you are capable of getting through them. Extensive study and clinical schedule in medical college can really stretch and you will often feel exhausted and frustrated. What you need to do at such times is to seek motivation. Be it your friend, your tutor, your mentor, your peers, or your family; communicate with them and get your exertion out. Always remember the bigger picture. Know your purpose and aims and keep revisiting them to gain motivation. When you keep working out your stress, you will find things falling into place and a balance will be attained. Maintain Health and Fitness Medical college is a busy place to be, while pursuing the MBBS course, but if you let it run yourself down, you will find it harder to keep up with the pressure of work. Skipping a meal to complete assignment, or grabbing fast food to munch on while preparing for the exam can be convenient, but is it healthy? Definitely not! Eating unhealthy food with high amounts of carbohydrates and inadequate nutrients, or skipping a meal altogether means deliberately subjecting yourself being unfit. Your body needs sufficient nutrition and a complete meal to function appropriately. Providing your body

with adequate calories daily and engaging in physical exercise on a routine basis is an effective way to look after yourself. You can join the campus gym, or activities like Yoga, running, biking, swimming, or sports based on your preference. Physical activity will help your mind relax and get away from mental conditions such as stress and depression. Subscribe to Just One Health Policy Daily Email or News Blog Medicine, particularly in the modern world, has much importance beyond the realm of clinical information. As a doctor, you will one day be called to be a leader, and your understanding of health policy and health systems will drive your success. You do not have to understand every sentence, or even read every word. But be open to absorbing what you can so you will be better aware of the goings-on in healthcare. The future of medicine is in dynamic health delivery systems. While you are cramming over the Kreb's cycle, take a few minute break to review the latest info on real-world medicine issues. National Medical Commission (NMC) bill, Clinical Establishment Act (CEA), National Accreditation Board for Hospitals and Healthcare Providers (NABH), are being built and discussed. Embrace that change and learn as the systems are being designed. Being a Team Player Medicine is a team sport and to become a successful doctor, you need to learn and master the art to become a good team player and team leader. Participate and do whatever it takes to help out with patient care. Medicine today is carried out by healthcare teams. You will work with nurses, technicians, physiotherapists, ward assistants,

social workers, and office staff. Be willing to do scutwork. This is when a resident or consultant asks you to do little tasks such as getting a chart or running errands. Be a team player and try to pitch into whichever clinical tasks need to be done. Have a Satisfactory Social Life Medical college does not, by any means, imply sacrificing your social life completely. Yes, adjustments have to be made but that does not mean giving it up completely. You need to give some time to yourself for relaxation. Take frequent breaks from studying and have a life aside from the medical college. Give time to your family and friends. Learn how to maintain a balance between your MBBS course and your social life. It will go a long way with you. It can be difficult with long subject materials waiting to be studied, but it is critical for your mental well-being. This is why you should learn to manage your time from the beginning so that you can assign and take out some time for yourself. If you ignore having a life outside your college and studies, you are likely to face social isolation. Your relationships will suffer and your social connection with friends will weaken. Having a highly active social life prior to medical college can make it difficult for you to get used to the changed routine where social life literally vanishes. However, with effective planning and management, you can still have a good social life and maintain healthy relations without letting your studies suffer. Retaining good social life will also help you in dealing with stress and have a fulfilling time that is crucial for your behavioral health.

Bearing in accordance with the challenges that are faced by young medical students, it is imperative that you learn how to cope with the pressure. What you learn in the medical college in terms of organizing and management are lessons valuable for your entire medical career ahead. If you learn to keep yourself organized in every circumstance while in medical college, it will help you immensely in future where the pressure will be far more and the nature of work more demanding. Medical college is just the beginning. Taking the flight accurately can lead you toward a steady and smooth journey ahead. Find a Medical Mentor Always respect your seniors, teachers and mentors. A mentor during medical college can offer you expertise and motivation as you work toward your goal of excelling in medical college and becoming a doctor. Finding a good medical mentor can provide you with the perspective of someone currently in the medical profession. Here are few suggestions for finding a mentor who can help you be successful: Go for Role Models: When going for mentors, always choose a person with a medical career whom you want to be like. Going for a mentor with a medical career can help you better because they’ve been through all the same struggles and phases that you are and will have to go through. Work on Building Relationships: When you work in a medical environment, there is a high possibility you will run into several inspiring professionals and doctors who have the potential to

become your mentor. You have to look for them and strive to allow them to know you better. Ask for more responsibilities and try to know more about them and their way of working. This is building professional relationships and connections to get better guidance. Do not Fear Asking: Remember that you are never too old for learning. Make yourself curious to know how things are done and explore how your mentors are dealing with situations. Do not be afraid of asking questions to know things better. Ask your mentors about how they tackled challenges and what they learned out of it. But make sure not to ask questions that you can easily find answers through online sources. Go to your mentors with prepared questions. If you are going to them to help you make a decision, make sure that you are well-researched and have a succinct and articulate question ready rather than going with vague thoughts. Welcome their Opinion: Every person thinks differently and can have a different opinion. You have to go to your mentors with an open mind and sans any preconceived notions. Remember that you are going to them for guidance and advice. Their opinion can align with your thoughts or can contradict what you have thought for so long. There is no need to get offended about anything. You should be welcoming to their thoughts and advice. It is best to get advice of a couple of mentors so that you have diverse opinions by the end of the day and have more points of view to contemplate. Retain a Connection with your Mentors: Mentors are not restricted to a particular year or project. You can always go back to them for help and guidance. Their experience and knowledge can

help you make better decisions. So, make sure you stay in contact with them and take their opinion when applying for residency and making specialty choices. You are going to meet mentors along the way as you progress. Make sure you do not let go of your early mentors just because you found new ones. The earlier ones understood you when you were new to the field and helped you when you were naïve. So, make sure that you have their take even as you progress ahead. Respect Your Teacher, Your Colleague and Your Patient Last but not the least, have respect for your teachers, your classmates and your patients. Respect the teachers and try to inculcate the positives from them. Treating your classmates the way you want to be treated by them is paramount in our field. If you cannot respect your colleagues, you will soon be missing out on a lot of stuff that could be very important to you. Your patients are the ones from whom you learn what it is to be a doctor. Take utmost care when speaking and listening to them and you will surely turn out to be a success. Learn and practice art of patient-care using empathic listening (also called active listening or reflective listening) is a way of listening and responding to another person that improves mutual understanding and trust. Take-Home Message ➢ Admission to medical college is the beginning of your professional journey. Taking the flight accurately can lead you toward a steady and smooth journey ahead.

➢ Make a plan for a short-term observer-ship visiting premier medical institute of India or overseas, if possible. You can discuss this plan with your mentor or dean of your medical college and explore the possibility of a short-term visit to premier medical institute. ➢ To be able to face challenges, it is imperative that medical students should learn how to cope up with the pressure. ➢ What you learn in medical college in terms of team work, organizational skills and time management are lessons valuable for your entire medical career ahead. ➢ Keeping yourself organized in every circumstance while in medical college will help you immensely in future where the pressure will be far more and the nature of work more demanding.

5. How to do a Successful Internship and Manage Your Time between Internship and NEET PG Preparation

“The only mistake you can make is not asking for help.” -Dr. Sandeep Jauhar, Intern: A Doctor’s Initiation Congratulations for completing the MBBS course successfully. Get ready for the internship that is a hard part of medical training. The intern is the most junior position in the medical profession or the residency

program.

Internship

entails

swapping

of

medical

specialties. It is deemed as the basic level training in almost every specialized field of general medicine or surgery prior to getting residency in one specialized field. Internship is an integral part of your career as a clinician. If you plan to get into dermatology subspecialty ahead, you will often wonder why should you get radiology training? Well, you would not want a radiologist sitting next to you while studying a case telling you what the X-ray says. Getting a brief training in all medical fields is mandatory so that you have knowledge of everything even if you specialize in one. The entire medical field is interrelated. You cannot completely excel in one without knowing the other. This is what internship is for.

Being an intern can be really tough. It can be worse than what you envisage and it is nothing that you can exactly prepare yourself for. There is no standard experience. Every medical intern has a different journey with a different set of experiences. Internship is a great learning opportunity right at the beginning of your professional life. It is going to teach you clinical pearls that will stay with you for rest of your life. Internship gives you the opportunity to practically implement and experience what you have been learning from a textbook while studying in medical college. It is undoubtedly a life-changing event that provides you to push your limits and unleash your potential. It coerces you to make use of your theoretical knowledge and take up clues from real life to make the right decisions at the right time. Medical internship acts as a bridge between MBBS course and art of clinical medicine. You need to take each step carefully and make the best of the time that you have. Getting the right start of the internship can be difficult for a lot of young medical graduates who do not know how to adjust well in the new, highly demanding setting. To make your internship successful, you need to work on yourself and things around you to ensure that a successful and productive outcome is achieved from your initial training. Here are a few ways how you can survive your internship successfully. Accept your New Role Accepting the change personally is essential as it helps you fit right into a new setting. To give your internship a positive start, you need to accept your new role first. The sooner you accept that, the better

your way ahead will be. You will be able to adjust to change quickly. The first few days, or even weeks, can be tough for you with all the clinical workload around you and the responsibilities you are given. But that is how your life is going to be for the coming year or so. Therefore, it is better that you embrace the changes right away. Make yourself open to modifications. The more flexible you are to the situations you are subjected to, the more likely you will be to settle well, and the sooner you settle, the earlier you are going to get on with learning how to be a clinician. There is no Hurry; Take your Time Most mistakes are made when you try to accomplish something in a hurry. Most interns face the wrath of their supervisors for the mistakes they make under pressure or getting the job done quickly. You do not have to rush everything. Take your time. Do things carefully and in the right way. You are new to the practical world and it is understandable that you will require some time to pick up the pace. Your supervisors/mentors know this. Understanding things is more important than completing them only a couple of minutes earlier. Take your time to understand the task and the process, and then do it patiently and properly. Clinical work during internship start off slowly and then the workload gradually increases and then just keeps on increasing. In the beginning, when the clinical work is less and you are expected to learn things, take the time and plan accordingly. When you do things properly, even if it takes longer, you will acquire efficiency in it, and then eventually you will be able to do it proficiently in lesser time.

Know your Patients Your professional life is now oriented around patients. The better you know them, the more productively you are going to work. As a medical intern, it is expected of you to provide the most updated information about your patients. Investigation and intervention plan will be developed on the basis of the patient information you provide. This obligates you to be extremely careful in acquiring the information and you must ensure to cover all details. Similarly, if you are in department like surgery, you need to know the patient as well as the planned surgical procedure and purpose behind it. Prioritize your Goals You need to align your priorities. Throughout your medical career in practicing medicine, your priority will be on patient-care. You have to keep looking for sources of information that can help you learn how to improve yourself and make yourself more helpful for your patient. Your utmost precedence should be the patients under your care and you should do the best to leave an excellent impression as an excellent doctor and a caring, compassionate human being. Be Willing to Ask for Help Your shyness, or your ego, should be left out of the hospital door once you enter into the internship. Remember that this is your learning time. You are not a specialized professional. You have a lot to learn and you will be needing assistance at every step. You need to learn to ask for help. There should be no hesitation in asking for assistance. There should be no reluctance in questioning. The more you ask, the more you learn. Nobody expects you to know

everything. You have to get help at anything you get stuck at. That is how you are going to know how things work. You can ask your supervisor, senior peers, fellow interns, healthcare staff, or any other person who has knowledge. The priority should be patient-care, not your complexity or ego. Walk with the Team Being an intern, you are bound to interact and work along with a number of people to provide your patients with improved care. It is ultimately natural to feel competitive with your fellow interns, but you must not forget that your priorities are changed. You all are working for one mutual goal-your patient. This necessitates that you develop effective coordination with other team members and work in collaboration for productive results. The changed approach in the present times has made teamwork compulsory. Your colleagues, residents, nurses, medical assistants, technicians, and other hospital staff will be a part of your team. You will have to coordinate with all of them to ensure that you reach your target goal effectively. Teamwork requires you to change your attitude. You have to be more open and interactive with the members so that you are able to communicate adequately. Also, you need to be more helpful. If you are going to help your colleagues on a busy day, he/she will be doing the same for you when you are in need. Know your Place Just because the designation of 'Doctor' has been prefixed to your name, it does not mean you are above other people at the hospital, especially the junior staff members or nurses. Know that they might

exceed you in knowledge and experience. They are probably working for years more than you first started your medical studies. You are also not the first intern to enter the hospital. Staying humble in life is going to take you places. There have been thousands of interns before you that the hospital staff has witnessed over time. This ultimately demands you to respect them for who they are. They are a valuable source of knowledge for you to learn from. The humbler you are, the better repute you are going to develop during your tenure as a medical intern. Do not Ignore Yourself It has been mentioned numerous times that your priority is your patient. Everything you do is subjected patient care. All goals are aligned for improved medical intervention for patients and their comfortable stay in the hospital. However, none of this can be achieved if you are not physically and mentally capable of doing it. To perform productively as an intern, you need to take care of yourself first. Your health and your sanity are valuable. Take care of them. The internship will lead you sleep deprivation, irregular eating patterns and no room for recreational activities. Under such circumstances, you still need to find a way to keep yourself normal. You can indulge in physical activities. Taking a few minutes break from your schedule to go for a run, practicing Yoga or allotting some time for reading can be effectual. You can also assign one lunch in the week with friends. This will serve in maintaining a balance in your life and will keep you healthy physically and mentally.

Throughout this demanding phase, it is important that you plan your internship ahead and prepare yourself adequately to have a productive time. The internship is a tough program. It requires you to shed your sweat and your blood to make through. It is the gist of the entire medical profession where you learn something about everything. It plays a fundamental role in helping you decide what path you have to take in the future. Getting through internship successfully makes you skillful in various departments. It helps you to excel in your skills and become a proficient clinician. You cannot be prepared for the internship beforehand because it is a new experience every day. Each day entails a new learning process, new challenges to tackle, and new patients to work for. The best you can do amidst your tenure is to be adaptable to the changing environment. You have to be willing to accommodate change on an almost daily basis. You need to make yourself more amenable to interaction and teamwork. Internship is a learning period. You have to keep yourself open to acquiring knowledge and skills. Take your time to learn. Ask questions. Be curious about things. The more you are willing to extract knowledge, the better clinician you are going to be. Internship, despite being tough, is an immense learning opportunity. It is the excruciating heat that transforms you into gold ready to be molded. The better stance you show in an internship, the finer it is going to make you. How to Become the Best Intern and Utilize the Internship Period in the Best Possible Way

The internship is not an easy time for a medical graduate’s life. If you thought medical school is difficult, wait until you start working as an intern. It will introduce you to an entirely new concept of challenges in the medical profession. The internship is basically about learning how you can manage patients and it is anything but easy. When looked from outside, it is only about gathering data, maintaining notes, checking up on patients and helping the staff work on the treatment plans. It is not as simple as it sounds. If you want to really learn during your internship, you have to consider yourself as the only doctor who is seeing the patient and you have the responsibility for the well-being of the person under your care. The medicines you are giving to the patient, the tests you are recommending, the results you are expecting, and whether or not the faculty member would agree with the plan you have come up with. It is all your responsibility to consider and have to be well aware of the expected outcomes. During the internship, you have to be prepared for any and all sorts of situations you may come across with the patient. You need to have the entire information on hand regarding the history of the patient, present clinical findings and the lab reports and results. Be the first person to get the relevant data. Do not delay informing the doctor if you see any signs of something going wrong that you cannot figure out on your own. Maintain kindness and empathy in your stance. Punctuality Matters

During the internship, you have to play the role of an efficient team member and forward your help in all situations to your fellow interns. Help them just like you want to be helped in times of need. Punctuality is the first thing you should be vigilant about. Try to reach before you assigned time and stay back for as long as you can. This will help you interact with more seniors and other residents to have better learning. Also, in case you are running late, make sure to inform your supervisor and notify the team to avoid any inconvenience. Help your Juniors When you become an intern, your attitude means a lot. You need to stay humble and interact with everyone with respect. Take a moment to indulge with the newcomers and students in the hospital setting. Help them in any manner that you can. Explain their things and share your experience to motivate them. This will not just help them but you as well. You will reinforce all the learning and will get a clearer understanding. Own your Actions Nobody is perfect and mistakes can be made by anyone. You need to build confidence in you to accept your mistakes and take ownership of your actions. The field you’re in is highly critical. Even the smallest mistake can cause detrimental damage to a person’s life. You have to realize the seriousness of the job and have to remain diligent about your actions. Strive for Expertise

The length of the internship period can be scary. It is up to you whether or not you get overwhelmed by it. You should strive to make the best of the time that you have. Use this opportunity to learn as much as you can and gain knowledge and experience from practical situations as well as from your seniors and those around you. Do not Complain An internship can be tiresome but you have to stay as upbeat as you can. Avoid getting into gossips or complaining. Instead, take every challenge head-on and strive to resolve the problems rather than fueling them further. Be a team player and problem solver. The internship is tough, but if you go on with it with a positive attitude, you won’t feel as pressurized. How

to

Prepare

for

Post

Graduate

Medical

Entrance

Examination during the Internship? Postgraduate medical entrance examinations are competitive exams and you have to know your competition well to make it through them. The first thing you need to do is to critically analyze and review your own performance from time to time. The best way to do so is to take mock exams and tests frequently so that you know where you stand and which areas you need to improve. The ideal time to start taking the test is right after your final year at the medical school. You must go for the exams even if you are not confident about getting good marks. You will improve with every test. It is not something that should discourage you. Start planning your routine and make an effort to adjust studying in your schedule.

Studying in Groups Studying in groups can be quite effective. You can cover more study material in lesser time and also get your concepts cleared while studying with others. Brainstorming with your colleagues and fellow interns can help diversify your knowledge. Discussing can also help to reinforce and to retrieve the information easier. Have a Goal Focus on your goal is an essential part of giving entrance examination for PG. It encourages you to keep striving for the ultimate achievement. The more succinct your goal is, the more it will boost your determination to achieve it. There should not be any confusion about what you want by the end of the day. There can be alternative plans and substitute options, but you should have a focused mindset. Smarter Working To clear the PG entrance exam, you need to work in a more efficient manner. Remember that it is a competitive exam and everyone else is working harder too. If you settle for hard work, it probably would not be sufficient enough to get you the required competitive edge. You have to be smarter in your approach. Focus on things that are more important from the PG entrance exam perspective. Look for the most important topics and prepare them efficiently. You can analyze the past papers and see what questions are more often asked and have the probability to be repeated in your attempt.

Give Yourself Breathers Exerting yourself with continuous study can actually have a negative impact on your performance. They can lower your productivity and slow you down. You need to take sufficient breaks to give your brain some time to absorb the knowledge and then start afresh. This will keep you fit mentally and also make your study more efficiently. Managing your Time This is another important factor that you need to keep in consideration throughout your medical school and the professional life ahead. It is no hidden fact that the medical profession comes with extensive study. You have to cover a lot of study material in almost all phases while you are in medical school, then an internship and even after that. If you learn how to manage your time right in the beginning, it will help you a great deal in the long run and in all aspects of your life, not just in studying. Take-Home Message ➢ You cannot be prepared for internship beforehand because it is a new experience every day. Each day entails a new learning process, new challenges to tackle, and new patients to work for. ➢ The best you can do is to be adaptable to the changing environment. You have to be willing to accommodate change on an almost daily basis. ➢ You need to make yourself more amenable to interaction and teamwork. Internship is a learning period. You have to keep yourself

open to acquiring knowledge and skills. ➢ Take your time to learn. Ask questions. Be curious about things. ➢ The more you are willing to extract knowledge, the better physician you are going to be. Internship, despite being tough, is an immense learning opportunity. ➢ Focus on your goal for selection in the MD, MS seat. You will be selected if you are focused.

6. Super-Specialty: How to Select the Most Appropriate Branch after MBBS

“In the sick room, ten cents’ worth of human understanding equals ten worth of medical science. - Martin H. Fischer (1879–1962) Knowing which specialty to pursue at the end of internship can be a tough decision to make. Medicine is a vast field. It has over 60 specialties and more than 30 sub-specialties. Amidst such myriad of options, a person is bound to get confused about what to choose and what not to. From your time in medical college, you should start looking for a suitable specialty that you can opt for. The most important factor in selecting sub-specialty as your medical career, you need to do careful planning including a selfassessment. Self-assessment is an important part of the decision-making process pertinent to selecting a sub-specialty in your medical career. Here are some areas that you need to analyze in order to choose the best sub-specialty for yourself.

Motivating Factors: You must determine what exactly motivates you. Ask yourself what makes you to dedicate your time and what makes your efforts worthwhile. Skills: Critically analyze yourself to know what your strongest areas are and what strength you have that complements your medical profession. You must have those skills too that you do not enjoy working. Make sure to categorize these skills accordingly so that you know which path to pursue. Personal Behavior: The way you respond to problems and react to the situation has a great deal to do with the kind of sub-specialty that would suit you. Analyze your behavior and determine how you behave around people and in different situations and rules. Cultural Preference: Establish whether or not you are comfortable working in small medical groups, or would you prefer working with a larger medical team that is multicultural. If you are a traditionalist, your preference would be different. If you are fast-paced and open to challenges, your preference for the sub-specialty would be different. Living Style: This matters a lot. If you are a family-oriented person and like to live close to your relatives, you should not opt for something that requires a lot of traveling. As you step into practicing medicine, the decision may get a little easier to make as internship allows you to test different waters. Rotating in different departments allows you to know more about what each specialized department entails. Having an insight into all the fields would facilitate you in making an informed decision. However, even an internship would not tell you about all sixty

specialized fields. It is going to tackle the major one and touch bases of others, but not all of them. You have to make additional efforts on your own. The smarter way is to start narrowing down the fields from the start. Your medical college schedule will give you an initial breakdown of all the major categories. Moving on, your clinical practices from the third year onward can help you further by exempting the specialized fields you think you would not be able to function optimally in. Then there is the internship. It is going to give a more thorough analysis of the specialized categories and help you reach a decision. While rotating between

Pediatrics,

Anesthesia,

Gynecology,

Ophthalmology,

Surgery,

Dermatology,

Internal

Medicine,

Orthopedics,

and

Psychiatry, among other departments, you can easily categorize these specialties into preferred and non-preferred departments. The decision may be full of uncertainty, fears, and ambiguity and it should be as your entire life ahead is at stake. The decision you make today is going to define what you do for the rest of your life. You have to make the call carefully. Avail any help you can from any reachable source. Use your own complete potential to understand which field will be more suited for you. Take your seniors’ advice. They will be able to guide you. Do your own extensive research. You will be surprised at what you can find online. However, you cannot trust every source either. Success stories of famous doctors from around the world can be helpful. You can learn from their mistakes and experiences.

Conversely, the best way to make the right decision pertaining to your specialization is that you make the best out of your internship. You can only know how one place is once you experience it on your own. So, if you have a rotation in Internal Medicine, make sure you delve into every aspect of it so that you know if this particular specialized field will suit your needs. When you get rotated into Ophthalmology, look into the details of the procedure and try to comprehend if this is going to suit you. If interacting is your forte and you have an interest in delicate sight-restoring surgery, then maybe Ophthalmology is for you. During the internship period, you need to be watchful of each and every detail in your rotations. Your future lies in these details. You have to look at the determinants on your own and then back them up with different sources of knowledge so that you can make a decision that is well-researched and carefully made. To choose the right specialized field, here are a few things that you need to keep into account. Know your Preferred Choice for Medical PG Medical graduates often make the specialty choice decision on the basis of what is expected from them by others. They follow what others think and decide for them. This should not be the case. It is your life, your career and your decision to be made. Just because your father always wanted to see you in Surgery, does not mean that you are definitely going to get into Surgery. The uncle who had always been your inspiration was in PSM (Preventive and Social Medicine), but that does not mean you have to follow suit. Firstly,

know that you are different. You cannot be what others are. You are you. Your understanding is different. Your preferences are different. Your forte is different. You have to keep things in mind while making the decision for a medical specialty. A non-medical person cannot tell you what is best-suited for you. Make the choice on the basis of what you want, not what others want you to be. Your choice should be the one that would give you job satisfaction. It is you who has to live with the choice, not your parents or any other person. Choose the Specialty Branch you are Passionate about This is really important. If you choose a field that is supposedly better paying but you only have a marginal interest in it, then it is a bad decision. You need to choose the specialty you are comfortable with and like being a part of. What is the point of serving your whole life in a field that you never liked in the first place? You may be able to make more money, but your heart will never be in it. Similarly, if you choose something you enjoy doing but you are not proficient at it, it will also be a struggling choice. You may gain a balance some time in your career, but the start would be tough. In such contradicting situations, the best choice for you is to find a field that you enjoy working in and are also good at. Rotations in your internship can help you identify the specialized field that holds the right kind of balance for you. Just look for the indicators. Keep your Options Open Sometimes it is really easy to decide which area you want to pursue your career in. It clicks right away in the beginning. But, for some, it can be tough. You may still be confused until the last

minute. In such circumstances, you need to acquire help from your senior members and professionals. You can lay down the areas that interested you and the things that appealed. They can guide you in making a better decision. Other than that, you can also look into options that seem ‘safe.’ Internal Medicine and Surgery are two safe options that can be good for you. They entail a lot of sub-specialties. Either of the two can help you refine your career path. Look for Details on a Daily Basis As mentioned, internship is an everyday learning process. You will get to deal with different situations each day. Each departmental rotation is a lifestyle in itself. Dermatology gives you more ‘normal’ work hours and free weekends; whereas, Plastic Surgery gives you more money. You will get to know these details during internship tenure. So, you have to align your preferences with specialty areas. If you are into more challenging situations, then Emergency Medicine and Surgical Specialties are the way forward for you. You have to pick up a lifestyle for yourself. This will make your life easier. Making the decision for your specialty in a medical career can be exceedingly tough. Your entire life ahead depends on that decision. You need to look for the right indicators and factors to decide which field will be better-suited for you. Internship is an immensely helpful experience for you to decide about your future. It is going to give you a little taste of everything and you can make your decision based on which area compels you the most. The rotation you enjoyed working on and captured your interest can become a wise choice for your specialization. However, this requires

you to be highly aware of things during your internship. You need to look out for big and small details that can assist you in making your call. Remember that the decision you are making is for ‘you’, not others. You are the one who is going to live with that choice. So, it should be based on what ‘you’ want to do and what ‘you’ prefer. The rest things will ultimately fall into place. Take- Home Message ➢ Internship is going to give you a little taste of everything and you can make your decision based on which area compels you most. The rotation you enjoyed working on and captured your interest can become a wise choice for your specialization. ➢ Making the decision for your specialty in practicing medical career can be exceedingly tough. Your entire life ahead depends on that decision. ➢ You need to look for the right indicators and factors to decide which field would be better for you. Internship is an immensely helpful experience for you to decide about your future. ➢ You need to be highly aware of medical specialties and superspecialties during your internship. You need to look out for big and small details that can assist you in making your call. ➢ The decision you are making is for you, not others. You are the one who is going to live with that choice. So it should be based on what you want to do and what you prefer. The rest will ultimately fall into place.

7. How to Survive Residency

“To live is to suffer; to survive is to find some meaning in the suffering.” - Friedrich Nietzsche Residency is hard and it can exhaust you physically, emotionally and mentally. No matter which specialty you take up, you have to go through similar pressure and unpredictable situations. The first year of residency is especially going to be tough on you in terms of difficulty. There will be few rewards, if any at all, and short-lived joys. Be prepared to have a dull and monotonous routine. There will be days when you will curse the specialty choice you made, and on others, you will just be questioning your entire medical career. Take a deep breath. It is all part of the journey. You are going to survive. Residency is challenging, but so is every other stage of your medical career. First, getting into medical college was difficult. Then it was surviving the college, which felt like an impossible milestone. When you did that, it was the internship. And now it is the residency. You must have gotten a vivid idea that in the medical profession

nothing is sans challenges and difficulties. You have to make yourself strong enough to endure all these tests. For residents, you will find work-life balance to be one of the immense challenges. It will be your race against time to meet deadlines and fulfilling the demands timely. As an ophthalmology resident, I always feared failure or making a serious mistake. That fear is common for all residents. It is a significant challenge that is faced in residency. Aside from meeting the timeline requirements and fear for mistakes, stress and burnout is an imperative issue that prevails among residents. You have to be careful about your mental and emotional well-being. Depression and negative thoughts have become rather common for medical residents. Almost half the people reportedly face depression during their residency program. The reason is that they are not able to give time to anything other than their work. Under such pressure, the emotional health and wellness gets ignored. Besides these challenges, financial stress also is also counted as one of the reasons which exhausts the residents mentally. In such situations, to make through the residency successfully, it is important that you find a work-life balance and explore sufficient solutions to the mentioned challenges. Here are some tips on how you can survive your residency. Manage Sleep Deprivation Medical life messes up your sleeping pattern since day one. Residency does no good either. If you want a good eight-hour sleep to function optimally, you have to sleep whenever your schedule allows you to. Residency requires you to work at least one 24 to 30

hour shift a week, giving you only five or six hours of sleep on the remaining days of the week. This can easily lead to sleep deprivation. Under such circumstances, the best you can do is sleep around your rotation. Nap whenever you can. Catch up on sleep before the next tough rotation. Other than that, you also have to maintain some habits that would keep you sane. Reading a book, for instance, is a good option. A good healthy breakfast and taking regular meal should be mandatory in your schedule. This will contribute to making your lifestyle healthier and giving you more strength and stamina to endure pressure. Financial Solution Becoming a healthy earner in your medical profession may take some time. Residency can be challenging in the financial context. You have to be careful in your expenses for the first few years. You have to find financial solutions in small things that you do. Small sacrifices are better than bigger ones. Your spending discipline will take you the way forward. Having a Support Group Now, this is really important for surviving the challenge residency. You need to have people around you who are willing to help you. Be it your family members, your friends, or the hospital staff. While family and friends can give you moral support and help you gain a balance in your work and social life, the hospital staff can help you immensely in the work environment. Maintaining a healthy professional relationship with the nursing staff can help you in getting things done efficiently and quickly in the hospital. This can assist you

in meeting deadlines. They all are your support group if you want to make them. Your attitude is going to define your relationship with them. You have to help others so that they can help you in return. Manage your Life Your life is going to be as disciplined as you want it to be. If you keep on rushing to meet deadlines without planning beforehand and compromise on your health amidst the hectic schedule, then that is the way it is going to be. However, if you sit down and plan everything out, your life will move toward becoming more organized and in control. It will give you mental and physical relief, which is essential for every resident. Your bills can be scheduled for auto-pay. This will ultimately release you from several obligations, giving you more time to spend on activities like gym, yoga, healthy eating, and socializing that is important for your well-being. Residency is a vital step that brings you closer to becoming a clinician. As the career level advances, challenges are bound to become tougher. You have to build your stamina to endure those challenges. Residency is only going to suppress you as much as you let it. You can successfully survive the residency by taking good care of yourself mentally and physically. The financial stress endured by residents can be reduced if one plans smartly. Spend wisely. The more disciplined your spending is, the fewer problems you are going to face. Spend on things that are necessary. Every other luxury can wait until you are more stable in your career. Similarly, if you realize the importance of having the support of people around you in the hospital, your residency is going

to be way smoother. Having a friendlier attitude and an open stance toward communication can help you maintain good relationships with hospital management. This can assist you in regulating your daily tasks more effectively. Residency does not have to be hard. Though there will be challenging situations, if you know how to manage them without losing your cool, you will survive with flying colors. All you have to do is to be watchful of details and organize your life. Remember your Bigger Career Picture Dream big and dream to become one of the most successful doctors in your field and work hard to achieve this. You do not have to give up your other interests for your medical career. If you have a creative bone, do not put it off only because you are into a more serious profession. If you have ambitions other then medical, find time to pursue them. This will enable you to live a more satisfying life and lesser possibility of burning out during your medical profession. It can be actually a good way of keeping yourself challenged to manage two entirely different things simultaneously. Take-Home Message ➢ Residency will be challenging situations. However, if you know how to manage them without losing your cool, you will survive with flying colors. All you have to do is to be watchful of details and organize your life. ➢ The financial stress endured by residents can be lessened if you plan smartly and spend wisely. The more disciplined your spending is, the fewer problems you are going to face.

➢ Spend on things that are necessary. Every other luxury can wait until you are more stable in your career. ➢ If you realize the importance of having the support of people around you in the hospital, your residency is going to be way smoother. Having a friendlier attitude and an open stance toward communication can help you maintain good relationships with hospital management. This can assist you in regulating your daily tasks more effectively. ➢ Throughout your residency period remember your bigger career picture. ➢ Dream big and dream to become one of the most successful doctors in your field and work hard to achieve this.

8. How to Obtain a Clinical Fellowship

“When a man goes through years of training to be a doctor, he will never be the same. He knows too much.” - Enid Bagnold Completing residency is an immense accomplishment for a doctor. You will find only a little resemblance to the person you were when you first stepped into a medical college as a medical student and who you are now. Medical student, then internship and finally residency – the journey transform you completely. Following the residency, if you want to become specialized in one particular subspecialty, doing senior residency or acquiring fellowship is the option for you. Choosing a specialty can be the most important decision in your medical profession. A sub-specialty can be more crucial. You have to be extremely careful while applying. Whichever choice you make, you have to stick with it for the next twenty years or so. Obtaining a senior residency or clinical fellowship (at premier medical institute in India or overseas) can be challenging just like getting into the right residency program was. However, with the maturity you have earned over the period of time, it must have become clearer to you what

matters when it comes to applying for a coveted candidature. Fellowship follows the same suit. It requires you to make the choice carefully and then give it your all when applying for it. The best way to make the decision is through analyzing all the sub-specialties and weighing their scope and your interest in the area. So, if it is ophthalmology that you have pursued your residency in, you have several options available for sub-specialty fellowship like

Cornea

and

Refractive

Surgery;

Uveitis

and

Ocular

Inflammation; Vitreo-Retinal Surgery; Glaucoma; Orbit, Oculoplastic and Ocular Oncology; and so on. The list is so long that you are bound to get confused. Fellowship: Application, Interview, Selection You have to use every source (including Google) available to you to get information about the training programs proffering fellowship in the selected sub-specialty. Your colleagues, seniors and mentors can be a good guide to the potential programs you can look into. Your fellow residents can also provide you with substantial information about fellowship programs. You can draft a list of possible options available to you. You have to be really sure about the requirements of the application process so that you know whether you are eligible for the program or not. If you do not check the details accurately, there is a high chance all your efforts and time is going to be a complete waste. You need to put in substantial time and effort to get the application process

executed

correctly.

The

application

submission

is

approximately a year prior to the commencement of the program.

You have to be highly aware of the deadlines. You do not have to wait until the last day to submit your application. Do it at the earliest possible time. It will get into the eye of program director sooner and well before the applications start to flood in. Ensure that you remain honest in all your mentioned details. Be clear to mention your exact skills and forte. Exaggerating anywhere can land you into trouble. It will get pointed out instantly by the professionals interviewing you. Your application should include your interest other than the medical field as well. This will project you as a more versatile and a whole individual. If you have been called for the interview, it is best that you inform the respective representative about the date you are available for the interview. If you want to change the date, or cancel the interview, be sure to inform the program in advance. This will enable them to make reasonable adjustments to reschedule or consider another candidate for the position. You have to be courteous in your attitude throughout. If you think you can get away with a rude attitude or misbehavior because you are not going to complete your fellowship with that precise program, know that the medical research field is small. You may find yourself returning to the same program director one day. It is better to part ways on good terms. On the interview day, showing up on time speaks highly and reflects your reliability as a candidate. The way you dress and the way you speak to everyone contributes immensely to making an impression. It is not just the program director you have to impress, but the entire program management.

Fellowship/senior residency at well-known medical institutions entails tough competition. If you make the right use of your knowledge, skills, and experience, you are going to sail through. However, you have to be extremely sure of everything you do. Your experience with the interviews and applications process till now would have given you a vivid idea of how small things can make you win or lose. You have to bear all of these things in mind to make it through on the final day. While weighing the options pertaining to where you should apply for the program, your primary focus should be on the offerings of each program. You have to see the details of every program to know where you are eligible and which program suits your requirement best. Your application must entail a reflection of the person you are. It will help cast a positive impact on the recruiter right from the beginning. Similarly, your interview should be an epitome of professional maturity and your inclination toward the subspecialty. At this level of career, what matters most is how you project yourself as an eligible candidate who can contribute positively toward the mentioned sub-specialty. The secret to success in obtaining fellowship is your passion, your determination and the hard work you are willing to put. If you are able to convey the message to the panelists that you have all these things, you are likely to land the fellowship seamlessly. Take-Home Message ➢ The secret to success in obtaining fellowship is your passion, your determination and the hard work you are willing to put. If you

are able to convey the message to the director or panelist team that you have all these things, you are likely to land the fellowship seamlessly. ➢ Apply to each of the option carefully, knowing what exactly their offerings are and which program suits you best. ➢ Your interview should be an epitome of professional maturity and your inclination toward the sub-specialty. At this level of career, what matters most is how you project yourself as an eligible candidate who can contribute positively toward the mentioned subspecialty.

9. Thriving the Fellowship Duration

“The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires.” - William Arthur Ward Fellowship will be rewarding and ensures your successful career ahead. Your fellowship may begin in the same manner as the residency, but with greater emphasis on training and knowledge in the chosen field. Fellowship also becomes a necessity when you are aiming to enter into academic medical practices. To make a highly valued career path, you have to undergo unprecedented challenges that may erupt up as a substantial threat. Fellowship requires you to transition from non-academic practices to academic. Your approach is switched toward looking into opportunities and making discoveries that

may

lead

you

toward

developing

new

therapies

and

interventions. Your contribution to the clinical practice is converted to a substantive approach where you are provided with the opportunity to educate and train the providers of the next generation. Choosing the Right Mentor in your Fellowship

In your fellowship, you have to build good relations with people around you. You have to find people who can help you in making through the program. Your program director, senior colleague will mentor during your fellowship. You can learn immensely from their skills, experience, and knowledge. However, you need to find more faculty members to whom you can connect with and learn from. This is highly important during your fellowship. While your program director can help you with the curriculum related challenges and issues, having another mentor can guide you in getting through the rest of the struggles that you may face amidst the fellowship. In your fellowship, you will either be assigned mentors by the management or you can choose one on your own. This varies from program to program. You have to be proactive in your approach to look out for the faculty members in the program, and study their academic and professional history. Ask your senior fellows for the names that have good repute and high experience. Finding the right mentor(s) in the fellowship is extremely important. It helps you to establish a stable footing in the program. Based on personal experience, the best advice to the medical professionals is to choose the best mentor, not the best project. Having a supportive and good mentor is going to benefit you more than working on the highest trending topic. A mentor who is deeply involved in your ambitions and needs will prove to be more beneficial for your career than your project. You need to be careful in choosing the mentor if you have been given the choice. Your preference should be of suitable age. A too young mentor would be just as consumed in his or her career as you are. Similarly,

a too old senior mentor would accentuate more on happenings that once were part of the clinical practice but are now outdated. Your mentor should be able to point you in the right direction. They should be able to support you, provide you with valuable feedback and guide you in the right perspective. Push your Boundaries and Face your Fears Fellowship gives you a tremendous opportunity to play trial and error. You are going to make numerous attempts to get the things done right and would have to face rejection every time until you have it perfect in every manner. You may get frustrated and irritated with every rejection, but that is when you are learning the most. Having already spent substantial time in residency working on one particular specialty, fellowship compels you to step outside your comfort zone and sustain more pressure than before. Being trainees, you are rather restricted to the orders of the supervisors and are guarded by the practice codes. Becoming a fellow, allows you to take risks and enter into the new field. Working on a research project, you can submit manuscripts in any area you want. You can choose your own level of challenge when selecting patients. You can work on the toughest situations and try your hand on the route less taken. The fellowship is the prime time where you have the room for failure. This ultimately gives you the best possible option to grow and learn extensively. Failure and its pertinent fears have no room in fellowship. Fellowship is highly rewarding in terms of growth. The more attempts you make and failure you observe, the more you learn.

Select a Research Project with your Career Goals The fellowship program is a prestigious place to be a part of. It may be your natural inclination to cast good impressions on your mentors and seniors. You may be willing to agree to any project that is offered to you. This is one of the worst mistakes you will make during your fellowship program. When you commit to something without complete research and careful analysis, you may be in trouble. The projects you choose to work on should be in line with your career goals. You have to learn to turn down the projects if they do not work with your goals. I would like to share my personal experience revealing how selection of an interesting research project and support from a mentor (during the residency or fellowship) lay a strong foundation to advance your medical career. While pursuing my residency in ophthalmology at N.S.C.B. Medical College, Jabalpur, M.P., I was allotted a research project (as MS thesis) on a project related to neuro-ophthalmology. Neuro-ophthalmology was not my field of interest and it was not common for residents to change their thesis topic or thesis guide. I did not have courage to ask my chairman to change the topic. Fortunately, I was appeared in PGIMER entrance examination and selected for ophthalmology residency. At PGIMER Chandigarh, our chairman, Prof. Amod Gupta was kind enough to allot the thesis on subject of my interest, pediatric cataract surgery, and Prof. Jagat Ram and Prof. Arun K. Jain as my mentors. Anterior segment and pediatric ophthalmology was area of my research interest and I always enjoyed working very hard in the field of my thesis. With guidance and support from my mentors, my research

project was completed in time and later published in the prestigious Journal of Cataract and Refractive Surgery. Also, with the help of my mentor (Prof. Jagat Ram), I also got opportunity to work with Prof. David J. Apple and Prof. Edward Wilson in USA. I also had the opportunity to become a co-editor of a book on Pediatric Cataract Surgery that was published by Lippincott Williams and Wilkins, a renowned medical publisher. I also had the opportunity to meet several famous doctors and innovators including Sir Harold Ridley (inventor of the artificial lens)and Charles D. Kelman (inventor of phacoemulsification). When looking back at this incident from 1995, I realize very well the importance of a research project and how the foundation of a successful medical career was laid by my mentors. I cannot imagine, what would have been my professional career today, if I did not have the opportunity to change my research topic and what difficulty I would have faced if I had not been able to complete the project in time. Maintain a Balance The skills you learn in your medical college are going to prove to be valuable throughout your medical career. One of those skills is learning how to maintain a balance between work and life. You cannot ignore yourself completely while striving to meet the project requirements and deadlines. You have to give yourself time as well and have a life outside fellowship program. Working on subspecialties makes the work all the more exerting. If you are in clinical practice, you will be dealing with crucial situations like fatal cases and strive to save lives with less chances of survival. This can disturb your emotional balance substantially. You need to give

yourself frequent breaks from all the pressure and make efforts to retain your sanity level. Engaging with your non-medical friends, family, and relations can be a good way to catch up emotionally and mentally. Start off with choosing the right mentor. This decision is going to impact your entire fellowship. Choose the mentor who can contribute positively to your career. You can choose more than one mentor. Your aim should be to attain as much guidance as you can. Secondly, the fellowship is going to give you a lot of room to explore. Take up that opportunity and strive to push your limits. Step out of your comfort zone and fight your fears. You will have the liberty to work with any and all kinds of situations and patients. You have to challenge yourself and push yourself toward unleashing your complete potential. Take-Home Message ➢ To thrive in the fellowship, start off with choosing the right mentor. This decision is going to impact your entire fellowship. Choose the mentor who can contribute positively to your career. You can choose more than one mentor. Your aim should be to attain as much guidance as you can. ➢ The fellowship is going to give you a lot of room to explore. Take up that opportunity and strive to push your limits. Step out of the comfort zone and fight your fears. You will have the liberty to work with any and all kinds of situations and patients. You have to challenge yourself and push yourself toward unleashing your complete potential.

➢ To survive the fellowship successfully, you have to pick up your projects carefully. You must not say yes to whatever is offered. You only pick the projects that align with your goals. This is crucial for a productive performance.

Part III: Glide

10. Career Opportunities for Doctors in the Medical World

“I am a doctor. It's a profession that may be considered a special mission, a devotion. It calls for involvement, respect and willingness to help all other people.” - Dr. Ewa Kopacz, Former Prime Minister of Poland Choosing the right career path for oneself is one of the most difficult and important decisions in the life of a doctor/medical professional. It is not uncommon for young doctors today to be concerned about the future of the profession. Faced with everything from potentially huge investment (in private practice) or poor job satisfaction (such as in government job), it makes sense to worry that the best and brightest students might avoid medical career and choose less worrisome careers. Fortunately, the Indian healthcare system has undergone rapid changes over the last 10 years or so, and this has also affected the practice patterns in the medical fields as well as the job scenario for youngsters. India is one of the fastest growing economies in the world and the good news is that the healthcare industry is a rapidly growing field in India, as there is an increasingly aging population, and this aging

population has access to greater income for their medical treatments. While there were only a handful of health centers doing good clinical and surgical work till about 15-20 years ago, today there are an ever-increasing number of hospitals, medical institutions, day care centers, which have access to the latest technology in the field, and are doing good quality clinical and surgical work. While residency and fellowship training may prepare young doctors for doing clinical, diagnostic and surgical work, this training does nothing to prepare you for the many factors that you have to deal with in private practice. Armed with degrees, and somewhat naive enthusiasm, it often comes as a rude shock to realize that we may still not be prepared for the real medical world. One key factor in the immediate post-training period is to choose the right professional path, which will help you to realize our professional goals smoothly. What are the Career Options for Young Doctors? In today’s world, there is a multitude of options available to the young doctors. There are the conventional options of choosing an academic career in the government, or the non-government set-up, and the default option of starting your own private practice or working in a charitable hospital or the government health system at various levels. The other emerging options include working in one of the corporate hospitals (or its chain), or starting some sort of a group practice or trying for an overseas stint for the short or long term. Based on my experience, I am elaborating pros and cons and silent points of career option for young medical professionals.

1. Academic Medical Career: An academic career offers you an intellectually stimulating atmosphere, and an opportunity to learn and train continuously. It also offers you the support of colleagues inhouse whenever you need it. You will also have access to the latest technology, equipment, and gadgets, and most of these jobs will also offer you freedom from day to day management hassles at least at the junior level. However, there will generally be a hierarchy and there will always be pressure to do academics along with clinical work, and a pressure to publish papers. Some of the best academic institutions in some medical branches (for example ophthalmology) are in the non-governmental sector. Then there are the medical colleges, which also provide a similar intellectual atmosphere, and learning opportunities, etc., but the facilities available in these medical colleges are very variable across the country. A medical college job also gives you job security and stability, and the prestige that comes from being a 'professor'. But the prospects for financial growth are limited in these set-ups. 2. Government Service: There are other hospitals in the government set-up, apart from the medical colleges which also appoint doctors at various levels. These may vary from the Regional Institutes to District Hospitals. Again, the infrastructure available in these hospitals is very variable. While this does give the opportunity to serve the needy patients at various levels, the red-tapism and political interference are almost universal and we have to learn to deal with these issues. It takes time to adjust to the working in these places and to get comfortable, but this does provide job security and stability, and an option for a relatively easy and laid back life.

3. Private Medical Practice: Most doctors even today end up in private practice, and this option is becoming attractive because of the greater financial returns as well as the increasingly available technology with flexible payment options. It offers a great degree of autonomy, and there is huge potential for earning relatively much better than any other option, but this potential is not necessarily always realized. Your success will depend mainly on your hard work and your skills, both your clinical surgical skill and your skill in dealing with patients. You could have a variety of models for private practice. a. Own complete set-up – Starting a complete set-up for doctors depends on the branch they are practicing. For example, a physician may not need huge investment, while sub-specialty branches (like ophthalmology, orthopedics, etc.) need large capital and involves a great deal of struggle and responsibility, but is still doable. This will give you complete freedom and autonomy. b. You could also start up a small OPD clinic of your own, and join a large hospital for doing surgeries, as this is a good trade-off, which will not need as much investment. c. Group practice seems a very attractive option, and theoretically offers many advantages like cost sharing, better patient services while simultaneously more free time by rotation etc. However, the difficulty arises in maintaining the association long-term without letting ego hassles come in between. The best groups can be formed by a fresh out of college group of 2-3 people, as they have

similar training background, as well as similar fears of starting a new on their own. d. You could also join an established private practitioner in your area, but this kind of association works long-term only if you can provide some sub-specialty service and add value to the practice, over and above what the senior practitioner provides. 4. Charitable Organizations: There is a well-established and huge amount of charitable work in the field of medical practice in India, and this gives the young surgeons a great degree of surgical experience. The remuneration in these hospitals has also gone up in the last few years, as most of them do paid cases as well to keep themselves self-sustaining. However, many of these large hospitals are in remote towns, and it may not be suitable to settle down there for the long-term with the family. 5. Corporate Hospitals: There is an increasing number of Corporate Hospital chains coming up, and they are opening more and more centers. These hospitals offer the doctors good money and most of them also do not burden you with administrative responsibilities. Having extremely good surgical skills is crucial for future growth. But many of these hospitals work like industry and may burden the doctors with targets etc. 6. Overseas Medical Career: One may want to try the overseas option for a short or a long stint. Depending on one’s goals, one may choose the country of destination. While the USA remains the country of choice for seeing the latest scientific developments and getting exposure to the world of academics, there are other options

like Oceania, Middle East and Africa, if one wants to earn some money and raise capital for coming back to India before starting their own set-up. The key is to decide what exactly one wants to achieve and collect maximum information before making an informed choice. The help of seniors and alumni would be crucial in this regard. One of the ways of going overseas is to apply for a fellowship. There are quite a few paid and unpaid, short-term and long-term fellowships available, for which you can apply from India, and many would do the selections based on a telephonic interview, after seeing your CV, etc. Some of these are available through the International Council of the particular specialty, some through the Medical Organization of that country, and some through individual university websites. Information about all of these is available on the internet, the requirements, etc. are clearly listed. One can apply for these shortterm fellowships and utilize that time to learn new things as well as to try and work for long term plans if one is so inclined. To summarize, there are many jobs available today and most of these offer good salaries, however, not all of them offer job satisfaction. Whatever option you choose for yourself, good training is a must in today’s world of increasingly demanding customers, and the sooner this training is acquired, the better, rather than postponing it for a later date. Choose carefully according to your own personality, as well as your family requirements now and in the future, and do not feel pressured by 'trends'. People may say things like that the era of individual practitioners is over, but in a diverse country like India, there is space for everyone. It would be a good idea for residents to find some time to visit various institutions,

academic centers, private practices, etc. so that they can see firsthand what kind of work is done there, and then make informed choices, and yet always have a Plan B if that does not work out. It is also worth spending the time and effort to know your seniors and alumni, etc. who will not only help and guide you to take the right decision but will also be of crucial importance if you decide to go overseas. At the end of the day, the ultimate aim of this exercise is to be happy, and as long as you are happy doing what you are doing, you have made the right choice. Young doctors can select their career path carefully. If they decided to pursue private practice keeping in mind that running your own practice is a huge work and responsibility. Think well before you choose what exactly you want to do. If you feel you are not cut out to handle

all

the

responsibility

(including

clinical,

financial,

administrative, etc.), choose another option like working in hospital or a shared facility. If you do choose to have your own practice, the initial few years are very crucial and remember to focus only on patient satisfaction at this time. Also, remember to be strong even if there are minor setbacks. Keep the big picture in mind, and do not fret over small things. In the end, remember that the ultimate aim of life is to be happy and professional success is just one means of achieving that along with many other things. Take-Home Message ➢ Young doctors can select their career path carefully. If they decide to pursue private practice, keeping in mind that running your own practice is a huge work and responsibility.

➢ Think well before you choose what exactly you want to do. If you feel you are not cut out to handle all the responsibility (including clinical, financial, administrative, etc.), choose another option like working in hospital or a shared facility. ➢ If you do choose to have your own practice, the initial few years are very crucial and remember to focus only on patient satisfaction at this time. ➢ Stay strong even if there are minor setbacks. ➢ Keep the big picture in mind, and do not fret over small things. ➢ Always remember that the ultimate aim of life is to be happy and professional success is just one means of achieving that along with many other things. ➢ Grab all good opportunities that come your way. Do not be afraid to move out of your comfort zone. ➢ Do not hesitate to take calculated risks. You will not gain much in life if you keep playing safe all the time. ➢ You can achieve any goal if you set your mind to it. ➢ Nothing happens until you have the burning desire to make it happen. Only then hard work translates into success. ➢ Never stop learning. Keep pushing yourself beyond your limits and keep working toward your goals. ➢ Work hard and bring out the best in you. ➢ Strive for excellence and do work that adds value to people. ➢ Have an open mind; be receptive to new ideas and information.

➢ Long-term success depends on your ability to adapt to the changing circumstances. ➢ Medical profession is demanding and only those who are driven, willing to move out of their comfort zone and persevere can succeed.

11. Secrets to Become the Best Doctor and Building the Best Medical Practice

“The Art is long, Life is Short.” - Hippocrates The field of clinical practice presents several challenges and opportunities for medical professionals. There are many forms of clinical Practice today, including Solo Practice, Group Practice, Corporate Practice, Institutional Practice and newer forms of Practice Consolidations and Mergers. There are also newer challenges (NMC Bill, NABH accreditation, Clinical Establishment Act, generic drugs, possible price cap on devices, Goods and Services Tax, etc.), which have an impact on the way we practice medicine, and it is in our best interests to stay ahead of the challenges posed by these policy changes. With decreasing reimbursements, increasing cost of equipments and a changing economy, it may become increasingly difficult to stay afloat and flourish. Here, the author shares valuable pearls for the young doctors to overcome these challenges—from personal enrichment to building a

successful medical practice and dealing with increasing patient load and the eventual difficult patient. What are the Qualities of the Best Doctor to Build the Best Medical Practices? A good doctor needs to be a people’s person at heart. Someone who enjoys interacting with all sorts of people. He/ She needs to be truly skilled in art and science of medicine and surgery, as modern medical science has really evolved to a very high level of precision over the last few years, and therefore the patient expectations have also risen dramatically. However, in this competitive and demanding world, both the science and technique as well as the art of communication are important. While it is quite enough to be a good clinician or surgeon and give good results, to excel, one has to learn good communication skills, strive constantly to give the best results, as well as the best overall experience to the patients. How Can Young Doctor Imbibe These Qualities? Young doctors first and foremost need to learn and fine- tune their clinical/surgical skills as best as they can, and the earlier, the better. At a young age, without the additional responsibilities of family and children, it is possible to travel to different cities and countries, and get the best possible training. Good surgical training is the bedrock that no one can do without it in today’s age. Along with this, young doctors should also make it a habit to observe their seniors interacting with patients, particularly difficult and demanding patients. If you have plans of having your own practice, then you need to know the basics of financial planning and administration. Observe

the facilities that are provided in good practices, and pay attention to the small details that can make a significant difference to the overall patient satisfaction. How Can These Qualities Help Young Doctors to Start and Run a New Medical Practice? By default, even today most young doctors end up starting their own practice, though the practice patterns are now changing rapidly, with more emphasis on group practices, shared facilities, etc. When you start a new practice, often you realize that the residency training has not prepared them for this at all. When managing a new medical practice, the doctor needs to go beyond clinical medicine to truly satisfy and manage a patient, and beyond patient management to run an efficient, financially viable growing medical practice. According to John Shaw Billing, “The education of the doctor which goes on after he has his degree is the most important part of his education”. At this stage, we need to keenly and quickly learn the basics of practice management, in terms of staffing, administration, providing the right ambience, marketing, communication and patient handling skills etc. In short, while you need to hone your clinical/surgical skills during training, you must also focus on your soft skills if you want to run a successful practice. How Can You Manage High-Volume Patient Workload in Medical Practice? If you are fortunate enough to have a high volume patient workload in your practice, it often becomes a challenge to give enough time to each patient and fully satisfy them. Here effective communication

skills become very important, where you can give all the necessary and relevant information in a short time, and utilize your chair time with the patient most efficiently. However, despite all this, there will be patients and attendants who need repetitive explanations and guidance, and here the role of well-trained staff, and particularly counselors becomes very important. You must utilize the services of well-trained and groomed staff and counselors who can take over the work of explanations and can give the patients more time, thereby reassuring them and satisfying all their queries. Depending on the workload and the practice setting, you can delegate many other tasks to the staff members. For example in our high-volume ophthalmic practice, optometrists do more than half the work, and trained ophthalmic technicians perform investigations etc. However, it is important to keep motivating the staff regularly to provide their best services to the patients. How Can You Handle Unsatisfied Patients? This is becoming an increasingly difficult but necessary art to master. We must take part of the blame for raising the patient expectations so high, that they have become very difficult to satisfy. A lot of aggressive advertising, tall claims and high treatment costs have convinced the patients that clinical and surgical procedures (in branches like ophthalmology, for example, cataract and refractive surgery) are miraculously precise, where nothing can go wrong. In this scenario, the first thing is to have good counseling for all patients. Adequate chair time needs to be given so that the patient expectations are realistic, and there is no mismatch between their expectations and what can be delivered. Despite these efforts, if a

patient ends up dissatisfied with the results, the first thing is to give a patient hearing. Many irate patients often cool down enough with a feeling of having been heard and understood. Never try to brush aside their complaint, even if they seem insignificant to you. Patients will seldom create much trouble if the doctor is respectful and sensitive and hears them out, but will become increasingly aggressive if they get the impression that the doctor makes them feel inferior or is too rushed to listen to them. Also, it goes without saying that we must do the best that we can to solve the cause of their dissatisfaction, and be financially considerate while doing so to minimize patients to take course of consumer court. How Can You Market Yourself Early on for Successful Medical Practice? Marketing and image-building are an essential part of practices today, and is no longer considered an unhealthy word in medicine. However, marketing in medicine bears a greater responsibility to be ethical and appropriate. We owe it to the dignity of our profession to ensure that our marketing is not in poor taste. Marketing is not synonymous with advertising, and aggressive advertising is still controversial among medical circles. Subtle marketing on the other hand is less expensive, often more effective and also acceptable. But with the increasing presence of corporate sector in the medical profession, advertising is here to stay. Marketing in the medical field can initially be cold call type like newspaper advertisements, billboards, etc., where you make unsolicited contact with a wide audience. For a new practitioner, this is necessary as you need to inform the widest possible audience in your area of practice about

your services and expertise. Later, one can progress to inbound marketing using the Internet and social media for potential customers, giving them a platform to ask queries and know you and your services before they choose you and in-house advertising, where the services available in your practice are prominently displayed in your own premises with clear information and staff is willing and capable to answer any queries related to these services. For a young practitioner, it is important to control the finances in marketing, and after the initial few cold calls, turn to more focused marketing and do not try to 'outdo' competitors in advertising. It is also a good idea to organize educational awareness activities and camps at sites of public gatherings, which is a inexpensive and effective way to market yourself. Finally, you must aim for a scenario, where your satisfied patients become your best marketing tools, because this word-of-mouth publicity is the strongest and most convincing to potential customers. How Can Young Doctor Take Leadership Roles? To grow professionally among peers, one needs to have good oratory as well as public relation/communication skills. Start by attending the meetings of the medical societies in your area and offer to organize activities on special occasions (for example, W.H.O. Day), where you can display your organizational as well as presentation skills. Societies always need young, dynamic people willing to take on responsibilities, without displaying any ego. Remember not to get involved in factional politics, and be respectful to all seniors.

How Can You Grow Your Medical Practice? If you can provide good services, the work is bound to grow. You need to ensure that you deliver not only good clinical/surgical results, but also ensure an overall good experience for your patient. This would mean that you focus on all services provided in your practice right from the ease of parking near your practice, service with smile at reception, less waiting time, comfort in the waiting hall, adequate facilities for drinking water, toilets, refreshments, if needed, reading material to keep them busy while waiting, professional, reasonably quick service, cheerful and cooperative staff and an adequate explanation of fall their queries and concerns. Of course, the satisfaction provided by the doctor would be the main driver, and you need to develop your own soft skills and communication skills so that the patients feel reassured on meeting you, and you can inspire confidence in them. Learn to connect with your patients and empathize with their concerns. As you grow, try to provide more services (like express services, lounge for VIP and postoperative patients, etc.) depending on the financial viability. How to Manage Your Team? If you have other doctors and managers/staff members working for you, it is crucial and often difficult to keep them satisfied and motivated. One crucial factor is opportunities for financial and/or professional growth. Also, be accessible to listen to genuine problems of your staff and give them a patient hearing. Just like your patients, the staff also wants to feel heard and understood. Do small activities (for example we celebrate birthday of every staff member at

our practice), to foster the team spirit among all the members, and make them feel valued. At the same time, also let it be known that you observe everything, and any misdemeanor will be strictly acted upon. Always appreciate and understand everyone's talents of your team. Try to identify the activities and tasks the staff-member does best. Make it easy for employees to improve on their unique talents and reward them for their performance and success. Managing Yourself: How Can You Work Efficiently while Managing Busy Practice and How Can You Achieve Work-Life Balance? In a busy practice, efficiency is important to ensure that the patients are seen quickly, and your working time also does not overstretch. Learn to delegate all except the core work. Develop an excellent team and employ good quality staff that can take off some of your burden. Have enough staff to guide the patients and answer their queries and develop effective communication skills yourself, so that you can give a quick yet comprehensive explanation to the patient about his/her condition. If your practice is managed efficiently, this will leave you time for your family. However, the most important factor for achieving a good work-life balance is to firstly recognize its need and importance. Remember that your work is just one aspect of your life, which cannot replace the equally or often more important aspects like health and family. Ambition is an endless race, and therefore works to satisfy yourself and not to get ahead of others. Violence against Doctors: What Can Doctors do to Overcome this Frightening New Epidemic?

There is increasing trend of violence against the doctors in India and it has become a frightening new epidemic. Almost every week, there is an incidence of violence against doctor or hospital. In today’s world, sadly doctors do not hold the same place of respect as they did 15-20 years back and there is a steadily declining mutual trust and erosion of the doctor-patient relationship. As a responsible member of medical fraternity, it is our duty to strengthen doctorpatient relationship and follow measure to prevent or minimize violence

against

doctors.

Small

and

medium

healthcare

establishments are vulnerable and there are increasing incidence of violence against doctors. All the members of medical fraternity need to remain alert about violence and aggression against doctors. It is advisable to look for indicators of violent behavior such as staring and eye contact, tone and volume of voice, anxiety, mumbling and pacing (STAMP). Violence and aggression against doctors can be minimized by following the acronym- P.S.M. P: Prevent or restrict entry of public. At no stage hordes of relatives should be allowed by the patient’s bedside. Entry should be strictly by passes and this must be implemented through good security, preferably by ex-army personnel. Security guards and good quality CCTV cameras must be placed outside as well as inside the hospital at sensitive areas like ICU, operation theater and casualty. S: Strengthen Doctor-patient relationship by Communication. As mentioned earlier, much needs to be done to improve doctor-patient relationship. This must begin by the doctor informing the relative of

what is going on. Always inform about the cost of the treatment, prognosis, need of repeat surgery and regular follow-up, etc. M: Medical Unity and Media Management. Last but not the least, medical community need to be united to handle the crisis of violence against doctors, especially by forming a WhatsApp group (Rush to Stop Violence against Practitioner RSVP). United medical fraternity can also build pressure on Govt. to bring and implement tough law to protect medical professionals. The Prevention of Violence Against Medicare Persons and Institutions Acts, which have been notified in 19 states in the past 10 years, have failed to address the issue. To prevent

violence

against

doctors,

government

spending

on

healthcare must be increased and the Indian Penal Code should be changed to provide for a tougher penalty that could act as a deterrent to violence against doctors. Also doctors need to ensure to share their version in media so the balanced view can be published. Take-Home Message: ➢ Do not compromise on your medical or surgical training. Get the best possible training that you can get and empower yourself. This will give you a firm foundation to build a sound career on. ➢ Complete your studies/training at the right age, before you plunge into family responsibilities and get the requisite qualifications, training and exposure. Do not worry if it takes more time, involves spending a lot of money or going overseas. You will later on realize its worth in terms of providing you a competitive edge over others. ➢ Success depends on you how much knowledge you can gather from your teachers. If you are receptive, obedient, hard-working and

eager to learn there is no end to how much you can learn from them. ➢ Be totally focused during your training period and learn as much as possible. Concentrate on your clinical and surgical expertise so that at the end of your training, you are confident of your skills. There will be many other things in life that will threaten to shake your confidence. Do not let surgical competence be one of them. ➢ Be humble. Do not let success go to your head, work with sincerity and dedication, always keep patient welfare topmost in mind even if you are in private practice and follow ethical practice. ➢ Learn a patient dealing and cultivate good communication skills, be approachable and accessible to your patients. Document everything properly. This is very important especially if you are in private practice. ➢ Aspire to better yourself. To secure an edge over others, improve your knowledge, skills, and expertise. ➢ There is increasing trend of violence against the doctors in India and it has become a frightening new epidemic. ➢ All the members of medical fraternity need to remain alert about violence and aggression against doctors. It is advisable to look for indicators of violent behavior such as staring and eye-contact, tone and volume of voice, anxiety, mumbling and pacing (STAMP). ➢ Violence against doctors can be managed by following the acronym, P.S.M.- P: Prevent entry of mass in the hospital; S: Security/CCTV camera, and strengthen doctor-patient relationship

by an effective communication; M: Medical unity and media management.

12. The Hospital Space versus Private Practice

“As to diseases, make a habit of two things - to help, or at least, to do no harm.” - Hippocrates It takes years of training to become a clinician but even that might be inadequate to prepare you completely for medical practice as a career. It is a journey of continuous learning and gaining more experience from everyday routine. It may seem appealing to you to start your own practice rather than getting associated with the existing hospitals. A clinician’s long journey through exams, study materials, and rotations comes to an end when he or she enters into the hospital space not as a medical student, or an intern, or a resident, but as a fully qualified clinician. The entire feeling is changed. You feel more down to earth, more modest, and more responsible. It is well-known that with knowledge comes power, and with the knowledge comes responsibility as well. Once you have stepped out of the academic phase of the medical career, you are now obliged to dedicate yourself completely to the purpose you shed all the blood and sweat. As a doctor you are responsible for the patients health, happiness and well-being and you should never betray their trust.

When you start your own practice as a clinician after residency or fellowship or join a healthcare institution, the first thing that strikes differently to you is the hospital space. Previously, you were looked down as students, internees, and residents, but now your responsibilities have increased and you are no longer under the supervisors’ eagle eyes or continuous monitoring of the nursing staff. However, now you are answerable to your own self. Your professional maturity and level of responsibility have escalated and it is about time it reflects in your personality and attitude. Choosing how to serve is your own decision to make. But if you are planning to start your own practice, it is imperative that you serve some amount of time in the hospital space to know how things work. You may find yourself laced with adequate hospital experience from all the time that you have spent there up until now. But now the way you will look at things will be changed. You will look from a more managerial perspective. This will help you immensely in starting up your own practice. There are several things that you have to take into consideration. It involves financial perspective, forming the right panel to work with, hospital and nursing staff, and many other similar things. Setting up your own practice requires you to undergo several procedures and prepare your hospital to register under Clinical Establishment Act (depending on state you are practicing), TPA Empanelment and NABH Accreditation are some of them. Third Party Administrator (TPA) is an agency that works with the purpose of settling cashless hospitalization claims. Empanelment allows the provision of quality health services at a reasonable cost. This promotes the channelizing

of a system among the healthcare providers and regulates hospital expenditure of the patients with insurance. The agency works for an insurance company and is in direct communication with the policyholders to settle disputes. Empanelment, on the other hand, entails bringing hospitals on the provider network panel where the people

insured

under

TPA

are

assured

to

avail

cashless

hospitalization. To ensure that quality of health service is maintained, and all hospitals are following the protocol outlined by the government, it has become mandatory for all the service providers to attain a certificate from the National Accreditation Board for Hospital and Healthcare (NABH). This is necessary if the providers want to continue with their contract under the state-run insurance scheme. So if you are planning to start your own practice, you have to be aware of how things work in the hospital space in terms of financial, legal and policy management. Staying associated with a healthcare institute will help you gain substantial insights about how to start up your own practice. Moreover, working in the hospital space will help you build contacts with the people in the medical industry who can help you later on in establishing your own setup. Hospital Employment If you choose to join the hospital, you have to be watchful about how you adjust yourself in the same old environment but with a new and more responsible position. Hospital employment can be a good option if you want good work hours and a guaranteed income by the

end of every month. This will also relieve you from any unnecessary administrative headaches that accompany the private practice. Also, hospital employment does not require you to have a certain repute to bring you patients. You will have your patient base right away on the account of the hospital. If you choose to start your practice from scratch, it will not only take you time to build credibility in the community but will also require a substantial amount of patience to let your patient base develop. This may get frustrating when you have already spent too much time and effort on studies and you are ready to get your hands on specialized clinical practice. So in this sense, hospital employment is a feasible option. You will get your patients and a handsome income. Starting with hospital employment, you will also be able to receive the perks that your private practice may not offer. This includes paid off days, vacations, and residential facilities. When you get associated with a hospital that has a good track record and positive image in the industry, it ultimately puts you in the good books, too. This helps in building your individual image as well. This is immensely necessary, and you may not be able to achieve this in the private practice right away. Conversely, hospital employment may demand you to give up your autonomy completely. You have to follow the guidelines strictly and adhere to the standard code of practice. You may be restricted in developing interventions; including only the devices that the hospital allows you to use and performing practices that hospital permits. Hospital employment gives you little room to take a decision.

Salaries in the hospital employment contract can be appealing but you may face challenges when it comes to compensations and renewal of contracts. This keeps the clinicians on an uncertain edge. Private Medical Practice Starting off with your private practice, you may go solo or you may have to embrace the position of a shareholder in a group or corporate, where you have substantial stakes in the profits and equally share in the losses. Private practice can open doors to several opportunities for you that you want to avail. Apart from your clinical practice, you also have to get in the role of Human Resource (HR) management, get into marketing and finance, test yourself in contract negotiation, and take the role of facility management. There is a lot that you can do in private practice. It widens your horizon beyond the mainstream medical field and outgrows your potential as an administrator. Being in private practice gives you the top position in the organization, providing you with the liberty to get as creative as you want with your working technique. It gives you more room to experiment and incorporate new findings and methods. You have the power to take a decision and take things in the direction you deem right. Whilst hospital employment offer you paid leaves and vacations, private practice gives you more flexibility and you have the liberty to decide your own work schedule. Private practice, however, limits your career growth. Where would you move higher than the top management level you already are on? Also, working with other clinicians may lead to disputes in terms of

business expertise and recommendations. Being in the managerial position, you have to endure loss and also deal with the problems that come with the loss. You have to manage things effectively while curtailing the consequences. This can complicate your life tremendously. So, unless you have developed effective managerial skills and have become well aware of how to deal with different organizational problems, it is beneficial that you gain experience through hospital employment. Private practices are generally expensive to start. You have to purchase and maintain professional machinery, have necessary equipment and maintain sterilization, deal with the insurance companies, and keep up with the changing healthcare legislation. If you decide to pave your own way as an independent medical practitioner, you have to not only face start-up challenges but will also be vulnerable to financial, managerial and legal problems. While private practice can be beneficial in terms of profit, know that first, you have to invest substantially and then wait until your investment starts to actually give you something back. Getting a good name among the community is also a difficult task when you plan to start your practice right away after residency or fellowship. Hospital employment, on the other hand, gives you a strong back and a substantial patient base. Starting off with a well-reputed hospital can give you a good start. In hospital-owned practice, you will be constrained in terms of decision making, but you will be supported by trained and experienced staff.

Contrary to private practice, hospital employment (such as at apex medical institutes like AIIMS, New Delhi or PGIMER, Chandigarh, etc.) can give you the opportunity to grow professionally. The decision that you make pertaining to the type of practice you want to continue should be based on your personal reflection. You have to envisage yourself in both positions and then decide which place would be more suitable for you in the coming five to ten years. Take-Home Message ➢ Private practices are expensive to start. You will face startup challenges and be vulnerable to financial, managerial and legal problems. ➢ Hospital employment offers a strong back and a substantial patient base. Starting off with a well-reputed hospital can give you a good start. ➢ Hospital employment can give you the opportunity to grow professionally. ➢ Private practice can limit your career growth but can also allow you to carry on with your practice without any external pressure.

13. Medical Professionalism and Qualities of the Best Doctor

“We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.” - Dr. Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science The medical profession is trusted like no other profession in the world. Entrusted with human lives, doctors are not called angels or messiah for no reason. Medical professionals are respected by the public, it requires sincere effort from the clinician’s end to ensure that they act within the parameters of certain ethical and professional boundaries. To delve into the phenomenon what medical professionalism is, it is imperative that we clear the meaning of profession and

professionalism first. The Merriam-Webster dictionary defines profession in the following words: “A calling requiring specialized knowledge and often long and intensive academic preparation.” The academic preparation here denotes the degree of skill, learning, or science. Whereas, if you look into the definition of professionalism, it says: “The competence or skill expected of a professional.” The definitions denote that in order to execute an occupation or commence a task to earn income, one need to be adequately skilled at it. From a medical perspective, medical professionalism requires the clinicians to have the ability to communicate the medical knowledge, discuss diagnosis and treatment options in an easy and comprehensible way to the public. Professionalism in the medical field entails confidentiality, consistency, truth, honesty and continued compassion. Conversely, this perspective of professionalism is now deemed outdated. The eminent sources of information and high accessibility means have made it convenient for the public to acquire knowledge pertaining to diseases and various medical conditions. The public is not as unaware as it used to be a couple of decades back. This has compelled the meaning of professionalism to adapt to the changing trends and be more customized according to the needs of the present setting.

The modern definition of professionalism, as defined by the Royal College of Physicians is: “A set of values, behaviors, and relationships that underpins the trust the public has in doctors.” Professionalism can be deemed as a collection of qualities that enable the public to trust the doctors and other medical professionals. As a matter of fact, in the contemporary setting, the trust between the doctor and the patient is not assumed. It is hardearned. You ought to display appropriate professional qualities and skills that will earn you the trust of the patients. Those qualities and skills are accumulated as medical professionalism. Among the necessary qualities, the most important ones are integrity, compassion, altruism, skills, multi-professional teamwork and continuous striving toward improvement in patient-care. Qualities of a Best Doctor Being a best clinician, you need to develop a strong level of trust with the patient and generate a sense of relationship within the context of professionalism. This is important so that the patient is able to communicate effectively with you and allow you to gain a better insight into their condition. This will help you develop a better intervention plan. Know that a good clinician is an excellent communicator and places the foundation of a good relationship with the patient on the basis of trust. Apart from communication, the skills that make you a competent medical professional are discussed in the sections underneath.

When you choose to start your career as a clinician, you have a long academic history of extensive training and knowledge. Becoming a clinician in medical career demands that you are laced with an ample set of skills in the selected specialized field. These skills make you an expert in the provided sector. With appropriate accreditation and qualification, your expertise is validated. Maintaining Standards The professionalism in the medical field demands that you have the ability to maintain a set of standards in your duties that are deemed acceptable by your fellow peers, the medical staff around you and the patients. When you follow a set of standards consistently, it serves in projecting a positive and professional image of you in the workplace and people around. This contributes immensely to instigating a sense of respect for you. Respectability Being a clinician, professionalism demands you to behave in a manner that is deemed appropriate for the workplace. Working in a healthcare organization, you will be expected to interact with senior and junior medical staff, the management, fellow-doctors, interns, residents, and patients. You

need

to

bear

into

consideration

the

standards

of

professionalism while communicating with them. The way you speak, the way you dress and your personal conduct is all part of

professionalism. If you are careful in these aspects, your respectability standard will automatically escalate. Responsibility Responsibility

is

one

of

the

key

aspects

of

medical

professionalism. The more you honor your commitments and adhere to your promises, the more sense of reliability and responsibility will be projected. The professionalism in your field demands that you complete all the assigned tasks and address all the concerns aptly and timely. Being in the shoes of a clinician requires you to lead by example and make extended efforts to execute your duties appropriately. Any lacking from your end can lead the patient to the critical condition. Honesty Professionalism in any given career is incomplete if you are not honest with your job. Honesty is exceedingly imperative in medical professionalism. It denotes your commitment toward your work and reflects how upright you are as a person. You are expected to be a fair person with an upright character. When you follow the law and adhere to the legal code of conduct, it ultimately escalates the public’s trust in you as a medical professional. Your actions, inside and outside the hospital, serve immensely in building your reputation. A professional person is the one who executes his job duties with zeal and pride. You need to pay attention to the details and take responsibility for your actions. The professionalism of your field

demands that you commence your given task with utter precision and extreme care. Even a small mistake from your end can cause unrecoverable damage to the patient whom you have been entrusted with. You also need to make consistent efforts to upgrade yourself with the latest knowledge and techniques to persistently improving your skills. You have to demonstrate commitment and honesty to your work by taking a deep interest in the matters at hand. If you are not satisfied with something, make every effort in your capability to set it right. Be flexible toward criticism and mistakes. Welcome criticism and acknowledge

your

mistakes.

They

are

immense

learning

opportunities. Instead of taking things personally and making it an issue of your ego, make a practice of learning from them and develop skills that will prevent the same mistakes from occurring in future. Avoid Any Act Causing Negative Impact Your indulgence in any illegal activity, criminal behavior, or a legal conviction can cast a negative impact on your professionalism. You have to be careful in the hospital space. Any misconduct or behavior that does not suit the hospital’s code of conduct is going to land you in problem. You will be considered unprofessional if you fail to meet the clinical commitments. As a clinician in a hospital-owned practice, you have to be careful about how you act and converse with patients and hospital management. Reflections of rudeness, abuse or disrespect in your

behavior are a major dent in your hospital and public reputation. It denotes unprofessionalism and irresponsibility from your end. Professionalism is everything that makes you more responsible and dedicated to your job. Your job is highly sensitive and your career is hugely dependent on the reputation you maintain in the public and among your peers. You have to be careful all the times in what you do and what you do not. One mistake can cause substantial damage to your patient; a small slip in behavior or conduct can indent your field reputation. Follow the WHO Surgical Safety Checklist The WHO surgical safety checklist was developed after extensive consultation aiming to decrease errors and adverse events, and increase teamwork and communication during the surgery. The 19item checklist has gone to show significant reduction in both morbidity and mortality and is now used by majority of surgeons worldwide. Take-Home Message ➢ Medical professionalism requires the physicians to have the ability to communicate the medical knowledge, discuss diagnosis and treatment options in an easy and comprehensible way to the public. ➢ For doctors, professionalism demands to adapt the changing trends and be more customized according to the needs of the present setting.

➢ Doctors need to develop a strong level of trust with the patient and generate a sense of relationship as per the standards of professionalism. ➢ The surgeon should follow the WHO surgical safety checklist that was developed after extensive consultation aiming to decrease errors

and

adverse

events,

and

increase

teamwork

and

communication during the surgery. The 19-item checklist has gone to show significant reduction in both morbidity and mortality and is now used by majority of surgeons worldwide.

14. How to Become the Perfect Surgeon “The mind of Aesculapius, the eye of an eagle, the heart of a lion, and the hands of a woman.” - The 15th-century England’s attributes of an ideal surgeon. Good surgeons know how to operate, better ones when to operate, and the best when not to operate. It takes wisdom, experience, strength, and courage not to intervene. The minute that a surgeon cuts the skin or a physician prescribes a drug, harm is done. -Anonymous Medicine is a field where one needs to consistently strive for perfection in order to build the competitive edge and retain optimum perfection. Surgical disciplines of medical sciences require a lifetime of learning, and learning requires repetition. Entering into the surgical field is another critical stage where your life is on the verge of transformation as you make a career choice that is for the rest of your life. Moreover, surgery is a field that demands nothing less than perfection as even the smallest mistake can lead to detrimental damage. If you are interested in the surgical discipline, the question arises: why do you need to become a perfect surgeon? Surgeries on any part of human body are delicate, highly crucial in nature and any minor mistake can lead the patient to irrevocable damage in the form of dysfunction in the human organ. This makes surgical profession demanding, riskier than any other medical field and requires perfect

surgeons on the list to execute surgeries and minimize the damage risk. What are the Qualities of a Perfect Surgeon? Perfection requires a surgeon to have a number of qualities to become best at what they do. Having these qualities makes them a surgeon who is not only professionally competent but personalitywise too. To become a competent surgeon, the resident/young surgeon needs to have the following skills and qualities: 1. Master Surgical Skills The skills can be refined by watching surgical videos and using wet-lab training, practicing on surgical simulators before operating on real patients. This is the first quality that is extremely necessary to make you a perfect surgeon. You cannot expect to become an impeccable surgeon without having the mandatory set of skills required for your field of practice. If you are well-practiced and wellaware of the true skills of surgery, then only will you succeed in the field. With skills comes the precision of knowing how and when to utilize these skills in which situation. Learn and master surgical skills, you have to be highly precise too in using skills. 2. The Art of Patient Satisfaction Now, this is something that is rare among surgeons yet highly sought after. Not every surgeon is as good at satisfying patients as they are with performing surgical procedures. This requires the surgeon to have highly proficient communication skills that can help them convey their message effectually to the patients and address

any concerns they may have pertaining to their condition or the surgical procedure. 3. High Knowledge Base In the medical field, you can never be knowledgeable enough to say that you know everything and there is need for nothing more. The learning process for doctors is continuous, and a surgeon aiming for perfection knows the importance of this process. They continuously work on increasing their knowledge base to ensure that optimum care service is delivered to the patients. Surgical field is witnessing inventions and innovations in the surgical procedures and discoveries of new techniques rather frequently. To become a perfect surgeon, you have to keep up with these advancements and discoveries to ensure you stay abreast of the research and deliver results accordingly. Tips to Become the Perfect Surgeon Becoming the perfect surgeon requires you to practice consistently and work relentlessly on refining your skills and knowledge to make yourself as updated as possible. Some useful tips that can help make you a more responsible and ultimately perfect surgeon: 1. Carry Out a Pre-Op Preparation A comprehensive pre-operative examination and investigations are very important before surgery as there is nothing worse than going into operating room ill-prepared. It ultimately impedes your confidence level and curbs you from performing optimally. It is important that you take substantial time before the surgical

procedure and give attention to the case you are about to perform. Talk to the patient, answer queries, take their consent and listen carefully to what they have to say. This will enable you to know what thought process they are going through and how you can acquire their trust and satisfaction subsequently. Besides studying your case and talking to patients, the details of the operating room is another important thing you need to be watchful for. Having all your things in place and conducting your own survey of the room helps you prepare better. 2. Be Observant The best quality you can cultivate in yourself during your medical college and training years is that of observation and information absorption. These two skills are going to get you to the level of perfectionism. When you observe things and acquire information from them, it ultimately makes you more vigilant in your doing and careful in how you execute surgical procedure. So have a sharp eye for details and always follow the 'Checklist System' to minimize any mistake. 3. Read, Review, and Repeat To nail your surgical career, you need to develop a thorough habit of reading and doing it a lot. Reading articles about surgical techniques/innovations, recently published cases and research studies about discoveries and trials can help expand your knowledge base and compel you toward critical thinking. This reading refines your skills as a surgeon and makes you more abreast of what is

happening in the field so that you can mold your practice accordingly and offer optimum care. 4. Find a Mentor, Give Respect, to Get Respect There are many great teachers who are willing to mentor young surgeons. You have to give respect to your peers, subordinates and patients to earn back their respect. A perfect resident is not the one who is perfect in the surgical room. He is perfect in all aspects outside the surgical room, too. As a matter of fact, you can only perform optimally in the surgical room if you are able to develop the trust of those whom you work with and those you work for. So, bear this reciprocal method all the time – you are going to get what you give out. 5. Practice in Wet Lab using Animal Model or Surgical Simulators Being a surgeon, you need to further refine your skills because there is practically no (or very minimal) room for mistakes. As you learn and perform delicate surgery as resident-in-training, you put your patients at risk. This is a tough truth and you have dealt with it while training. The question is how to limit (minimize) that risk and add value to the patient who has agreed to let you operate on them. In most residency programs the resident gets the chance to perform surgery in the last year. However, it is better to start practicing surgery from the beginning of residency, which includes getting both hands going under the operating microscope in your practice lab, minor room or operating room. Residents should practice surgical steps, suturing, on animal or surgical simulating models/devices as

this is helpful for hand-eye coordination. Practice using both right and left hands and assist the surgery (as much as you can) while keenly observing all minute details. During the conferences, never miss the opportunity to participate in organized wet lab and simulation sessions seriously. Structured learning limits your risk to our patients. 6. Minimize Error by Following the WHO Surgical Safety Checklist The WHO surgical safety checklist was developed after extensive consultation aiming to decrease errors and adverse events, and increase teamwork and communication during the surgery. The 19item checklist has gone to show significant reduction in both morbidity and mortality and is now used by majority of surgeons worldwide. 7. Perfection for Left-Handed Surgeon It is a rather common question to ask whether left-handed people can become a perfect surgeon or not. Well, the answer is yes, they definitely can. Being perfect is not a skill or a certain art that needs to be learned. It is actually a matter of practice – a whole lot of a practice. The process may not be as easier for the left-handed people because the apparatuses and tools are designed keeping in mind right-hand users, but nothing is impossible to do if there is consistent practice behind it. Any art can be mastered when you keep doing it consistently. Left-handed surgeons, however, have to face more difficulties as patients are not much comfortable with their laterality.

It has long been recognized that good surgery requires technical skill, safe judgment, and dedication. Adding to these criteria would be communication skills, decision-making skills, and empathy for the patient. Yet, those individuals who prove to be ‘great surgeons’ must have something more to stand above their well-trained peers. The surgeons must be technically sound; make sensible, logical decisions; communicate well with their patients and know when (and when not) to operate. In summary, a perfect surgeon needs to learn how to operate, when to operate and when not to operate. It is not just the medical profession they need to get a grip on, but should be able to integrate attributes of other professions, too. Having good memory and excellent accuracy, extensive knowledge and a curious soul, precision like an engineer and vision like a keen observer, reckoning like a lawyer and wisdom like a philosopher; a surgeon should be a know-it-all person having the essence of several professions to do the most crucial job in the world. Take-Home Message ➢ Perfection is the process of repeated practice. So, practice continuously to become a surgeon who is perfect in their field. ➢ With skills, work on precision as well to master the surgical procedures. Precision allows you to use your skills wisely and appropriately in accordance to the situation. ➢ A perfect surgeon has tremendous communication and interpersonal skills which they use for building patient satisfaction and developing a competent team.

➢ Work continuously on increasing your knowledge base to ensure that optimum care service is delivered to the patients. ➢ During the surgical procedure, pay attention to the patient and talk to them about what and how they are feeling. Also, focus on the details of the operating room to make the process easier for you. ➢ Follow the surgical safety checklist. Have a good eye for details. Observe each surgical step and acquire information from them, and keep yourself abreast of all the recent developments.

15. Interacting with the Patients and the Art of Patient Satisfaction

“Given one well-trained physician of the highest type he will do better work for a thousand people than ten specialists.” - William J. Mayo Patient education and patient satisfaction is an integral part of effective healthcare. Being a clinician, your communication skills have to be just as apt as your clinical skills. This is mandatory for effective interaction with patients as well as for patient satisfaction. You have to deal with patients on a daily basis and you are responsible for communicating it to them how to lead a healthier life. Also, you are obligated to explain them clinical diagnosis lab results, medications, and treatment plans. Communication is a two-way street. You have to be good at communication and should also be able to encourage the patient to communicate back. Your jargon must not be too ‘medical’ for the patient so that they will be able to understand. You should be able to explain the diagnoses, treatment, and expected outcomes to the patients in simpler terms so that they are easily able to comprehend it and make an informed decision.

The years that you have invested in the medical college, internship, residency, and fellowship entail the ultimate objective of treating and healing patients. The knowledge earned can effectually hinder the communication between you and the patient if you do not know how to deliver the message to the patient in a manner that they understand it. To ensure better interaction and maximize productive outcomes, you have to adapt communication skills that can make the process better. Here is how you can do it: Listen Carefully Active listening is the key to communication. You cannot understand what the other person is trying to say or thinking until you do not listen to them carefully. Being a medical professional, you are heavily dependent on the information that is provided to you by the patient. You can only develop effective outcomes if you know your patient well. You can, although, know the condition of your patient well through diagnosis and medical results, but you will only know your patient completely when you know how they feel and what is going in their mind about the condition they have. You have to allow them to talk about themselves. Give them time and deal with them patiently. Give them the room to make up their answers carefully. Encourage patients to explain their symptoms and recall their medical history. You have to let them talk without interrupting them. Listen to your patients carefully and be observant of their non-verbal clues. You will be surprised how much you can learn from the body language of the patient. The more

attentively you listen to the patient, the better information you will get and the more it will encourage the patient to talk. Avoid Medical Jargon Using medical jargon in your interaction with the patients is one way to overwhelm them. As much as it reflects your knowledge, you have to be careful about it when you are communicating with the patients. You do not want your patient to get all confused with all the mouthful words. You have to make it easier for them. Talk in a language that they can easily understand. No matter how much your mind coerces you to use the medical terms going in your mind that fits the situation better, do not do it. It is only going to create more emotional distance between you and your patient. You have to bridge the gap, not increase it. You have to learn the skill of how to communicate in an easy and simple language. That is how you can interact effectively with every patient. Bearing in accordance with the low literacy rate of India, you are bound to encounter rural patients who have a hard time understanding even simple words. Therefore, you have to make it easier for your patients. Use simpler words and easier sentences to get the interaction executed more effectively. If possible, speak few words in their local language to win their confidence. Use Visuals Visuals hold immense power when it comes to communication. They can work far more effectually than texts and words. You will be surprised how easier things can be demonstrated through relevant images rather than verbally explaining them. Especially in the

medical field, you have to explain various conditions and procedures to the patients and you also have to be careful about the complex medical terms, diagrams. Visuals that can come in really handy as they enable the patients to get a better understanding and a more comprehensive grasp of the knowledge that you are aiming to deliver. Talk Patiently The tone you speak, the speed and the clarity in your speech play a vital role in communicating with the patients. You have to demonstrate a certain level of patience while talking to the patients. You have to be aware of the fact that they do not know what you do and it is your responsibility to explain the things that they need to know in a simple and understandable manner. Your speed while communicating should be slow. Take time to deliver the message to the patient so that you know they have understood it. Talking patiently will also improve clarity in your speech, making the words more comprehensible for the patients. If you are running short on time, instead of dumping the information on the patient, make an effort to schedule a follow-up appointment and take time to go over the information thoroughly. Acquire Patient Engagement Patient engagement is the surety that they are involved in communication and are getting what you are trying to tell them. The information that you are trying to deliver might get overwhelming for the patients to process. Therefore, you have to make sure that you have the attention of the patient and they understand what you are

saying. The best way to acquire engagement is frequently asking the patients if they are getting the information. You can also ask them questions to ensure their attentiveness. Encourage Patient to Talk and Ask Questions Talking is important. You have to encourage the patients to talk about themselves, their medical condition and ask questions to clarify their doubts. You are only able to get the required insight if the patient is willing to communicate. The symptoms of the present condition cannot be completely understood by diagnosis. You have to know what the patient is feeling or experiencing before you finalize what diagnostic tests they should be undergoing. You would not know the root cause of the condition unless the patient tells you what treatment they have taken previously. You have to ask open-ended questions from the patients so that they are encouraged to talk more openly about the subject matter. Art of Patient Satisfaction Patient satisfaction is one of the essential components that helps deliver effective and optimum quality healthcare service. Patients are the ultimate final point of your profession, and art of patient satisfaction is an important quality of successful doctor. You need to utilize your skills, knowledge, and experience in a manner that it serves the patients in the best possible manner. Here are some ways how you can enhance patient satisfaction during the clinical practice. Be Punctual in your Schedule: Always try to maintain your consultation time and avoid (or minimize) long waiting time by team

work and efficiency. Inform your patients, if you are running late as it is unprofessional to make a patient wait for the long time but is also considered rude and insensitive. Serve with a Smile: It costs you nothing to be kind and courteous. Your humble profession demands that you keep a friendly stance with the patients. This is important in cultivating a relationship of trust and reliability between you and the patient. This will encourage the patients to have faith in their doctor and communicate with you about their condition. The information that the patient will provide you will help immensely in improving the intervention plan and enhancing the quality of care simultaneously. Provide Intervention Details and Acquire Consent This is an integral part of patient service. If you want to save yourself from unnecessary legal troubles, you have to follow the code of conduct religiously. Acquiring the informed consent of the patients should be an obligation you should never take lightly. This is important for your own protection from legal troubles. You are obliged to attain the agreement of the patient after giving them a detailed overview of the suggested intervention in an easily comprehensible manner. Laying out the risks involved and the expected outcomes, and the total cost of treatment, you have to give the patients room to make a fully informed choice and then acquire their written consent. This is necessary under medical ethics and also contributes to patient satisfaction. Communication is the Key

Communication is an integral part of almost every profession. You cannot expect a salesperson to close a deal without communicating. A client service representative cannot execute his job without having appropriate communication skills. Communication, explanation about the cost of treatment, need for follow up in very important in the medical profession to avoid medico-legal problem. Legal troubles can be avoided if you, the clinician, know how to interact and communicate with the patients. Patients are an essential source of information. You have to get the required information out of them in an effectual manner. This you can only achieve if you are appropriately laced with a set of communication

skills

and

have

reinforced

the

effective

communication tactics frequently. Listen Proactively, and Do Not Interrupt Communication starts with active listening. You have to have good listening ability with minimum interruptions. The more you let the patient talk, the better. Also, you have to be in control of the language you use while interacting with the patients. It should be sans any heavy medical jargon and should constitute of really simple words that are understandable for the patients. Images can be an effectual tool for you to execute productive communication. They can help the patient in the situation better. Transparency about the Cost of Treatment Always provide details of cost of treatment. Patient satisfaction is highly associated with good communication, ethical practice,

transparency about the cost of treatment. To ensure higher patient satisfaction, you need to provide quality care. Providing patient satisfaction also requires you to follow certain ethics that entail being punctual on your schedule, serving the patient courteously and getting their informed consent. You have to keep in mind all these while interacting with the patients to ensure that you provide them with quality care and a fine experience. Clear Communication to Avoid Malpractice Claims Communication between patient and professional and giving information about the cost of treatment is not just necessary — it can save lives and prevent malpractice claims. A 2016 study from USA found that communication failure was directly responsible for 1,744 patient deaths over the course of five years and was the root cause of some 30 percent of malpractices claims. Take-Home Message ➢ Listen to your patients carefully and be observant of their nonverbal clues. ➢ Talk in a language they can easily understand. Always provide details of cost of treatment. ➢ Use visuals to explain procedures and conditions to the patients. Be careful about the anatomical terms, and diagrams as patients do not know what you do. ➢ Talk slowly and take time to deliver the message to the patient so that you know they have understood it.

➢ To acquire patient engagement, ask them frequently if they are getting the information. You can also ask them questions to ensure their attentiveness. ➢ Asking open-ended questions can encourage patients to talk more openly about the subject matter.

16. How to Deal with VIP Patients “Three directives for caring for VIPs: Vow to value your medical skills and judgment; Intend to command the medical aspects of the situation; Practice medicine the same way for all your patients.” - Mariano EC, McLeod JA. Emergency care for the VIP patient. Intensive Care Medicine 2007 While working as an ophthalmic surgeon for past 15 years, I had the chance to deal with several VIP cases ranging from politicians, spiritual guru, administrators, or famous persons of the city, or celebrity. It is quite obvious that you cannot treat the 'Very Important Patients' in a similar manner as your regular patients. It has to be qualitatively different. These patients require greater access, higher attention and more resources from the provider they have chosen to get the health services from. The quality care for the VIP patients, regardless of the perceived benefits, may stagger a little due to the requirement of healthcare staff to go beyond the average standards of the healthcare organization. The staff is usually accustomed to the procedures that are applicable to routine patients. Taking care of VIP patients can become rather challenging. The presence of such patients may instigate an overwhelming sense among the hospital staff and create an ethical tension. This may cause the staff to perform inferiorly. Moreover, it can also impact the professionalism and ethical approaches to healthcare delivery. This is a highly challenging situation where you have to be exceedingly careful and take steps rather vigilantly. The situations,

obviously, differ in every experience. At times, it is a media circus outside the healthcare facility. Other times it is the exceeding influence of the VIP patient themselves. You may feel strained by all the internal and external pressure while trying to maintain the quality of care. It often happens that the influential patients get a team of medical professionals from different institutes to work alongside you. This can be a total disaster as too many cooks may spoil the broth. Also, when there is too much attention on you while you are treating a VIP patient, you are bound to lose some nerves here and there. The pressure fuels nervousness and it hinders the optimum functioning of your brain. VIP care is often sought for increased benefits, but it can very much turn into the opposite if the clinician does not know how to handle the pressure and challenges in a better way. As tough as it is to resist the charm of a VIP patient, it is imperative that you make a decision carefully. Working with these patients will require you to be a tough nut to crack before the media. You have to be watchful of what you say and do, as you will be under the media trial, too. You have to be sure about how much liberty you have to talk about the VIP patient’s personal and health-related information. Any slip-up can land you into legal problems. It is imperative for you to understand that VIP patients may include people with elevated fame and social status, but that does not mean you have to go all the way to change your practice means and standards. Only because they have higher social status, or more popularity, does not obligate you to provide the qualitative care any differently.

You have to maintain a balance and adhere to the rules, making no additional favors that you would not consider doing for any regular patient. To deal with the very important patients in a better yet professional manner, here are some ways that you can apply: Rules are above Everyone: The pressure that you have in the presence of very important patients in your healthcare organization can substantially impact your clinical practice. It can influence your wisdom and approach toward things that you normally would not consider doing. You may be tempted to go out of the way, not following rules and regulations, when it comes to catering to the VIP patients. You must not. They are paying more for better healthcare, not for changing your entire conduct. You have to resist any temptation, pressure or influence that may affect your clinical judgments and practice. As a clinician, it should be your utmost ethical priority that you do not let circumstances influence your judgment and perception. Your ultimate aim and priority should be the provision of high-quality care to all your patients. You should be able to maintain consistency in your operating procedures and avoid any such attempt that may lead toward compromising the care. The term 'VIP syndrome' was coined as early as 1964 by psychiatrist Walter Weintraub, who described how 'the treatment of an influential man can be extremely hazardous for both patient and doctor.' He found, even back then, that the admission of VIPs to an inpatient setting was 'often followed by considerable turmoil within

the institution,' which can unfortunately undermine the quality of the care that the patient receives. There are several cases of intervention care gone wrong only because the medical professionals were unable to adhere to the procedures and regulations under the influence of VIP patients. When doctors' judgment gets clouded, the outcomes start to lack efficiency and as a result, the patient suffers. The wrong diagnosis is pretty much common across the globe for VIP patients. Caring for VIP patients requires innovative solutions so that their VIP status does not adversely affect the care they receive. Michael Jackson and Eleanor Roosevelt are primary examples of how VIP patients suffer when the medical staff is suffering from VIP syndrome. You have to train yourself to resist any and all sorts of influence from anyone. You cannot choose to modify the care and diagnosis rules for patients only because they are more influential. Your only drive should be the provision of quality care. This is your job, your obligation. Remain steadfast in your principles and learn not to let anything control your better judgment. Emphasize on Teamwork: Teamwork is important in every situation. Be it working on complicated cases, handling challenging situations, or dealing with conditions such as VIP patients; teamwork has become essential in the clinical practice. You can no longer rely on working solo and still provide optimum quality care to the patients. The contemporary setting of the world demands that you work in collaboration with other people and mutually work to achieve productive outcomes.

Having VIP patients in the hospital is a complex situation. The possible media circus outside your hospital setting, eager to get any bit of information related to the celebrity, philanthropist, or any influential person admitted under your care can make things rather difficult to handle. Moreover, the presence of such an individual may create nervousness in the air or instigate too much excitement among the staff that it becomes difficult to execute proper care. To deal effectively with such a situation, it is important that you have a strong team who can communicate and coordinate effectively with each other and resolve clinical issues effectively. However, you must be able to retain control on your team, as you are the clinician who is directly responsible for the clinical care. You must ensure that your team is not making any compromises in clinical care and everyone is performing their responsibilities well. You must coordinate with the consultants, gather multiple views, discuss findings and then develop the best-suited care plan for the VIP patients. When you take an upper hand in the decision-making, it gives less power to your team members to do anything out of the way for the VIP patients that may impact the intervention plan. However, you have to strongly encourage effective communication between the team members so that you are systematically updated about the proceedings and orientation in treatment and care. Communication is the Key: As emphasized upon previously, you need to ensure that there is an effective flow of communication between the clinicians, nurses and the hospital management. This should also include the family of the VIP patient, and the visiting

medical professionals who are invited for opinions and are accompanying the patient. As much as the information is effectively communicated, the better everyone will be able to commence their task. Catering to VIP patients brings challenges in terms of logistics and security as well. As a matter of fact, the VIP patient is vulnerable under your care. You have to ensure that their security is up to date, and no news or information is leaked out that the patient and their family does not want to get outside the hospital premises. This elevates the burden of responsibility on you as a clinician. Under such

circumstances,

the

better

you

are

at

maintaining

communication, the more your staff will stay informed of what measures to follow to protect the privacy of the VIP patient and maintain discretion to ensure security. You can maintain coordination with different departments so that you do not experience any hindrance and unnecessary external attention during visits. For instance, you can coordinate with the radiology department and select the off-hours appointment for the patient just so you do not have to pass through the public and bring the attention of the public. Handle the Media Appropriately: Media can be rather tough to deal

with.

The

relentlessness

of

journalists

and

media

representatives is not something the world is unaware of. One essential thing that accompanies the VIP patients is their need for privacy. They may demand you to retain the discretion at all costs.

Even professionally, you are obligated to sustain the patient-clinician confidentiality. You can work things out with the patient and their family to decide how they want to deal with the media. It could be the patient’s own representative to relay the medical information and health status of the patient, or it could be a clinician-led press release. In either circumstance, the consent and approval of the patient must be achieved. Having a hospital clinician in the media conference can be beneficial as a medical professional can explain the news better and answer any relevant question. Also, a hospital representative delivering the news can cause more satisfaction than a publicist or celebrity manager providing the statement. Protect the Patients’ Security: When you have political figures, celebrities or royal members under your care, their security becomes an important part of your care plan. You have to be additionally careful about the location in which the patient is residing, the people who have access to the patient’s ward/ room, and other logistic details. You have to take care of the limited accessibility, and accommodation of security personnel to ensure the safety of the patient. You may need to ensure that the location in which the patient is residing is safe and suits the precautionary measures of the security. Patients that are celebrities, royal members, political figures, or belong to any other influential group, require a rather modified courtesy. You have to accommodate their needs without

compromising your professionalism and duties as a clinician. Your ultimate objective must be to provide optimum quality healthcare. You have to remain steadfast with your professional duties and care provision standard so that there is consistency in the treatment. Sometimes VIP patients may get sub-optimal healthcare due to challenges that medical staff may face under their influence. It could be because of the visiting medical professionals whom the VIP patient has invited or the overwhelming feeling experienced by clinicians due to the presence of the patient. It is your duty as the clinician to ensure that the treatment is carried out in a professional manner without any compromise on the quality of care. You have to make sure that you as well as the rest of the hospital staff abide by the rules in every situation, irrespective of the fame and influence of the patient. To handle the situation better with the patients, you have to maintain strong teamwork and effective communication within and outside the team. You have to coordinate with other departments to ensure that the treatment of the patient is carried out seamlessly without any security risk. Handling media can be a difficult process. You have to carry it out carefully and with the consent of the patient. The situation with the VIP patients may get challenging but it will help you refine your skills as an administrator. Take-Home Message ➢ As a clinician, it should be your utmost ethical priority that you do not let circumstances influence your judgment and perception. Your ultimate aim and priority should be the provision of high-quality care to all your patients.

➢ Have a strong team who can communicate and coordinate effectively with each other and resolve clinical issues effectively. If the information is effectively communicated, everyone will be able to commence their task efficiently. ➢ Have a hospital representative who can handle the media and deliver the news regarding VIP patients. ➢

You’ve

to

accommodate

VIP

patients’

needs

without

compromising your professionalism. Your ultimate objective must be to provide optimum quality healthcare.

17. Sharpening the Saw: Role of Medical Conferences to Upgrade the Knowledge and Skills

“The glory of medicine is that it is constantly moving forward, that there is always more to learn. The ills of today do not cloud the horizon of tomorrow, but act as a spur to greater effort.” - William J. Mayo Medical conferences help in refining the skills of doctors consistently through updating them with the latest developments and technologies. Over the last few years, the number of medical conferences is steadily increasing. Organizers are putting lot of effort to hold these events and sponsors are spending lot of money. However, a serious concern is the decreasing number of participants, particularly young doctors, that is visible from empty scientific halls. Since many educational videos are easily available on Internet and web-based teaching platforms (such as webinars, podcasts, and social media platforms such as YouTube, etc.), it is pertinent to ask the question: Are medical conferences losing their relevance and how to reverse this trend by increasing participation in these conferences and how can young doctors maximize benefits from these conferences?

Medical conferences are supposed to fulfill a critically important role in the ongoing education of young doctors, residents, and practicing doctors. There are many objectives which these conferences

meet

apart

from

merely

imparting

education:

Sharpening the surgical skills, ability to interact with peers/keyopinion medical leaders, trying newly introduced equipment, and developing

consensus

in

contentious

areas,

all

leading

to

improvement in health-care delivery, and outcomes. The health paradigm is changing swiftly and almost every branch of medical field is advancing rapidly too and surgical procedures are upgrading with new and innovative techniques and equipment. The medical fraternity across the globe needs to keep up with this change and development. To individually keep up with these radical changes may not be as feasible for the professionals. Medical conferences fulfill this need and play a critical role in the education of medical professionals and their team members such as nursing staff and medical technicians. Here are some benefits that residents/young doctors can avail if they choose to make use of the opportunities that medical conventions offer: Improve Surgical Skills: Surgical discipline of medical field requires the professionals to have highly accurate skills to practice intricate surgeries that require maximum precision with minimum to no room for error. The conferences usually offer 'skill transfer courses' and can help young doctors learn new surgical techniques and improve these skills before they start their hand-on surgeries.

Professional

Networking:

Medical

conferences

are

an

opportunity for young doctors to meet the pioneers of the field from all over the world. They can form connections that can help them improve their practice and grow in their profession. Conferences offer tremendous opportunity for young professionals to develop networking and cast a positive impression to ensure a fellowship and/or super-specialty training. Beyond Education Training: Being a medical professional, your learning never ends. It is the need of the profession and requirement for competency. Conferences offer training that helps you remain updated and knowledgeable at all levels. Setting Career Scope: Meeting with the specialists of the field, who have been working for years and have remarkable experience in hand, can offer counseling to entrants for career establishment. They can understand the scope of the career they are aiming for and get a glimpse of how it is going to be should they choose to pursue a particular career. Now question comes how residents/young doctors can take maximum benefits from the medical conferences? With the perks of acquiring information and building networks, there are some preparatory and attending obligations that need to be fulfilled to take maximum benefit of the conferences. Here are some of them: Set Yourself Apart from the Crowd: Conferences have numerous participants from all across the world. It is important that you set yourself apart from the crowd. This can only happen if you get visible enough in the event. The best way to do so is to take up a

role. Becoming a presenter, facilitator, or volunteer (such as during a skill transfer course) can help you gain an edge over other participants. Strive for Connections: When you attend a medical conference, treat it as an opportunity to make yourself known to the fraternity. You need to socialize more and connect with professionals from diverse backgrounds. The more you develop relationships with masters of the field, key-opinion leaders, and known surgeons of your field, the better networking you will have. Select the Conference Carefully: You need to be careful in your selection and choose the conferences that are most relevant to your sub-specialty or area of interest. Analyze the breakdown of each session you are interested and then narrow down the ones that are most relevant to your career choice. If you do not filter these sessions and choose to avail all of them, it would only take up your time unnecessarily for topics and skills not relevant for your practice. So, be vigilant in choosing the sessions. Remember What You Learn: This should be your priority. Conferences are meant to educate and train you. Networking and other things come alongside. The ultimate objective is to inform and you should be making use of this objective. Sessions can get prolonged and have lot of information, but you need to absorb the knowledge imparted on you. This is the only way you can implement the new technology, policy, or knowledge in your practice for which the session is organized.

Every young doctor wants a successful career and medical conferences are playing a tremendous role in helping us get there. The information technology advancement has facilitated the process of organizing medical conferences. The ability to conduct and attend the conferences virtually, offering simulation training and relaying online learning resources have helped yield positive results for the medical fraternity. Simulation training sessions offer residents-intraining or young surgeons to get hands-on experience before practicing them in real. This has served in improving the skills of trainee surgeons and has brought a constructive progress in the overall results. In the present age, the medium of presenting and attending conferences has changed the nature of conferences, but their effectiveness has only escalated with time. They are more beneficial and informative now than they used to be. More young professionals and residents-in-training are now able to become part of these conferences irrespective of their location. Some examples in the field of ophthalmology include- All India Ophthalmological Society, Academic Research Committee (AIOS ARC) educational program, iFocus (national postgraduate education program in Ophthalmology), and Young Ophthalmologist Society of India (YOSI), Women in Ophthalmology Society (WOS) conferences, which have done a remarkable job to update ophthalmology training in India. Scope for Improvement of Medical Conferences There is always room for improvement to make things and procedures better than they already are. First thing that needs to be covered is the number of specialty conferences. While each

conference is important, the schedule and commitments of the doctors should be valued as well. The number of specialty conferences should be limited and should be organized in an efficient manner with more emphasis on organizing few wellattended specialized conferences rather than several poorly attended events. Surgical branches require more skilled and trained medical professionals. Therefore, specific areas should be focused on skill development to ensure efficiency. With an increasing trend to organize more and more medical conferences, there is bound to be repetition, which makes these conferences less attractive. We need to focus on quality and reducing the quantity will perhaps make them more relevant. Every medical conference needs to have a specific goal and vision that is achieved by the end of the meeting. It is important that the conferences are backed by extensive research, or else the purpose of the event would remain unachieved. The organizers also need to be aware that educational material is today available at the push of a button, and therefore the conferences need to reorient in a manner that they are useful over and beyond the material available on the Internet. Some organizations are doing that like Mentor- Mentee and Women in Research program by the Women Ophthalmological Society (WOS). Take-Home Message ➢ Medical conferences are an important element in the advancement of the medical field and training of doctors.

➢ They serve as a platform to unite and educate the practicing doctors and improve the quality of medical care. ➢ Participation in the medical conference help young doctors for sharpening the skills, ability to interact with key-opinion leaders (KOLs), trying new equipment, evolving novel and locally relevant ideas, developing consensus in contentious areas, all leading to improvement in healthcare delivery, and patient outcomes.

18. Stress Management: Work-life Balance

“It is neither wealth nor splendor, but tranquility and occupation which give you happiness.” - Thomas Jefferson Every profession is difficult when it comes to coping up with pressure and stress. The medical profession, however, tops the list because of the nature of the profession and the situational sensitivity it entails. Sure you can not expect a person to be calm, while dealing with a patient who is amidst the struggle between life and death. The seriousness of the profession makes it all the more difficult for the clinicians to maintain the right control on their stress level. Lack of stress management is not limited to your workplace. It is likely to find its way into other aspects of your life and cause damage. Therefore, this necessitates a level of balance between your work and personal life. You do not want your profession to affect your family life or compel you to make a compromise with yourself or your family. There are several factors that promote stress. Having identified those triggers, you can effectively work on diminishing them and retaining control over your mind. Being associated with the clinical practice, it is the nature of your job that fuels stress. Conducting hours long surgery, dealing with aggressive

patients and their family, working on complicated cases, witnessing people struggling between life and death, and patients losing the battle for life – it can get tremendously overwhelming. The strain incurred not only affects your mind and body but it also impacts those associated with you, that is, your family. On the contrary, unstable relation with your wife, husband or partner, juggling with house chores, keeping up with family obligations, children's homework and other personal stuff can also cause exertion on your mind, leading you toward under-performing at your work. This can cause highly damaging consequences. The sensitivity of your job does not allow you much room to perform less any day. You cannot make up for things later. It is human lives that you are responsible for. Therefore, it is harmful in both ways. You cannot let any of them suffer. You have to work on developing skills that can help you retain a sufficient balance between the two so that one does not get affected by the other. Your mind needs to be stress-free and focused on the task at hand. To eliminate stress, it is important that you maintain a healthy living that has a balance between your work and personal life. Your mind is only able to perform effectively and stress-free when you make the conditions favorable for it. Here are some ways how you can cope with stress. Maintain the Boundaries: Always remember that there is no room for work at your home, just like your home problems should be left at the door of the hospital. You have to retain the boundary between the two. As long as you do not let one invade another, you will be

able to keep the stress limited as well. If you keep yourself in the same zone, your mind will never be able to step out and get some change to relax. Work-related problems should be limited to work only. Your personal life should not be involved in it. For instance, after a stressful day at work, you go home and relax with your family and friends, and the next morning you start fresh with new energy and positive mind. If you keep on worrying about work at home too, it will decrease your brain’s functioning and impact your health and efficiency. Make Meditating and Exercising a Habit: Meditating and exercise both have a wondrous impact on a person’s mind and body. They help you relax and release your tension. They promote healthy outlets for emotional and mental exhaustion, encouraging your mind to stop stressing. Mediation has proven to be highly effectual in improving a person’s mood and stimulating positivity. It decreases emotional exhaustion and enhances empathy and satisfaction. It is Okay to Say No: It is not rude or arrogant to turn something down. If you cannot accommodate them in your schedule or you have other commitments, you have the right to say no. You are not obliged to accommodate additional tasks if they do not fit your schedule. You have to learn to refuse in a polite manner. This is extremely necessary to maintain your brain’s stress-free status. Your job is already time and energy consuming, you do not have to give your personal time to accommodate additional favors.

Stay Positive: Positivity matters a lot. It is important that you think positive and be around people who are far from preaching negativity. You have to surround yourself with an optimistic approach and take things constructively. This will keep your mind relaxed and boost energy in you to stay happy. Take Some Time off for Yourself: Give yourself some ‘me’ time. This is exceedingly necessary to ensure your well-being and to ‘destress’ yourself. Taking breaks gives you time to distance from work and regular routine. It serves immensely in fueling your energy and boosting your motivation. Working at the same routine can easily exhaust and stress you out. Make a practice of taking your scheduled days off. This will cast a positive impression on your mind. Striking Work-Life Balance Juggling work life and personal life can be difficult. You do not have to compromise one for the other. It is usually the personal life that gets dispensed for the sake of professional. It should not. Your longlearned skills of planning and management should be at their quintessential best. This is the time where you should be more in control of your schedule and timing. There is no rotation obligation, no examination to look up for, and no supervisor to answer. Aside from emergency cases, you have more freehand to decide how much work you want to take. You have to set the limits for yourself, and you have to maintain a steady balance between the two parts of your life, professional and personal. Here are a few things that you can look into to decide how to attain work-life balance:

Keep it Track of Time: Being focused on your work is good, but it does not mean that you ignore everything else. You have to manage things in a manner that you are able to take your personal life and career simultaneously with a good balance. In your planner, you must keep track of both professional and personal tasks. Prioritize tasks and give both obligations equal attention. Make a practice of delegating the all non-clinical tasks. Hire people to help you with your chores. You have to manage your time in a manner that things get done on their specific schedule. Keep a Checklist: The more organized you are the more in control of the situation you will be. This will reduce your stress substantially. Make a list of things you have to do and the events you have to attend. Keep a to-do list at home and work. This will allow you to know what things are to be done and what lies ahead of you. Keep Your Off Time ‘Phone-Free/Email-Free’: The worst part about emailing, internet and smartphones are that you are no longer away from work despite being away. The notion of 'ease of access' has only made it worse. It has obliged you to stay connected with work in the time that should essentially be your own. So make it a practice of keeping your phone and emails either off, or their usage limited. You have to give your mind time to unfold and give away stress. Work-life balance is not only important for your personal health and relationships but is essential to improve your productivity and performance as a clinician. When you keep a healthy work-life balance you will ultimately have a better physical and mental health

and have an improvised attitude toward your life and profession. It is an effective way of minimizing work-related burnouts and gaining emotional health. Take-Home Message ➢ You have to retain the boundary between your personal and work life. Work-related problems should be limited to work only. Your personal life should not be involved in it. ➢ Indulging in meditating and exercise can have a wondrous impact on your mind and body and help you relax and release your tension ➢ Learn to refuse and say no, and surround yourself with an optimistic approach and take things constructively. ➢ Prioritize tasks and give your personal and work life equal attention. ➢ The more organized you are the more in control of the situation you will be.

19. Managing Marriage with Your Medical Profession

“The family is the test of freedom; because the family is the only thing that the free man makes for himself and by himself.” - Gilbert K. Chesterton Practicing medicine, by no means, is an easy or straight-forward profession. It requires blood and sweat, and a whole lot of sacrifice to get where you dream of reaching. Relentless study hours, neverending course material, long work shifts, endless clinical rotations, and consistent work pressure can all accumulate up and dominate your life. They can compel you to trade your personal time, preference and commitments with that of work and clinical obligations. With long years at the medical college, and internship or house job, and then followed by residency programs, becoming a doctor is not something one would call easy. When you are single and on your own, it can be easier to sacrifice personal time and skip family commitments for the sake of your work obligations. But once you enter married life, the context of your entire life changes. You do not have just yourself to think of any more, but have responsibilities toward your spouse too. These are not just everyday responsibilities that you can overlook. It requires your

sincere efforts and dedication to maintain your relationship with the affection, communication and care it needs. Being a doctor, if you marry a non-medical person, it can be difficult for your partner to adjust to your life. They won't be used to the schedule you have been practicing for years and they definitely won't know the drill the medical professionals have to go through. Substantial efforts need to be made by both partners to reach a mutual understanding where the non-medical partner understands the complexity of the medical profession, and the doctor also takes steps to make married life more comfortable for both of them. For a doctor to marry another doctor or medical professional can come with some conveniences as they are aware of how things are in their line of work and what kind of situations may arise. They can provide better support for each other and can lead married life successfully. However, things can get strained between doctor partners too, if they do not have efficient strategies to make their marriage work and keep their better halves happy. Long-term relationships can be challenging for doctors because it is not easy to balance the competing demands of their career and keep up with the obligations that relationships and family come with. There is a general trend among doctors that they marry late. The motivating factor is that marrying early would hinder their career growth and curtail the flexibility and liberty they have to pursue any career path they want. So, they are inclined to making commitments only after they have established their professional roots and career, and have moved out of the highly-demanding initial phase.

There are different approaches taken by different doctors and experiences vary in all situations, but the dual-physician marriages are found to have a higher level of satisfaction due to shared professional interest. Studies have reported that the differences and conflicts in the personal and professional roles between physician partners are mainly due to call-hours, professional obligations intersecting

with

personal

commitments,

and

an

increased

responsibility toward the profession. This role conflict has resulted in job stress, burnout, and changes of the professional line in the career. Such a thing is more common for female doctors. Considering the societal setup of Asian countries especially, married female doctors are also expected to take up some share of domestic chores and have to keep up with both professional and family obligations. They are under greater pressure to maintain a balance between work and personal/ family life as compared to male doctors and husbands. According to statistics, female doctors working more than 40 hours a week have a higher probability of being divorced than those working lesser hours. A survey shows that out of 240,000 health professionals (including physicians), 25.2% dentists, 31% healthcare executives, and 33% nurses were divorced. Pharmacists have a lesser divorce ratio. The same survey reports that female physicians are one and half times more likely to get divorced than their male counterparts. If looked as per specialty, nurses have the highest divorce rate of 33%, followed by dentists with 25.2% and pharmacists with 22.9%. One of the older reports of John Hopkins University (USA) declares psychiatrists as

the medical professionals with highest divorce rate of 50%, followed by surgeons having 33% failed marriages rate. Challenges Faced by Doctors in Marital Life Challenges prevail in either case, whether or not you decide to marry a person within the profession. The nature of the challenges varies obviously, but this also hugely depends on the personality and temperament of individuals. Here are some main challenges for doctors in their marital life. 1. Communication Challenges This is perhaps the most commonly faced hardship among doctor couples. They both have an ocean of knowledge and experience of their own that makes it difficult for them to avoid clashes and entertain differences in decision-making. This can be a challenge for non-physician spouse, too as the partner does not get to know where they are coming from and vice versa. This makes communication rather difficult between the two. 2. Improper Work-Life Balance This is another integral challenge that disturbs the marital life of doctors. Having a doctor as a partner may give you leverage because they understand how things go about in the healthcare profession, but for non-medical spouses, they need some time to get used to the schedule. Even among doctor couples, untimely hospital calls, longer clinical sessions, and prioritizing profession over family time can result in marital conflicts. 3. The Share of Responsibility

Marrying a non-medical partner comes with an unbalanced responsibility share. Doctors, due to their increased commitments, may not be able to fulfill family obligations as devotedly, compelling their spouses to take up a greater share. This can result in conflict. In physician marriages, this is common too when both partners have to keep up with their demanding professions and they find it hard to share the responsibilities equally which ultimately causes a strain in their relationship. How to Maintain a Healthy Marriage To maintain a healthy marriage, medical or otherwise, it is important that deliberate efforts are made from both the partners to make the relationship work. There is no one-sided approach that needs to be taken but a mutual stance assumed by both the spouses. Here are some ways to maintain the spouse relationships and keep the partner happy. 1. Give Your Relationship Time and Attention It is true that medical profession can consume a lot of you time and thought. But once you are married, you need to set aside time for your spouse too and give them the attention they deserve. You need to maintain a balance between your work and married life. Build your relationship with care and patience, and put more thought and deed into it. You need to cut down some of the additional professional obligations to accommodate your married life better. If both the partners are doctors, they need to take equal measures to give each other adequate attention. If your spouse is non-medical spouse, then

you have to understand that your wife or husband is not accustomed to your profession. You will have to build their trust accordingly. 2. Seek Professional Help There is no shame in getting help whenever you need it. It is better to get counseling rather than ending up with a broken marriage. Couple therapy and other such initiatives are quite helpful in straightening out the differences and see where the problem actually lies. Being doctors, you should be more convinced of the benefits that counseling can bring into your life and make your married life happier and bring more satisfaction. It can also help your nonmedical spouse to understand you better. 3. Communicate Effectively Communication can become challenging when you both come from the same profession but have different points of view, experiences, and knowledge. But, making conscious efforts to actually listen to your partner and be patient with their views can bring surprising benefits to your marriage. Make a habit of listening to your spouse's perspective and instead of being judgemental or arrogant, try to see them from their perspective. You need to choose your battles. It is okay to bow down sometimes. You do not have to win always. It is your relationship that needs winning. This is the base of strong marriages. 4. Engage Your Partner Keep your spouse involved in your activities. Update them about your professional life. Share your thoughts with them. Ask for their

opinion about things are going on in your life. Appreciate them for the efforts they are making. This is necessary whether or not you have a partner from the medical profession. Such an attitude actually relays a sense of value and care. You make your spouse feel that they are equally engaged in your life and you value their opinion and feelings. Marriage is a beautiful institution that cannot be fulfilled singlehandedly. Both partners have to pay an equal contribution to make it work. The contribution may lack or exceed sometimes, but efforts should be made consistently. Having a happy married life and a supportive partner is actually the key to productive performance at work. 5. Know Your Strength and Work as a Team Doctor and their medico spouse complement each other in professional work and family life. Several doctors are doing excellent professionally and also maintaining satisfactory work-life balance and I am one of them. I would like to share our professional experience and the significant role played by my spouse in private medical practice. Our marriage was late (as is common in the medical profession). My spouse (Dr. Vidushi Sharma, MD, FRCS) is also a very qualified, competent eye surgeon. After marriage, we completed our advance training in Australia, which took two years. It took us almost 2 years to decide our career path after wedding and we decided to return to India and started private practice in Kota (Rajasthan) from scratch. It was a difficult and unusual decision to leave a prestigious academic career overseas and settle in non-

metro city of India. However, with our combined strength, we did overcome the initial challenges very nicely. There are endless works when you start a new practice (specially difficult after working for several years overseas and with limited financial capital). Dr. Vidushi accepted this challenge very well and her contribution to build a successful medical practice was phenomenal. We worked as a team and distributed work in a way that was based on our individual strengths. I enjoyed interacting with patients and their family members, so I participated in awareness camps and other activities to spread the buzz about our new practice. My spouse, Dr. Vidushi, had excellent oratory skills and she prepared more than 300 health awareness and educational videos that we uploaded on YouTube. Dr. Vidushi also had excellent writing skills that helped us to spread the word about our new practice through media as well as scientific conferences and national and international journals. Many young doctor couples in India can do even better in their private medical practice, if they can make a list of their strengths and limitations and allocate work accordingly as per famous quotation from Groucho Marx- Behind every successful man is a woman and vice versa. Take-Home Message ➢ Doctor marriages come with convenience as they are aware of the field requirement and know what kind of situations may arise sometimes that can make you prioritize differently. ➢ Long-term relationships can be challenging for doctors because it is not easy to balance the competing demands of medical

professional career and keep up with the obligations that relationships and family come with. ➢ Differences and conflicts between personal and professional roles between medico-spouse are due to call hours, professional obligations intersecting with personal commitments and an increased professional responsibility.

20. Women and Medicine: How to Achieve Balance in Career and Family

“The Gift of Balance in Your Life – May you find the balance of life, time for work but also time for play. Too much of one thing ends up creating stress that no one needs in their life.” - Catherine Pulsifer India has a huge potential to gain a much better economic value if we are successful in achieving gender parity. If our momentum toward women equality is accelerated, we will be able to add US $700 billions of additional GDP by the year 2025. This will raise the country’s annual growth by 1.4 percent. The western world has reached heights of tremendous growth and success only because they have gender-equality and have women standing beside men and even leading from the front. On the other hand, in India, we are still struggling with a somewhat patriarchal approach. Men have to step back a little and give women their due opportunities to improve their potential. In medicine, female medical aspirants outnumber male counterpart in the medical college admission tests, and from 2010 to 2018, there was an increase of 4,500 more female doctors over male doctors. This trend is, however, noticeable all over the world.

Despite such high admission percentage, there is a grave shortage of female doctors in India. According to a report published, there are only 17% of allopathic doctors in rural areas and just 6% of them are women. This denotes that there is less than one female doctor per 10,000 people in rural areas. This makes the ratio 0.5 in rural areas. Sadly, the gender gap in the medical field is mainly because of the lack of practice of women clinicians after graduating from medical college. Medicine in India has become a male-dominated profession because of its lengthy and demanding hours. Women are unable to dedicate such long hours of medical practice mainly because of the fact that in India they are still struggling with maintaining career and family responsibilities simultaneously. Reportedly, in the country, women clinicians are restricted to selected fields mainly in obstetrics and gynaecology and other few branches as pediatrics, pharmacology, pathology, and microbiology. The reason behind these limited choices and safe options are the challenges they face in maintaining the right amount of balance between their career and family. Field of clinical medicine requires dedication. It requires a caring attitude that is totally dedicated to taking care of patients and saving and improving the lives of others. It requires long working hours fulfilling professional obligations leaving less (or no) time for personal life, family, marriage, and children. These sacrifices can be easier for male clinicians to make. For female clinicians, the scenario may be difficult in India, where family values are given utmost importance.

For men, it is possible to spend long hours at work or travelling around for professional and academic purposes. However, for women, they cannot completely focus on career obligations as they have to keep up with family responsibilities as well. This raises the imbalance between career and family. The struggle faced by women in maintaining the right balance hinders their ability to perform in a fulfilling manner. This kind of dilemmatic situation is one of the main reasons why women in India and its neighboring countries, Pakistan and Bangladesh, find dutiful to balance family life with medical practice. Obligated to perform multiple roles at the same time, as a clinician, spouse, and mother, it is usually the profession that gets sacrificed. It should not be this way. A clinician must not be coerced to make a choice between family and career. After all the years of relentless efforts, struggle, and time invested in reaching to the position you are at today, you cannot give up your profession just because you are unable to find the right balance. We have to step up and change this approach. A

woman

clinician

must

choose

certain

specialties

(like

dermatology, radiology, etc.) that would give her a more relaxing schedule to dedicate time to family responsibilities. It will be very difficult to find a good work-life balance in busy surgical specialities in today's time with high patient expectations. Women clinicians can carry out their dual responsibilities conveniently if we, as a society, change our approach or patients expectation are less. In India, a woman is expected to take up the role of a mother, a spouse, and a professional, and is looked upon to fulfill the responsibilities of each of the roles optimally. Male doctors on the other hand, are only

answerable for their occupational roles. It should not be this way. Male doctors should also have an equal share of responsibilities and should be equally answerable for all roles. Career-family balance has become even more important for women professionals, medical or otherwise. Given the changing statistics, the rate of divorces and separation is increasing in India. The ratio of divorced and separated women is more than that of men. This denotes the obligation falling on women to look after their children single-handedly and managing other roles alongside. This further demands them to maintain a suitable balance between work and life. Decisions pertaining to career and occupational choices should not be difficult for women in any profession. If a female medical graduate wants to pursue a specialty in obstetrics and gynecology, she should not have second thoughts about how she is going to keep up with other roles or if she would be able to juggle her family and professional life. She should be able to make her decision and choice freely and fearlessly. All she needs to learn is the art of maintaining a balance between her career and family without compromising on either of them. Achieving Career and Family Balance There is literally no secret to achieving balance in life. It is completely dependent on your own personal choices and decisions about how you want to combine your career with your family life. The ultimate aim, however, should be not letting one impact the other. You have to maintain a fine line between the two and not let it blur.

What you need to accentuate on is the development of creative solutions that can help you deal with the challenges while balancing the responsibilities of various roles yet have the time of your life as well. You have to live your life as well. Your life must not become totally oriented around your designated roles of doctor, wife, and mother. You should have a life that has a good if not excellent balance between your family and career and has some time for your own self as well. Developing some skills and constructing strategies can help you attain this balance and give you a more satisfying, fulfilling, and productive life. Having a Support System: This is highly necessary. You need to have people you can count on. They can be your mother, siblings, friends, your spouse, co-workers, and even your children. Learn to ask for help. You cannot do everything by yourself and asking for help is not something to be worried about or feeling guilty for. You can delegate work, have your responsibilities and work burden divided. Ask for support whenever you need it. Your fear is only hypothetical that they are going to turn you down. You will be surprised by the support your peers, friends, and family will be willing to provide. Making No Room for Guilt: You will never be able to reach any quality achievement if you are continuously struggling with the feeling of guilt. Feeling guilty never gets you anywhere. It only drains your emotional energy and increases the pressure on your mind, leading you toward depression and anxiety. This ultimately impacts

your efficiency professionally as well as personally. Dwelling in past will only staying from moving forward and keeping up with the present. You have to let go of any and all negative thoughts about yourself. You need to liberate your mind from the shackles of negativity and stay on a positive course. Setting Your Limits: You have to analyze yourself and outline your boundaries about what is and is not acceptable to you. You have to draw your own limits in terms of other people’s behavior, time, and even space. This is highly important in making yourself immune to external pressure and power. No one can exert their demands or orders if you have projected your limits visibly. You have to show what your personal values and limits are. This will help you in turning down additional favors and cases that you do not want to take or cannot accommodate in your schedule. These boundaries that you set around yourself are important in maintaining a suitable balance between work and family. Establishing Your Standards: You have to position the standard bar for yourself. It is you who needs to make the decision what actions you are willing to hold yourself to and what behaviors will define you. When you execute this task on your own, you are actually taking control of self-image. You can either let other people determine your standards and, as a result, you consistently struggle to either meet those standards or outlive them to improve your reputation.

This

ultimately

influences

your

work-life

balance

adversely. So, it is better to do it for yourself and keep your mind peaceful.

Organizing is Going to Take You Places:The key to career family balance is organizing. The more you are able to keep your personal and professional life organized the better balance you will be able to achieve. Align your priorities with your schedule. You have to work smarter not harder. Organize the tasks as per their urgency and importance. Make a practice of delegating work whenever you can, and getting help from your support network in times of need. Being Forgiving:You cannot do everything right at the same time. Give yourself some room for mistakes and leaving things undone without feeling guilty. You have to change your stance with your responsibilities. Things are definitely going to be different when you have kids. You just have to be flexible in assuming responsibilities. You need to adjust your goals accordingly so that the balance does not get impacted. These are just a few of many strategies and skills that you can implement in your life to attain an appropriate balance between your career and family life. Being a woman, you do not have to make difficult choices, but right decisions. You must not let the gendered approach determine your professional and occupational choices. You can maintain a fine balance between your career and life without letting one affect the other and still thrive in both. Though we need a change on a societal level to modify the approach of the community as a whole, the change begins individually. Highlighting priorities, aligning goals, organizing things, delegating tasks, and having a strong support network can contribute immensely in helping you maintain a healthy balance. You have to

mark your own limits and set your own standards to retain a firm hold and control over your life. If you do not do this, someone else will do and it will resultantly make you struggle more to retain the balance. Advice to Women Doctors My advice to medical students and young doctors would be to focus on getting the best possible training at the earliest opportunity. This is even more important for women, as it becomes very difficult to devote time to full time rigorous medical training programs at a later stage in life, particularly after marriage and kids. At an early age, it is possible to travel far and wide for the best training opportunities, specially in surgical disciplines. Medical practice is not easy because of heightened patient expectations and an aggressive consumer culture that is spreading fast. In such a scenario, it is absolutely essential to get the best possible clinical training, so that your competence is your big strength when starting clinical practice. I would also like to advise young doctors to choose their work based on their own personality and preferences. Some people are very good at communication and interpersonal relations and therefore do well in private practice. Some other people are interested in teaching, and do well in an academic setting. Some realize that they would do well in non-clinical branches, and some others decide they would want to change their field altogether. Assess your priorities and desires, and take an informed decision, as you can not keep changing these decisions. The most important thing is to decide on your own definition of success, and then stick to it, so that you are not just successful, but also truly happy.

Take-Home Message ➢ The key to career and family balance is using organizational and managerial skills. You can efficiently keep up with both when you know how to plan and organize accordingly. ➢ Ask for support whenever you need it. Have a strong support system. ➢ Set boundaries around yourself to create a balance between work and life.

21. Doctors and Time Management: How to Achieve More in Less Time

“Life and Time are the world's best teachers. Life teaches us to make good use of Time and Time teaches us the value of Life.” - Dr. A. P. J. Abdul Kalam The lack of time is a consistent complaint that is commonly made at all levels of a medical career. A medical student does not find enough time to study everything he/she is expected to do. An resident does not find enough time to sleep. A fellow is short of time to manage a social life alongside the clinical work. A clinician finds shortage of time when it comes to meetings other than work. So, yes, it is one of the many things that remains the same throughout your medical career. Being a clinician requires you to examine patients, study diagnostic results, plan and perform interventions, participate in academic sessions, and handle administrative responsibilities, etc. This can get really tough and compel you to make a compromise on either your professional duties or your family and personal life. You can tackle this precise challenge by ensuring effective time management and maintaining a work-life balance. In the preceding chapters, it has been discussed how important work-life balance is. To ensure this

balance in life, you have to implement time management as well. Just like you always feel that time is short, you have to consistently hold on to your time management skills as well. The more control you have on your time, the better you will be able to use it. In complex situations, you may often encounter feelings like you have got no time to do all the work that you have on your platter. It is easier to panic at this time and you become prone to make mistakes. If you know how to make the best of the limited time and how to schedule the overall day, you can attain more success. A decade ago when patients had to wait in long queues for hours for a medical specialist to visit is swiftly passing by. Today, patients want instant solutions to their problems. They want high-quality service with the minimum waiting time. Moreover, medical interventions now demand multi-professional teamwork. A clinician is no longer working on his own schedule. It is others’ schedule that is associated too. Tardiness is going to impact other professionals as well. But then there is not always a lax attitude from your end; it could be the delays caused by surgery that went longer than anticipated or the last moment emergency call that you could not turn down. Though these factors are not in your control, they are not going to justify your position for long. If meetings are getting delayed time and again because of your late arrivals, it will ultimately cast a negative impact on your workplace reputation. To guard yourself against wasting other valuable time, it is important that you manage your time effectively. Here are some

common reasons why medical professionals struggle in terms of time management. Not Saying ‘No’ When you start accommodating additional cases and tasks in your already tight schedule, your other prescheduled meetings begin to suffer. You have to learn to turn down requests so that your other obligations do not get condoned with more important things. You have to prioritize things accordingly. You cannot expect to make it to your scheduled appointment if you keep doing what others ask you to do. Unplanned Schedule Your day completely gets off the track when you do not make a schedule at all. Starting off your day without knowing what lies ahead of you is bound to make you lag behind the clock. Knowing about meetings and appointments at the last moment will rarely allow you to make it on time. Have a schedule of your appointments, procedures and follow-up visits and review them ahead of time so that you know what your planning for the day is. This will prepare you for what to expect and how to manage time. Lack of Teamwork The contemporary setting demands team work. You can no longer single-handedly take care of everything. You need the help of your assistants and subordinates to accomplish your tasks on time. The support of your clinical staff is crucial if you want to make the best

out of the given time. If you start doing even the smallest task on your own, your schedule is going to suffer. Delegate most of the responsibilities to your staff and teammembers. You have to have effective management skills to get the work done by your team. This will make you meet your scheduled tasks on time. Manual or Traditional Way of Patient Record Handling Lagging behind on technology is one of the worst mistakes you are going to do. Gone are the times when manual forms were filled and filed to maintain patient records. Today is the world of technology. You have to keep things simple, fast and accessible by following Electronic Medical Records (EMR). Manual handling of data only takes a substantial amount of time and effort. You can save a lot of your valuable time by transferring the manual data to digital. This will make it easier for you to access, study and analyze the current and previous data. Not Communicating with Patients Communication is integral no matter where you go. Whether it is an interaction with your staff, your peers or your patients, communication proves to be the bridge of reliability between you and the other. Your communication with the staff ensures that you are aware of the patient appointments and follow-ups, and your staff knows what commitments you have so that they schedule the appointment accordingly.

Communication with patients ensures that you do not end up with no-shows and get your time wasted. Having an effective coordination with other professionals assures that you develop a level of reliability with them. This is important in protecting your image within the medical community. When you have good relations with other professionals, they are likely to cover up for you when you are running late somewhere or getting delayed. No matter how legitimate the reason maybe, time is the greatest asset and you have to make the best of it in every situation. You have to use all your resources to ensure that you are getting productive outcomes from your time. To get more things done in a lesser period of time, you have to learn to delegate your responsibilities and make smarter choices. Undermining the importance of time management will have you fighting a lost battle with your ever-escalating 'to-do list'. It is important that you look out for wise solutions and decisions to effectively manage your time. Here are a few tips that you can make use of and get better time management. Work on Developing Self-Awareness Time management starts with learning about one's own self. You have to begin with knowing your own fortes and weaknesses. When you know what your strengths are, you will be able to utilize them better. Knowing your weaknesses, habits, and goals will enable you to know how you can accommodate your schedule around them. When you know which tasks take more time and which goal is high on priority list, you will be able to manage your time accordingly.

Work on Your Team's Efficiency Your team is a great asset for you at the workplace. You must know how to enhance their efficiency in order to manage your own time. The better your team is at executing their tasks and duties, the more managed your time will be in hospital or clinics. You have to ensure that there is a sufficient level of communication between you and the staff so that they know what schedule to follow. This will make the routine activities flow smoothly. Start Early Starting early has countless benefits. It gives you substantial time and opportunity to prepare your mind, get used to the surroundings and make necessary arrangements prior to the appointment. You can start your activities promptly and get a lead in the tasks to accomplish them efficiently and ahead of schedule. Your Planner is Your Best Friend The more planned your day is, the better you will be able to manage your time. Make a practice of maintaining a planner. Though, in medical practice, it can be difficult to stick with the planned time as you can never be too sure about the time an appointment with the patient takes. It could end in merely ten minutes or can even exceed an hour. Even if an appointment runs five minutes longer than the planned time, it is going to disturb the entire schedule you have planned ahead. You have to plan it in a manner that you plan sufficient time for each appointment so that it even if one appointment does exceed

its allotted time, you have slots in the subsequent appointments to cover up the loss incurred. Take Inspiration from the People around You No, you can never be too old for seeking inspirations. This is one thing that keeps on going all our lives. Looking at sources of inspiration keeps you motivated throughout and keeps encouraging you to work toward betterment. Working in the medical field, you will come across several people who can be truly inspirational. They can be your seniors who can inspire you with their dedication, professionalism, and ethics. They can be your junior staff or the hospital management who can impress you with their professional attitude. Your patients, too, can be a great source of inspiration to make your own life better. You just have to be watchful of the details. Your aim should be to look out for positive habits in people around you and make an effort to integrate into yourself. If you see a patient carrying a highly organized health record planner that takes him no time to present the required document, you can implement something similar to your Electronic Health Record system to make your data more organized and less time-consuming. Minimize Distractions Distractions can be your biggest foe when it comes to time management. They can totally ruin your schedule and make you lag behind substantially. Even if you choose to spend ten minutes doing something totally unnecessary, it will keep your mind occupied for far

more than ten minutes and influence your work productivity, making you lag behind in your tasks. It is good to take frequent breaks during work to help relax and relieve stress, but these breaks must not go beyond their allotted time. Your time management is going to be only as good as you want it to be. Your breaks must comprise of healthy activities like eating, reading, having a conversation with fellow doctors, or even going for a run. These activities help your mind relax and increase your productivity. Getting engaged in other distractions like continuously logging into social media, or leaving tasks in between is only going to keep your mind from focusing on the task at hand. As the famous saying goes, time waits for no one. You have to catch up with it on your own. Your professional obligations can make you lag behind in a lot of other commitments. This can substantially impact your reputation among your fellow peers. Considering the changing scenario of the medical world, we are swiftly moving toward multi-professional intervention planning. This means your time is not just yours anymore. It belongs to others associated with you as well. This makes it the all more necessary to be careful in your time management. You can refine your time management skills by prioritizing things accordingly and making sure that important tasks do not suffer amidst other activities. You have to make use of your available resources to ensure that your obligations get executed on time and you do not have to run late on other appointments. The most important of your resources is your team. You can attain immense

benefit by maintaining healthy communication and professional relations with your team. Moreover, you should look into measures that can help you manage your work efficiently and smartly. For instance, maintaining electronic

health

records

is

one

way

of

maintaining

time

management. They keep you from wasting too much time on locating the files manually. Similarly, having effective communication with patients can help you manage your schedule better and keep you from getting any time wasted unnecessarily. SUPER-SMART Time Management to Achieve Goal SMART means: Specific, Measurable, Attainable, Relevant and Time-bound goals. For medical students, the prefix 'SUPER' means, you have to supervise (review) it periodically to fine-tune it and customize for your success. S-Specific: As medical student, your goals should be very specific (for example getting a desirable PG seat in AIIMS, PGIMER or in top medical college in India) and you should be able to know what you want to accomplish. Identify requirements and constraints to achieve your goal. M-Measurable: By knowing what rank you want to achieve, you would not be able to quantify your goals. From previous years’ papers and statistics be aware of the marks and cut-off percentage required for you to achieve the desired rank. In every exam you appear from now on, try to achieve the required marks and if easily achievable, set a bit higher target.

A-Attainable: The goals should be attainable and realistic. If you set goals that are out of your reach or below your standard performance, they would never help you. It may be the case that you will have to stretch a bit but that should be realistic. R-Relevant: For medical students, a goal that supports or is in alignment with other goals, would be considered a relevant goal. For example, your other goal is to become a good musician and a AIIMS rank holder, but with the constraints you have, you won’t be able to achieve both the goals, then the set goal is not relevant. Think clearly and decide and choose one of the goals or decrease the level of one of your goal. T-Time-bound: For medical students, achieving a desirable rank is a long term goal. But to realize your progress, you will have to set short-term goals. Set your goals daily and prepare a timetable for yourself the previous day and stick to it. Spending half an hour on this on the previous day would not be a waste. With this try to analyze did you achieve what you desired as this would help you to prepare your timetable. Covey Time Matrix Stephen Covey developed a time management tool that is designed to classify the activities as important or unimportant and urgent or not urgent. This deals with your junk mail, sorting out which mail should be placed on the top of your inbox and which one should be pushed down because of lack of importance. With four quadrants of 'important and urgent,' 'important and not urgent,' 'not important

and urgent,' and 'not important and not urgent,' this 2x2 matrix helps boost your productivity and saves you substantial time. Pareto’s Principal Named after Vilfredo Pareto, an Italian economist, this Principle states that 20 percent of the causes instigate 80 percent of the effects. Pareto analyzed the economic demography of Italy and deduced that 80 percent of the land and wealth in the country was owned by 20 percent of the population. He conducted several other observations on the basis of the same hypothesis and then published this 80:20 principle. He gave several examples from things as domestic as fruit production in the home garden to the manufacturing of products and profits gained in the multinational corporations (MNCs). This principle is now cited as a universal baseline. Some of the practical examples from a hospital setting can be: ✓ 80% of job satisfaction comes for 20% of the daily interactions. ✓ 80% of calls and pages are from 20% of the nurses. ✓ 80% of medical issues arise from 20% of the patients on a daily basis. Recognizing Pareto’s principle can help you set realistic expectations and make the clinical jobs more productive. Parkinson’s Law The work expands to fill the time available for its completion– means that if you give yourself a week to complete a two hour task, then (psychologically speaking) the task will increase in complexity

and become more daunting so as to fill that week. It may not even fill the extra time with more work, but just stress and tension about having to get it done. By assigning the right amount of time to a task, we gain back more time and the task will reduce in complexity to its natural state. For effective time management, you must know about your own strengths and weaknesses that can help you know how to manage your schedule in a manner that it saves more time. Planning your schedule and following it is one of the best decisions you will ever make. Maintaining a planner helps you tremendously in managing your time. It prepares you for your schedule ahead of time and helps you prioritize what needs to be done first and what can be skipped. With all the technological advancements available, you can effectively manage your schedule hassle-free. Keeping a smart planner on your smart-phone or tablet or laptop can help you prepare for the day a night before. Using electronic health records, you can look into the details of the patient ahead of appointment so that it does not take the time any more than the scheduled slot. Take-Home Message ➢ Have a schedule of your appointments, procedures and followup visits and review them ahead of the time so that you know your planning for the day. ➢ Delegate responsibilities to your staff and team members to lessen your own workload. ➢ Learn to turn down requests so that your other obligations are not affected. You have to prioritize things accordingly to create a

balance. ➢ Transferring the manual data to digital can ease a lot of things for you. ➢ Communication with patients ensures that you do not end up with no-shows and get your time wasted. ➢ Knowing your weaknesses, habits, and goals will enable you to know how you can accommodate your schedule around them. ➢ The better your team is at executing their tasks and duties, the more managed your time will be in hospital or clinics. ➢ Your aim should be to look out for positive habits in people around you and make an effort to integrate into yourself. ➢ Getting engaged in distractions will only keep your mind from focusing on the task at hand and delay you.

22. Ethical Obligations and Medicine

“Primum non nocere—first, do no harm.” - Hippocrates The progress made in the medical field in the past hundred years has completely revolutionized the field. It has become faster to conduct diagnosis and identify diseases accurately using highly advanced diagnostic technology that provides results with precision and accuracy. Diseases that were once considered fatal and incurable are now effectively treated with immediate and efficient interventions. Improved treatment outcomes are achieved in the medical field that enabled the swift provision of healthcare and improved the quality of life substantially. However, at the same time, the advancements have led the field toward numerous legal and ethical challenges. The professionals in the field are subjected to immense dependence on technology which has resulted in influencing the decision making by the doctors. The professional obligation of the doctors necessitates them to prioritize the patient’s interest above everything else. They have to look into the best possible intervention options, and apart from that they also have to ensure that the autonomy of the patient is retained.

Doctors are obligated to maintain confidentiality in terms of patient’s health condition and protect the sensitive medical information pertaining to a patient’s health history and diagnosis details. All these obligations cast a substantial liability on the doctors, and they have to follow through ethical responsibilities in every situation. The ethical standard for doctors in India is outlined by ‘The Indian Medical Council (Professional Conduct, Etiquette, and Ethics) Regulations, 2002.’ The aim of this legal convention is to ensure that a similar ethical conduct is followed by the medical practitioners across the country and patient’s rights are not compromised. The

health

sector

in

India

has

witnessed

a

significant

transformation over a period of time. With more external investors interested in gaining financial benefits from the field, it has subjected the noble profession of medicine toward more impersonal practice and prioritizing personal gains above patients. The cost of the treatment is also rising swiftly because the dependence on technology is increasing. The approach of patients is also changing dynamically, and they are demanding more from clinicians in less time. This has led to compromise in the quality of healthcare and dissatisfaction among patients. Under such circumstances, the probability of mistakes from medical professionals has increased massively. Consequently, this has also elevated the legal claims made against doctors and healthcare providers. To control such incidents and limit medical negligence, The Medical Council of India (MCI) has formed

guidelines, declaring that medical professionals can be punished for their acts if negligence is detected in the investigation at their end. Simultaneously, the MCI also grants protection to the doctors from false claims made by the appellants and also tends to curtail the practice of harassment of doctors by the patients. The advancement in technology has drastically modified the health sector. While it has brought about time, cost, and care effective changes, it has also brought substantial damage to the foundation of the medical profession that was once looked up as selfless, noble, and ethical. The professionals are now liable for the damages that have occurred due to the medical errors or negligence. Also, they are legally obligated to follow a formal and standard code of conduct amidst their medical practices. There have been legislative changes in India pertinent to legal issues in the medial sector. Aside from the modification in law for ethical practice for clinicians, the process for legal claim against doctors and healthcare centers has also been improved. Previously, patients who suffered due to the negligence of doctors and healthcare services had to resort to civil courts to process legal claim against the guilty party. This would take substantial time and lengthy formalities to pursue the claims. To address this situation, the services of doctors were placed under the Consumer Protection Act of 1986. This made it easier for the patients to make a claim for monetary compensation and, elevated difficulties for the doctors who had to encounter more false allegations than real ones. However, the law now demands a stricter evaluation of the claims made before leading litigation against any doctor.

The point to be made here is that your professional obligations as a doctor must not stagger, regardless of the law or legal protection one has in the cases of claims made by patients. You have to adhere to the standard code of ethical practice that your profession demands. Your priority should always remain the health and wellbeing of the patient. Nothing should come above that. No monetary benefits, no personal favors, and no external influences should divert you from the real essence of your profession. To shed more light on the ethical obligations in the medical profession, the following sections discuss in detail different aspects that you, as a doctor, need to bear in accordance with every circumstance. Interest of the Patient The interest of patient must be recognized as the first consideration in ethical relations for all doctors. Included in the international Code of Ethics, you are obligated to identify the interest of your patient and place it above all. Your efforts pertinent to developing interventions for the treatment of the patient must be on the basis of what is beneficial for your patient. As it is beautifully written in the Hippocratic Oath to solemnly pledge before your teachers and fellow-graduates you will do good, and avoid evil and harm toward your patients. You promise not to assist suicides and other self-harming activities. You vow to maintain your patient’s confidentiality and always prioritize what is in the interest of your patient. These are exactly what your ethical obligations in the profession are. It is not as simple to treat the patients as you would

consider treating yourself. You have to be vigilant about the standards and ethical outlines of the profession. The thing that tops the ethical obligations is the ‘interest of patients.’ Your entire medical practice is based on the ethical personal relations you carry out in your professional life. You should not take into account factors like whether it would be less or more profitable to the hospital, or would mean the short stay of the patient in the healthcare setting. Your ultimate objective should be to offer your patient the care plan that is optimal for his or her condition and will serve in improving the quality of their life. Maintaining Confidentiality The obligation that comes after prioritizing the interest of the patient is the maintenance of confidentiality. You are expected to retain discretion about your patient’s illness, treatment, and other sensitive information. Though the law does allow you to break this pledge under certain circumstances, other than those exceptions, you are under the obligation to adhere to the vow. You have to be careful about whom you share the information with. It is important that you take the consent of your patient prior to discussing the condition with even their family. However, in cases where the patient is not in the state of being able to make the decision, you can take their family into confidence and share the necessary details. But, here, the burden of confidentiality shifts to the relative, caretaker or attendant of the patient. You are obliged to adhere to the confidentiality pertaining to the patient’s health condition until the patient is completely and

clearly informed about the sharing of information. Also, you have to ensure that the patient gives you the affirmation to share their information with someone else. You are only allowed to break the confidentiality pledge under the order of the Court. Other than that, breaching confidentiality is highly unethical and may lead to legal troubles. Respect for Autonomy Being responsible for your patient’s health does not give you the liberty to make decisions for them without their consent. You have to respect your patient’s autonomy in every situation. You have to know the wishes of your patient to receive the necessary information and make decisions for them. In medical practice, autonomy is denoted as the right of capable adults to make informed decisions about their medical care. This principle highlights the necessity for you, as a doctor, to seek the consent, well-written, from the patients before pursuing any medical investigation or treatment. You cannot force anything on the patient. They even have to right to deny the life-sustaining treatment and you are obliged to respect their decision. Refraining from Non-Maleficence Under the standard code of practice and ethical obligations, you should not provide any assistance or encouragement to patients in self-harming activities. Under the Hippocratic Oath, you are obliged not to take part in any non-maleficence. This means you should do no harm to your patients. As a clinician, you must refrain from providing your patient with ineffective treatments. Your ultimate aim

should be to give the best possible cure to them for their condition. There are several treatment options that are beneficial for patients but they also entail excessive risks that may cause harm to the patients. Under such circumstances, you should weigh the benefits against the risks. If the risks outweigh the benefits, let go of that option. You have to give your patient the treatment that has more benefits than risks. You should not ever become a deliberate part of providing ineffective treatment to the patients. When you know that the treatment is going to be of no good to the patient, you should never encourage its execution as it has the potential of harming the patient. As a clinician, you must do everything in your power to ensure that effective and safe treatments are provided to those under your care. There are then cases of patients’ who want to go for self-harming options. If a patient indicates self-destructive thought, you must discourage them from harming themselves. You must never promote ideas like suicide and cause grievous bodily harm to self. Your job is to bring people toward a better life, not push them further into the ditch of darkness. In the same context, there are practices like clinician-assisted suicides. This is where your ethical obligation and non-maleficence vow comes into question. Clinician-assisted suicide is one of the most controversial areas in medical practice globally. Some countries consider it legitimate and grant protection to the doctors, whilst others see it in the same context as murder or killing a person.

When looked from the perspective of Indian law, the Indian Penal Code of 1860 declares active euthanasia as an offence under Section 302, i.e. the punishment for murder, and Section 304 (punishment for liable in the homicide but not for murder). These are serious offences, which you certainly do not want as a stigma on your career. Even if your approach is to relieve the patient from his or her chronic suffering, at on their own request, you will be considered guilty. So, it is not the ethical obligation to 'do no harm' to your patient, but a necessity as well to save yourself from a murder charge. No matter what your intentions are, you must do nothing in your power to damage the health of your patients. The medical field is changing and so is the approach of both patients and doctors toward medical interventions. Laws are continuously changing, too. What is considered illegal today may become

legitimate

tomorrow.

Physician-assisted

suicide,

for

instance. But what remains unchanged in the profession are your ethics. This is not something you can expect to change with time. This is going to change with nothing. They would not wither, nor are they going to get old. These oaths are followed from ancient times – five centuries before the birth of Jesus Christ, to be exact. You must not let anything divert you from these obligations. It is a commitment to your own self, with the purity and nobility of your profession. Take-Home Message ➢ Professionals are liable for the damages that have occurred due to their carelessness. They are legally obligated to follow a formal and standard code of conduct in their medical practice.

➢ You have to adhere to the standard code of ethical practice that your profession demands. Your priority should always remain the health and well-being of the patient. ➢ The interest of the patient must be recognized as the first consideration in the ethical relations. ➢ You have to respect your patient’s autonomy in every situation and take their consent in every decision. ➢ As a physician, you must refrain from providing your patient with ineffective treatments. Your ultimate aim should be to give the best possible cure to them for their condition.

23. Law and Medical Practice

“The important question is not how to keep bad physicians from harming patient; it is how to keep good physicians from harming patients. Medical malpractice suits are a remarkably ineffective remedy. (In reference to a Harvard Medical Practice Study) ... fewer than 2 percent of the patients who had received substandard care ever filed suit. Conversely, only a small minority among patients who did sue had in fact been victims of negligent care. And a patient’s likelihood of winning a suit depended primarily on how poor his or her outcome was, regardless of whether that outcome was caused by disease or unavoidable risks of care. The deeper problem with medical malpractice is that by demonizing errors they prevent doctors from acknowledging and discussing them publicly. The tort system makes adversaries of a patient and physician, and pushes each other to offer a heavily slanted version of events.” - Dr. Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science

The existence of medical law and ethics is primarily to protect the fundamental rights of the patients. They are to ensure that the patients have substantial security related to their medical history

records, clinicians maintaining confidentiality on at their end, and the patient’s right to get adequate and quality treatment in times of emergency and other similar situations. However, in the contemporary scenario, the increase in the cost of medical education, expensive equipment, modern construction of hospitals and clinics, and advancement in the medical technology is changing the approach of both patients and doctors toward the field. This has ultimately resulted in a changed legislative stance toward medical practice. The legal issues are no more the same as they were before. Now, the patients are more inclined toward getting more modern and optimized facilities rather than looking for competency in doctors and care quality. This has resulted in increasing legal issues in medical practices. Legal issues are sparked when contradiction and problems begin to prevail between the rights and duties of the doctors. Let's look into the duties of the doctor first. The foremost thing that tops the list of doctor’s duties is to acquire the history of the patient and examine them thoroughly while aiming to get as much information out of the patient as possible by listening to them. Following this, the doctor is obliged to explain the pertinent facts to the patients in easy and comprehensible language about his or her health condition. The third duty in the list says that the doctor should give proper and effective treatment to the patients. As a doctor, the practitioner must be able to detect any complications and refer the patients to proper medical care in adequate time. He is also obliged to retain a sufficient record of their patients.

As for the rights of the doctor, they can refuse to treat a patient prior to starting any treatment, except when there is a medical emergency. A doctor can select drugs from the available range and prescribe it to the patient. If the patient does not want to follow the advice of the doctor, the doctor deserves to receive a written refusal from the patient. Moreover, the doctor has the right to delegate powers and duties to their trained staff or colleagues. The doctor cannot be questioned about starting his or her own private practice or group practice and can decide about their visiting fees. They also have the right to keep the patients’ record and use it in specific situations. There are several laws in India pertinent to the rights and duties of doctors. There are legal protections provided to the doctors, and there are legislations holding them accountable for their actions, too. Under the Civil Laws of India, every person has basic rights and there are legal remedies to protect these rights. What Does the Civil Law Say about the Clinician’s Practice? The Law of Torts outlines that the clinicians will be held accountable for any and all sorts of negligence in their acts. The Indian Contract Act, Section 70, signifies the necessity of contract between the doctor and the patient to which both the parties are legally bound to. The Act states that if the doctor does not fulfill the terms and specifications mentioned in the contract, and the provided treatment is improper, they shall be held accountable by the law. Similarly, if the fee is not paid by the patient, a civil lawsuit can be filed against the patient by the doctor. The clinician has the right to

decide what fee is to be charged for the treatment and how that payment is to be made. It could be divided into advance payments and deposits during the treatment during different stages, or it could be before or after the treatment. In the case of non-payment (for example a dishonored cheque), the doctor can carry legal actions against the patient. Both patients, as well as the doctors, are liable under the Civil Law of the country. They both have the right to consult the court if there issue suspected violation of their civil rights. Civil suits, however, can be expensive for both the parties and can consume a tremendous amount of time. Therefore, it is imperative that you know what the legislative requirements are and what can save you from legal proceedings. Criminal Law in India with Respect to Medical Practice Civil Law ensures that no basic and private right of the doctors and the patients are violated. As for more serious circumstances, there is Criminal Law that addresses the issues in medical practice across the country. The Indian Penal Code is applicable to the doctors that outline a number of duties they need to fulfill during their practice. The Criminal Law entails: ✓ Section 52 defines what good faith is in medical practice. ✓ Sections 87-92 provide guidelines pertinent to the consent of the patient in the treatment. ✓ Section 304-A is related to the death of a patient due to the negligence of the doctor and hospital management.

✓ Sections 312 to 316 outline the legal processes regarding cases of abortions and miscarriages without the adequate consent of the patient. ✓ Section 319 to 322 of the Indian Penal Code deals with grievous bodily harm incurred. ✓ The wrongful confinement of a patient is examined under Section 340 to 342 of the Criminal Law. ✓ Section 499 entails case guidelines related to defamation. These sections in the Indian Penal Code or the Criminal Law of the country are developed to ensure that the guilty party is penalized for their deeds and no act of negligence is passes without proper addressing. While most of the sections make the doctors liable for their actions, there are also provisions that ensure patients are not given the liberty to violate the rights and reputation of doctors. There are numerous other laws in the country that entail stipulations relating to medical practitioners. The Consumer Protection Act, for instance, is subjected to private and state-run healthcare organizations. Similarly, the Drug Act outlines the usage and regulation of authentic drugs in medical practice. The PCPNDT act banned prenatal sex determination in India. Liability and Negligence in the Medical Practice under Law Every individual is held liable under the law for any wrongful act that he or she has committed. Clinicians are no exception to that. The wrongful act conducted may be deliberate (Mens Rea) or unintended (Actus Reus). The intention behind the act determines

the course of the legal proceedings. If the wrongful act is executed with a guilty mind and bad intentions, it will be considered as Mens Rea and the clinician will be held punishable by the law. Liability

in

the

medical

practice

in

form

of

negligence,

incompetence, and malpractice falls on the clinician under certain conditions. If the staff hired by the clinician is unqualified and that has led the wrongful act, the doctor will be held liable. As for wrongful deed that includes the act of staff which is qualified, the doctor may not be considered liable directly. For instance, if you prescribed a drug to be injected into the patient in a limited dosage. If the nurse or other medical staff, who are qualified, inject a drug more than the prescribed dosage and as a result, the patient suffers, you would not be held liable lawfully. Conversely, if you have an incompetent and unqualified staff that conducts a similar act, you will be answerable for their actions. Negligence, in legal terms is an act of commission, or omission that you, as a clinician, should perform. It is defined as the act of carelessness carried out in the approach toward the patient that resulted in causing injury or damage to the patient. Negligence, in terms of an omission, highlights the oblivion of the doctor toward his act that leads the patient to incur damage. The law accentuates that when a duty is undertaken, it should be fulfilled with complete foresightedness, competence, care, and knowledge using all the acquired skills that you have as a clinician. Negligence occurs whenever the clinician breaches his or her duties and this act results in inflicting damage to the patient. Impact

of the medical errors and how to minimize them during the medical practice are discussed below. How to Minimize Medical Errors? Medical errors are a serious public health problem and a leading cause of death in the India, USA and worldwide. Errors infiltrate every aspect of our existence, including our professional lives. Imperfections in law or academia may be inconsequential or remedied with an apology, while other occupations may not be so forgiving. Doctors, like pilots, carry a greater burden as their errors can be catastrophic. Approximately 400,000 hospitalized patients each year experience some type of preventable harm with at least 43 million adverse events yearly worldwide, making medical errors the third leading cause of death after heart disease and cancer. According to published study, medical errors account for over US $4 billion per year. Medical errors cost approximately US $20 billion a year. Medical errors in hospitals and clinics result in approximately 100,000 people dying each year. Medical errors typically include surgical, diagnostic, medication, devices and equipment, and systems failures, infections, falls, and healthcare technology. Missed diagnoses or injuries from medication are common in outpatient settings. Most malpractice claims in hospitals are related to surgical errors, whereas most claims for outpatient care are related to missed or late diagnosis. Doctors and hospitals staff members are reducing errors and saving lives with an occupational concept fast-food restaurants have

long used: checklists. Protocol following the checklists remain an important part of patient safety. The Joint Commission has introduced several patient safety goals to assist institutions and healthcare practitioners in creating a safer practice environment for patients and providers. These include: Identify patient safety dangers and risks. Identify patients correctly by confirming the identity in at least two ways. Improve communication such as getting test results to the correct person quickly. Prevent infection by hand-cleaning, post-operative infection antibiotics, catheter changes, and central lines precautions. Prevent mistakes in surgery by making sure the correct surgery is done on the correct body part; pause before surgery to double check. Use device alarms and make sure that alarms on medical equipment are heard and checked quickly. Use medicines correctly and safely, double checking labeling and correctly passing on patient medicines to the next provider. Label all medications, even those in a syringe. This should preferably be done in the area where the medications are prepared. Take extra time with patients

who

have

been

prescribed

anticoagulants

and

chemotherapeutic agents. To prevent nosocomial infections, hand washing should be routine before and after visiting each patient. Why is Consent Important? Consent can save you from a wide range of legal issues. It can grant you protection from certain claims made by the patient. Under the Indian Penal Code (Section 90), when a patient gives you his or her consent for a treatment, drug or any action, they cannot complain if the situation deteriorates and does not go as per the patient’s expectations. Under your medical obligations, it is your duty

to acquire consent from your patients after imparting them the necessary information about the treatment. The patient should be able to make an informed decision on the basis of the information you provide them. The information should entail details about the outcomes you are aiming to achieve that can improve the health condition of the patient, as well as the risks involved in the process. The patient should be told about what complications can occur during and after the intervention. The information must be imparted in an easy and understandable language which the patient is able to comprehend. The consent you acquire after this makes you legally safe and the patient cannot complain if they are not happy with the results. The consent should be taken in writing and preferably in the presence of a witness. Clinician’s Obligation under the Consumer Protection Act Medical services have been widely addressed in the Consumer Protection Act (CPA) of 1986. This precise legislation has been subjected to continuous modifications over time to make it more appropriate for both the doctors and the patients. Under the Consumer Protection Act, the plaintiff (consumer) can confer the court within two years of time to claim for the damage incurred. Also, the claim can be made by the consumer themselves, or by other agencies like the beneficiary, a consumer organization, or the government. The complaint can be made for paid or promised payments, fault or deficiency in treatment, or shortcomings in quantity or quality of work performance. All hospitals in India, private,

corporate, and government-administered, are covered under the Consumer Protection Act. Avoiding Legal Cases in Medical Practice As the field of medical practice is expanding, there has also been an elevation in the legal issues. Despite the legal protection the doctors have, there are several situations that can lead them to legal cases. You have to be immensely careful about how you attend your patients and what you do in your medical practice. The more watchful you are of your actions, the more aware you will be of how to handle the situations and avoid leading them a point where you may have to face legal trouble. Things can, of course, happen unexpectedly and unintentionally, but there are certain things you have to take care so as to prevent yourself from getting into legal problems. Here are some quick tips that can help you immensely: Communication and Consent: These two Cs should never be ignored during the course of your professional life. They act as protecting shields in all situations. Communicating with patients means that you are delivering all the necessary information to them and giving them the right to make an informed decision. When you communicate with them you explore their concerns and address any issues which they might have with you or your planned intervention. When you hear them out and listen to their queries, it paints a better picture of their thought process. Clearing out their confusions and concerns, and then taking their consent gives you strong legal protection. They cannot claim anything related to the intervention

when you have informed them about all the details and they have agreed with the process. Maintain Records: The importance of documents should never be disregarded. They are the proofs that can come really handy in saving you from legal claims. Often, the patients refuse to accept that they have given you their consent for the particular treatment or medicine that has impacted them adversely. The written contract and consent between you and the patient is the evidence that can grant you legal protection. So, one should ensure that all these contracts are appropriately documented and maintained. Take Multiple Opinions: Multi-professional intervention planning is beginning to rise in the medical field. This reduces the risk of medical complications when the intervention is seen from different perspectives and all possible aspects are examined. It is beneficial that you take other clinicians’ opinion on your case so that if there is any gap you are not aware of, it is highlighted. This reduces the chances of risks and complications. Increased legal challenges have compelled medical professionals to be extra careful in their practice. You have to be cautious in your behavior and actions. The staff you hire has to be qualified and competent to avoid any negligence from their end. Any intervention or treatment that you plan for your patients must require the consent of the patient before implementation. All documents related to the intervention, including consent form and other details must be appropriately documented and maintained. You have to take the

necessary steps right from the beginning to protect yourself from legal issues. Take-Home Message ➢

Increased

legal

challenges

have

compelled

medical

professionals to be extra careful in their practice. You have to be cautious in your behavior and actions. ➢ The staff you hire has to be qualified and competent to avoid any negligence at their end. ➢ All documents related to the intervention, including consent form and other details must be appropriately documented and maintained. ➢ Follow checklist and patient safety protocol to minimize medical errors. ➢ You and your team have to take all necessary steps right from beginning to protect yourself from legal issues.

24. Webutation: How to Build Your Online Reputation

“It takes many good deeds to build a good reputation, and only one bad one to lose it.” - Benjamin Franklin In the web-focused world that we are living today, upholding a reputation and maintaining it has become immensely crucial for not just the companies and brands, but for clinicians as well. It is exceedingly imperative that you utilize the available channels to your advantage and take measures to propagate a positive image of yourself and your medical practice. In a contemporary setting, making or breaking a reputation is not a difficult thing to do. All it takes is setting up your official accounts on various social networks to start your online presence. But, it takes a whole lot of efforts to maintain your image. It can be one post, one tweet, or one review that can sabotage your entire repute and disseminate a negative message about you online. Being in a field of medical practice, it is important that you look after your reputation and the perception that is conveyed to the public. Digital media has provided us with tremendous facilities. Conversely, it has also escalated the potential risks. So, you have to

execute appropriate monitoring of social media. It can be a great source of Public Relations if you use it appropriately. The public is no more passive. You have to be aware of that. Anything you do or say to your patient can be the next big thing on social media. Spreading news online is denoted as one of the forces of social media and the Internet. So you have to be extra careful about what is being circulated about you. The decision making and perception of the public are now hugely dependent on the reviews they find online. If a person is in need of consulting an ophthalmologist, there is a high possibility that they are going to do an online research about the better reviewed ophthalmologists in the vicinity. Or, he is going to post on his Facebook page to see what recommendations people make. If people have a positive experience with you, it is likely that they will recommend you to others too. But few negative experience can harm your online reputation as well. It is often contemplated that online reputation management is not mandatory for a profession like medicine. Well, such is not the case in today’s world. You have to make use of social media for your benefit, or others may use it against you. It has become a norm for almost everyone with Internet access to conduct online research about prospective doctors and interventions before making the decision to pursue their services. Your online reputation precedes you when it comes to patients. They can develop their perception regarding you through online reviews and can decide about the success rate of their treatment even before meeting you. It is important for your professional reach that you give considerable

attention to your online reputation and presence. When you do not do what is necessary to maintain your online image and reputation, it makes you vulnerable and an easier target of defamation. Surely, no one would like to pursue a clinic that has no information available online or has low to no customer ratings and reviews. The more robust presence you have online, the more audience engagement you will have, and this will increase your popularity among people. This is all part of building an online reputation. As a matter of fact, your job is not to worry about the image you have on the web and your focus should be entirely on the quality of your work and fulfilling your ethical obligations. But you cannot completely keep your professional responsibilities and your online reputation separate. They are correlated. Digital practices and social media have become such an integral part of our lives that one cannot focus on one while ignoring the other. You have to work on maintaining a good online image and be aware of what is being said about you in the digital sphere. For your successful medical career, online reputation management is important. How to Manage Your Online Reputation For a doctor, in the professional sphere, their biggest asset is his/her skills and the quality of care they offer to their patients. Gone are the times when the patients were referred from one place to another. Patients have taken control of their healthcare and are making decisions on their own. This has necessitated that you make sure that your skills and care service quality is reaching the

audience. The efforts you are making to improve your expertise should reach the patients. The most effective way of doing so is by sharing it online. Know that you have to build a brand for yourself online. You can follow similar branding guidelines as implemented by marketers. You can make a strategy and have branding goals that will determine where you want to go and how you want to project your image. Here are some steps that you can follow to improve your online reputation: Explore Where You Stand Currently: The first thing to do is to know where you are right now. Only then will you be able to determine the course of action ahead. Put your name in the search engine and let the search begin. The results will show the exact rank you are on in the search list. Check out the list and open some of the pages. This will give you substantial insights regarding pertinent to the first impression you make on your potential patients. You need to evaluate how the results are. Are they what you expected? Is this how you want your patients to see you first? Is the information all legitimate? Are there any fake reviews about you? Answers to these questions are valuable for effective reputation management. Your subsequent planning will be heavily based on the data you acquire through this initial search. Once you have these details, look into the social media accounts under your control. Analyze what information you have shared there and the nature of the content on the websites. Carry out a cleaning expedition of your accounts and delete the posts that may negatively impact your image. Remove any controversial content and ensure

that whatever is available on your accounts projects your values and vision appropriately. Whatever you choose to share online can be easily used against you no matter with what intention you post it. So, you have to retain control over the content that gets published from your account. You can also take clues and hints from other doctors’ profiles and see how they are maintaining their online presence. This will give you some insight into how to lead the things ahead. Publish Regularly and Delegate this Task to Your Key Staff: Nobody is going to turn to a website or social media profile that is not updated regularly. To maintain a strong online presence, you have to make a practice of posting on your profiles regularly. If there is not much activity going on your website, it is likely for Google to pronounce it stagnant and drop the ranking substantially. Make sure that you have content developed and published on your website and profiles regularly. Integrate uniqueness into your content by incorporating various formats. Use pictures, video links and GIFs to make your website and social profiles more appealing and engaging. After training for few days, you can delegate this work to one of your staff and monitor the work done by him/her. Build Online Connections: As a medical professional, it is imperative for you to have good social connections online. Your social engagements also play an important role in determining your website's online rank. When you have high-quality content posted on your profile and website, it will

encourage other users’ engagement on your account. The combination can serve extensively in escalating your online ranking. Be Patient: Remember that nothing can be achieved overnight. You have to exercise patience. Building an online reputation is not easy. It takes extensive efforts to establish one, and substantial time to reap positive outcomes out of it. You will have to face several challenges like the sudden drop in the rank, spam messages, account and website hacking, and fake accounts meant to defame you. These challenges need patience and consistency to get over them. You have to be on your guard all the time to avoid any substantial and irrecoverable damage. Run continuous checks on your website and profiles for potential hackers and malignant components. Make a practice of regularly changing passwords for your accounts. This can limit the possibility of your accounts getting hacked. The online presence that you hold contributes tremendously in defining your success as a leader. It promotes your medical practice and expands your audience reach. It has the ability to portray you as an influencer and a mentor. Your online personality can help you improve your social connections. This includes not only the random public that follows you but also other medical professionals locally and internationally. It also includes your colleagues, patients, and the people who know you from the field. Online reputation management is undoubtedly an investment that you make for long-term benefits. It takes substantial efforts to ensure

that it is driven in the right direction. But the benefits that you enjoy in the long run are worth all the efforts. How to Stand Out on Online Platforms The online world is cluttered; there is no denying in that. Flooding by a large amount of content at the same time makes it excessively difficult to grab the attention of the viewer. In media, it is all about getting attention. You will get one chance and three seconds to get the task done. If your content fails to catch the viewer’s concentration, the opportunity is lost. Webutation or online reputation management is still uncommon among the medical professionals in India. So, it is important that you take the first initiative, you are most likely to get the early-mover advantage. However, there are a few things that you can take into accordance to get noticed online. Appropriate Profile Picture Never leave the profile picture space unattended. The profile picture is the first thing that gets noticed by the viewer. Make sure you have a professional and elegant profile picture uploaded in your social profiles. You can look up for other renowned doctors profiles to see what kind of pictures they have. This will give you a fair idea of what may work for you. Your profile can get you noticed in places where you least expect. On another person’s profile post where you have commented, in a discussion where you have taken part or a group that you have liked,

it is actually just your picture that is visible. So make sure you put in substantial thoughts before choosing the display picture. Role of Social Media in Medical Tourism and Medical Treatment Beyond Borders I would like to share my experience on how social media can be used as a special tool for medical tourism by doctor to reach out more

widely

and

build

new

relationships

and

professional

associations. These interactions can sometimes reach internationally and help in building bridges across borders in what is increasingly becoming a global village. We all know that technology has undergone a huge revolution in recent times and has also impacted the field of medical education and treatment. The place of big, unwieldy books has been taken over in many instances by slim computers and sleek smartphones. With communication becoming so fast, social media has caught on and has attracted hoards of users all over the world. These sites as well as others help us remain in touch with professional colleagues and stay abreast of the latest developments. With the availability of sophisticated and inexpensive recording and editing devices and software, surgical videos can now be easily made and shared with colleagues through various websites and social media. Medical Tourism: Connecting through YouTube My interest in documentation and sharing eye surgery prompted us to make a YouTube channel dedicated to ophthalmic surgical videos ( http://www.youtube.com/user/drsureshkpandey) which attracted many views (1,561,803) and subscribers (4,720). This helped us to

make new connections with medical colleagues, and it was our privilege to have 25 ophthalmologists come over to SuVi Eye Institute and Lasik Laser Center, Kota, India for training at high volume eye center from USA, UK, Europe, Middle East, Azerbaijan, and Australia. Their journey from a distant country to a non-metro Indian city (Kota, Rajasthan) is a testament to the rising influence of social media interactions. Transcending Borders While connecting with doctors from far away is a great experience, the real adventure of social media is in being able to connect with patients and the general public. The medical profession has always moved beyond borders, an example being Doctors Sans Borders and ORBIS aircraft being another glorious example of teaching and medical services beyond borders. Medical Tourism: A Journey From Karachi to Kota India and Pakistan share a troubled border, despite many efforts for peace. Many patients, especially children, have come over to India from Pakistan to receive medical treatment as well as surgical procedures at some big institutions. However, the story shared here is of Mr. F.U., a software engineer (working at Orthopedic and Medical Institute, Karachi, Pakistan), who was a myope and had developed cataracts at about 40 years of age. His own Internet search had led him to intraocular lens (IOL) websites, and he decided he wanted a particular multifocal IOL (Tecnis Multifocal IOL, Johnson and Johnson, USA) that was not available in Pakistan at that time. He then searched for the IOL in India and found many

videos that I had posted on the implantation of this IOL. He communicated with us through social media, and, after a few interactions, developed so much trust that he decided to come to India for the surgery. He came over on a medical VISA that was issued by Indian embassy in Karachi, Pakistan after thorough scrutiny. He underwent cataract surgery on both eyes with the multifocal IOL of his choice at SuVi Eye Institute, Kota in July 2012 and was extremely happy with the results. He even watched a Bollywood movie (Bol Bachchan) in the theater immediately after surgery and toured the city and was thrilled with the excellent vision he had at both distance and near without glasses, with no significant night vision problems either. The fact that he had come over from Karachi, Pakistan for his eye surgery made him somewhat of a mini celebrity, and his visit was well covered by local media. A program'Spreading Light Across the Border' (Aman Ki Roshni) was organized during his visit and Mayor of the City, the Inspector General of Police and some other prominent personalities of city participated. The speakers emphasized that with the help of social media the patient came to know about the Center in India and he undertook this journey from Karachi to Kota. His visit to India was a unique case of human trust and empathy that knows no boundaries, neither political, nor religious. When it comes to interpersonal interactions, Indians and Pakistanis have always been very warm to each other and this was just another reinforcement of the need for the two neighbors to live like friendly neighbors. In summary, social media has taken over our lives and has tremendous potential to be used as a networking tool to promote

medical tourism. It provides us all a great opportunity to reach a wider audience, and recent innovations are especially suited for the sharing of surgical techniques and tips. These sites may prove to be just what the doctor ordered to bring about greater interaction and trust among people otherwise separated by man-made borders. Interested readers can view the video: Social media and medical practice

at

your

finger

tips.

https://www.youtube.com/watch?

v=SO233GCcLZk Take-Home Message ➢ The digital sphere can be an easy-to-use and effective way of standing out in your professional circle. Though there are not many doctors in India who realize the importance of online reputation management, if they see the potential the Internet and social media has for them, they can take tremendous advantage of it. ➢ Your social media profiles can serve as your PR source. It can offer you a huge audience to address and gain public attention. ➢ You have to maintain a strictly professional stance even online. With opportunities certainly come risks. You have to be careful about what you say and how you say. Your words can be misinterpreted very easily and it can irrecoverably sabotage your reputation online and otherwise. ➢ Publish regularly on social media and delegate this task to one of your capable staff members. ➢ Social media has taken over our lives and has tremendous potential to be used as a networking tool to promote medical

practice, medical teaching and medical tourism.

25. Doctor, Heal Thyself

“We have turned doctors into gods and worship our deities by offering up our bodies and our souls - not to mention our worldly goods. And yet paradoxically, they are the most vulnerable of human beings. Their suicide rate is eight times the national average. Their percentage of drug addiction is one hundred times higher. And because they are painfully aware that they cannot live up to our expectations, their anguish is unquantifiably intense. They have aptly been called ‘wounded healers.” -Enrich Segal, (Doctors, 1989) Being the noblest of all professions in the world, healthcare providers have to go all out of the way to provide excellent clinical services to their patients. They spend long work hours and do overtime to ensure that the public remains healthy. They sacrifice their well-being and social life for the patient. This does give additional privilege to the medical professionals but it comes with certain consequences, too. Doctors have to deal with conditions such as depression, burnouts, and high-stress levels. The suicide rate is higher amongst medical professionals because of these conditions that are faced across the globe. A survey conducted in

the United States reports more than 20,000 physicians struggling with occupational stress and burnout. It is the right time for all doctors/healthcare professionals to take a look at their own health and wellness and ensure to heal the healer. To be a medical professional is a great privilege that is looked upon with respect and interlaced with humility, as doctors have been bestowed the noble responsibility of looking after patients. From medical college to residency and from trainees to medical specialists/super-specialists, doctors have had a certain job security and most of them eventually earn decently well. Yet, the life expectancy of doctors is 59 years as compared to 67.9 years of an average person in India. Doctors are expected to live longer as they know more about how to stay fit and healthy and address the medical conditions ahead of time. Despite this, the possibility of heart diseases and cancer among doctors is swiftly rising. Also, the emerging trend of doctors committing suicide—which was hitherto uncommon—is a matter of grave concern. This shocking revelation made by the Indian Medical Association (IMA) demands that this matter is studied thoroughly and that core causes are identified to know what has pushed down the life expectancy of doctors by more than 10 years. The 10-year-long study conducted by the Indian Medical Association for Kerala interviewed 10,000 doctors. During the study, 282 doctors died, 87% of them were male physicians and 13% females. When the reason for death was investigated, 27% had died due to heart diseases, 25% due to cancer, 2% by infection, and 1% by committing suicide.

The respondents mentioned stress as the major contributor of early deaths, followed by lack of periodic health checkups. Medical profession, by all means, is a stressful profession. No matter how much extensive training you have had in the medical college or during your training, you have to remain prepared for a sudden escalation in the responsibility and taking critical decisions in a matter of seconds. Dealing with situations where human lives are at stake involves persistent work pressure and stress which affects the mental health of the doctors. This stress elevates the possibility of doctors suffering various health problems. Doctors have the highest rate of suicide among all the professions as revealed by study of Schernhammer and Colditz. Authored by Andrew and reported by Medscape, it is stated that the exact number of doctors committing suicide is not known, but it is estimated to be 400 physicians per year in the United States of America. Medical profession leads the list of occupations with the highest risk of suicide rate, and is most common among anesthetists. The reason pointed out in the same report is the greater knowledge of doctors pertinent to effective and lethal suicidal means. Unfortunately, there is a substantial gap in accurate tracking and documenting of the data that would showcase the reasons behind the issue of suicide among doctors. By the virtue of their job description, doctors are at an enhanced risk of enduring mental health challenges. If we analyze the reasons behind doctors dying because of suicide, it is evident that there are two root causes: stress and depression. These two are interlinked

and one leads to the other. Doctors in developing countries are reported to have high grades of anxiety and depression. Dave, Parikh, Vankar, and Valipay conducted research on the prevalence of depression and stress among resident doctors and found that 27.7% respondents had depression, 36.6% suffered from anxiety and 24.2% had stress. Depressive mood and thoughts are found to have a strong correlation with suicidal thoughts. Takeuchi and Nakao's study reports over 30% prevalence rate of suicidal ideation and its relationship with symptoms of depression. In addition to long working hours and stress related to patient care, doctors have personal problems too, just like everyone else. Doctors face divorce, custody battles, infidelity, disabled children, and deaths in families. Doctors or residents work for about 60-70 hours per week — and sometimes more — and this means that they often have no (or very less) time to deal with their personal problems. Ignoring doctors suicides will only lead to more such losses as suicide is preventable, and healers, after all, too need healing. While suicide is a matter of concern, the much more common reason behind early deaths is physicians developing health conditions like cardiac problems and cancer. There are multiple causes identified that promote these conditions and result in shorter life expectancy of doctors. According to Indian Medical Association's research, desk-bound job and inactive lifestyle, lack of exercise, stress and obesity are primary instigators of heart diseases in the medical fraternity. Although the risk of heart diseases increases with age, doctors avoid having a regular medical checkup and tend to rely on self-diagnosis

and treatment. This often results in severe outcomes in the form of sudden heart attacks that can cause loss of life even in young age group. Many doctors are uncomfortable getting treatment from fellow physicians. This practice is especially prevalent in the regime of mental health. Categorized as “VIP syndrome”, doctors are held back from the required treatment due to their concerns about confidentiality and reservations pertinent to therapy or treatment effectiveness. Lehman studied physician depression and stress and claimed that if only doctors receive immediate treatment and confidential hospitalization, the death ratio can be decreased substantially. In addition to cardiac diseases, cancer is an important cause of premature death of doctors because of the fact that are more exposed to the environmental factors that promote the risk of cancer in individuals. Working in a setting with exposure to diverse carcinogens (ionizing radiations) can fuel the possible occurrence of thyroid and ovary cancers. Another problem more relevant for doctors is the work-related musculo-skeletal disorders (WMD) caused by spending long hours using the operating microscope or slit lamp. While this may not directly contribute to early death, it does cause health concerns like strain, backache, neck pain, carpel-tunnel syndrome, etc. and compromises the quality of life. A small ergonomic modifications, prophylactic neck and back exercises and timely professional consultation may help alleviate symptoms and maintain better work efficiency.

Why is Healing Necessary? Healing is referred to as self-care and wellness. There are several studies that indicate that doctors suffer from burnout and depression during their professional life. This can lead them to serious mental problems and can even direct them to substance abuse. Half the doctors in the United States are reported to have burnout symptoms. The statistics are not so different for India. How to Stay Healthy Keeping yourself healthy is an individual duty. You have to take the steps yourself to ensure that your mind and body both are functioning optimally. Here are some ways you can take care of yourself: Take Frequent Breaks Yes, your time is important. But, your health is no less important. In the contemporary world, a clinician’s job is no more bound to checking in with patients and making the scheduled rounds and surgeries. They have to spend substantial time behind the desk and before the computer as well. Even examining the patients in hospitals and clinics can compel you to sit in the same position for several hours. This is not new information for you about how sitting in the same posture can affect not just your posture but your mental health as well. Being a medical professional, you are well aware of the repercussions your sitting position can instigate. Also, working continuously on something for hours can also lead to exertion and

stress. This necessitates that you take frequent breaks during your hectic schedule. You have to plan your day in a manner that you put aside some time for breaks as well. This could be just a five-minute breather after every hour or so. It will give you the opportunity to break from the monotonous routine or schedule and give your body some activity. Your mind will get some time off too to alleviate the stress acquired. You can stand and stretch a little, giving your stiff muscles some exercise. As a clinician, it is easy to get engaged in your work and lose track of time. What you can do is schedule reminders on your phone that can tell you when you should stop working for a while and have some off time. Make Your Health a Priority What you advise your patients for their well-being, should be embraced by you as well. Have a diet plan that you follow strictly. It is easier to skip a meal when you have an excuse for tight schedules and impending deadlines. But you have to train yourself to adjust meals and exercise in your schedule and adhere to that schedule for life. Always go for periodical health checkup and investigations such as BP, ECG, blood sugar, fasting lipid profile, blood urea and serum creatinine, etc. Maintain a Good Sleep Cycle Being a medical professional and having a normal sleep cycle can be a hard task to accomplish. But nothing is impossible if you make an honest attempt. Sleep is equally important as diet and exercise in retaining your healthy self. Getting a good night’s sleep may not

always be on the cards for you, especially when you are in fields like gynecology or emergency medicine. In such circumstances, it is important for you to focus on quality rather than the quantity of sleep. It may be difficult for you to get the standard 7-8 hours’ sleep on a routine basis, but you can achieve quality sleep in less time that can assist you in optimal functioning. Giving your body adequate rest is highly important. Failing to do so can lead you to a variety of problems, depression being the most common of them. If you suffer from any sleep disorders, it is important that you share your concerns with a fellow professional who holds expertise in the field. You should avoid self-medicating even when you are a doctor yourself. Give Your Mind Sufficient Breaks Your mind is a high-functioning organ that determines your entire body's functioning including a physical, mental, and emotional workout. It is important that you give it substantial rest after the long working hours. It deserves to have breaks that can help in relaxing. Your diet, exercise plan, and sleep all have an influence on your mind, but these activities do not completely relax your brain in the manner it should be. You have to take care of your brain through activities like socializing, staying happy and taking breaks from the hectic routine. It is important that you indulge in social activities, meet friends and hang out frequently. This gets things off your mind and alleviates the prevailing work stress. Make it a habit of meeting with people outside your work circle. Join sports or social clubs and recreational centers. These things

may not be doable for you when you are at the beginning of your career, but as you progress through your career you have better control of your schedule and timing. Ensure that you incorporate some time for your mind as well where it can let go of the workrelated tensions and relax. Your health is in your hands. It is important for you to take care of it. You have to work with your mind and body in the best possible health condition. Your aim should be to keep a balance between your work and life, and avoid overdoing yourself in any situation. Being a clinician, you are obliged to care for the public, but you are only going to execute your job optimally if you are healthy yourself. When your brain lacks adequate rest or your body is deprived of quality sleep, it is only going to lead to a lack of efficiency in your performance. There are people's lives associated with your profession. Even a slight mistake at your end can cause them huge damage. Therefore, you have to heal yourself first so that you can heal others on the go. Starting as medical students, becoming interns or residents, and then full-time physicians, this journey is certainly not an easy feat and brings with itself plenty of struggles and hurdles. Apart from that, healthcare professionals also have the responsibility of caring for their patients, which can lead to increased stress levels and exhaustion. While healthcare professionals are well-respected, have job security, and other privileges, burnouts, mental health issues, and suicide are also major factors in their lives. It is essential that appropriate measures are taken by relevant authorities to help

prevent these issues so that medical professionals can continue providing excellent care to their patients. In extreme cases (such as emergency physicians), career change or alternative medical pathways are a reasonable consideration for physicians to manage burnout and avoid stress or suicidal considerations. Role of Medical Societies The various medical societies do a lot of work to disseminate medical knowledge and expertise with the latest advances among doctors. It would also be very helpful if these societies could also take an initiative to promote good health and healthy lifestyle. For example, at the Annual Meeting of All India Ophthalmological Society (AIOS), stalls were put up with the support of Industry and the Society for conducting various eye check-ups and health checkups (blood sugar and screening for diabetic retinopathy). Peer pressure can be a great motivator at any age and if the Societies take up activities to promote healthy lifestyle among doctors, it would make a great change. Take-Home Message ➢ Your health is in your hands. It is important for you to take care of it. You have to work with your mind and body in the best possible health condition. ➢ Your aim should be to keep a balance between your work and life and avoid overdoing yourself in any situation. ➢ Being a physician, you are obliged to care for the public, but you are only going to execute your job optimally if you are healthy

yourself. ➢ When your brain is not well-rested or body deprived of quality sleep, it is only going to lead to a lack of efficiency in your performance. There are people’s lives associated with your profession. ➢ Even a slight mistake at your end can cause people huge damage. You have to heal yourself first so that you can heal others on the go.

Part IV: Soar

26. Wealth Management for Doctors: How to do Financial Planning

“It is not about how much money you make, but how much money you keep, how hard it works for you, and how many generations you keep it for.” - Robert Kiyosaki The medical stream is considered to be one of the most promising fields across the globe. Whether it is India or any other country, the medical profession has earned the highest respect and has equally benefited in terms of earning the best monetary rewards. But what if all your hard-earned reward goes in vain due to the lack of good financial planning and wealth management? Financial planning and wealth management for doctors are among the most vitally required ingredients to plan the right direction for the wealth they have earned so hard. Economic Cycle of a Doctor A doctor might start earning properly after the age of 30-35 years, which is quite late compared to other professions. A doctor can either begin their career by starting their private practice or working

in a government, trust or corporate hospital. This means you begin on a regular income or salary late and hence your social life and events also gets delayed. A late marriage, a late kid, and long erratic working-hours also influence your financial life. A doctor does not have much time to concentrate on planning his finances. For most doctors, the peak time of earnings is between 40 and 50 years. Doctors and the Need for Financial Literacy Being a practicing doctor, you have the right knowledge and intelligence in the world of medicine; however, due to the lack of financial facts and financial planning, young doctors can make significant financial mistakes. This may sometimes lead to a personal financial disaster or an unproductive wealth management process. Financial literacy is a very critical part of wealth management and it must not be neglected. Considering the fact that most doctors work as private medical practitioners, financial planning, and financial management must be a part of the study in the medical colleges. It is mainly due to its absence that doctors are deprived of the right ways of planning their finances and end up falling prey to choosing poor loans, investments options, wrong insurance policies, and bad tax-planning instruments that lead to faulty financial decisions. Financial Planning for Doctors Why is financial planning said to be so important for the doctors? The fact is that financial planning and wealth management tend to be highly important for all segments of the society and doctors are no exception in this regard. However, mentioned below are a few valid

points to sustain the importance of financial planning in the life of doctors. 1. Real estate is a hot favorite investment option for most doctors and makes them fall prey to the huge sum of loans to be paid simultaneously. This makes most of their liquid money stuck. 2. Having blind belief in professionals trading on their behalf puts them in the back-seat. This results in unstructured and ad-hoc investments, which may or may not reward well. 3. Some doctors believe that tax planning is mainly done to minimize taxes, which lands them in situations that are not really favorable. This may even lead to lumps of loans, investing in real estate, and life insurance in a completely unplanned manner. 4. For doctors, having insurance should be your top priority to take care of yourself and your family in case of unforeseen events. There is an extensive list of risks you have to consider, for instance – health, disability, life, unemployment, personal umbrella, and malpractice insurance. Thus, it is very important to understand the common mistakes committed by doctors in terms of appropriate wealth management and financial planning. Mistakes to Avoid in the Path of Perfect Financial Planning for Doctors Knowingly or unknowingly, doctors tend to make a few common yet tricky mistakes for which they need to pay in their future. Few

common mistakes should be avoided by the doctors, which are mentioned ahead: 1. Most young medical practitioners are not aware of the major differences between a broker, an independent investment advisor, and a financial planner. This results in wrong issues falling into wrong hands and inappropriate decisions in turn. 2. Young doctors may not have the right understanding of the concept of appreciation, depreciation, and compound interests. 3. Doctors may not approach financial matters in a comprehensive manner. 4. Due to lack of enough financial knowledge, they may tend to fail to get a perfect retirement plan. 5. Most may focus on a short-term investment plan. 6. Doctor should take professional indemnity cover that is required to protect themselves financially if they are sued for negligence, malpractice or mistakes during clinical practice. 7. Doctors may concentrate on ‘what advice costs’ and not on ‘what is the worth and value of the advice’. 8. Some doctors may fall overconfident in this area, even though this is not their expertise. 9. Few doctors still have faith in investing in the traditional orthodox forms of investments, which stumps the right growth of their finances. Financial Tips for Perfect Wealth Management for Doctors

Mistakes can happen to anyone. It is always better to keep a few tips handy for effective control of the situation. A few effective financial management tips are mentioned below to help medical professionals. 1. Young doctors should not be tempted to splurge once they start earning money in the beginning of their professional career. You might feel you have missed out on opportunities to have fun as you have to spend several years studying and start to earn well much later in life. You might start splurging on fancy vacations, new cars, and buying expensive medical equipments (without proper financial planning), etc. It is important to keep a check on expenditure and concentrate on savings and investments. 2. You should ensure that you have adequate life cover and disability insurance cover so that the financial needs of your family and medical profession are taken care of in case of unfortunate events. 3. It is important to have decent medical professional indemnity coverage for all practicing doctors. 4. Since medical practice is the biggest investment for private doctors, you should know how to nurture, grow, and save for the future. 5. Practicing doctors have a very busy schedule as the practice starts growing. You will be called in for work many times post work hours. Apart from this, you have to manage family, health, social engagements etc. It is important that you have proper time management to ensure adequate work-life balance. You have to eat

right and exercise so that you are fit and healthy to carry on your professional work in the most productive way. You need to take a break from your work every day for some time and pursue what you like so that you are mentally fit. This is important for sound physical, mental, and financial health. 6. You have to make a financial plan and the plan should have financial goals listed and you should execute the plan to achieve these goals. If you do not have time to research and make one, you should consider hiring the services of an expert financial planner (The Financial Doctor). You need to have a proper investment plan and should invest in a variety of assets including equity, mutual funds, and debt so that you investment portfolio is diversified and you get optimum returns and long-term capital appreciation. You should ensure that your debts are not beyond your means. 7. You should pay off education loans (or any other loan) taken and only then go for home loan or loans for buying property to set up the clinic. You should revisit the financial plan regularly and tweak it as per changes in life situations and macro and microeconomic conditions. 8. You should also invest by upgrading your professional skills, learning about the latest trends in healthcare and networking with other doctors and medical professionals in the healthcare business. Take-Home Message ➢ Economic cycle of a doctor might start after the age of 30-35 years, which is quite late compared to other professions.

➢ It is always recommended to consult an absolute expert for the right wealth management and financial planning help, rather than just letting the hard-earned money go in vain. ➢ All doctors lead busy lives; but it is important to focus on your finances so that you can grow your wealth, manage your taxes, and have a healthy and secure financial life. This is important for a satisfactory medical career as well.

27. Spirituality, Power of Faith, Prayers, and Their Role in Healthcare and Healing

“True prayer is neither a mere mental exercise nor a vocal performance. It is far deeper than that - it is spiritual transaction with the Creator of Heaven and Earth.” - Charles Spurgeon Over the past two decades, the global healthcare industry has advanced tremendously. There have been significant achievements in terms of medical equipment, diagnostic abilities, treatment plans, and the nature of patient-care and service delivery. While this advancement has successfully made the industry more efficient and has improved its quality, it has also taken away the essence of caring and sentiments on the basis of which the service model for healthcare was developed. In contemporary settings, the healthcare model is based on technological and impersonal approaches, and a cure-oriented model is practiced instead. A huge portion of the industry is profit-driven and tends to run hospitals on the business model. Contrary to this approach, medicine, health, and personal wellbeing have always remained closely associated with spirituality,

care, and the elements of faith and prayers. If we compare the service-model of healthcare with the cure-oriented model, the importance of the former is more evident, and also how formal and impersonal the latter is. While you can achieve the required results from both, you will see how the patients are more satisfied when they are presented with the service-model of healthcare. Service is deemed as the work of the soul and is referred to as a spiritual activity. Taking your time to sit with the patients, listening to them, and valuing their opinions are things that make the core of strong doctor-patient relationships. Compassionate Care and Health If you see the literal meaning of compassion, it says ‘to suffer with’. Compassionate care means that the physician partners with the patient in their journey of dealing with the pain and getting over it. There are two ways of dealing with patients: either you dictate to them like a know-it-all who does not need any input from or any interaction with the patient other than necessary, or you offer to walk with them through the entire journey. Going for the latter helps you achieve better and more satisfying results. When a person is undergoing treatment, he does not suffer just physically, but mentally, emotionally, psychologically, and spiritually as well. Compassionate care helps the patient recover in all these three aspects. Being a clinician, your objective should be to ensure that your patient heals completely and recovers well not just physically but mentally and spiritually, too. Faith, Prayers, and Spirituality

Considering the culture that we live in, faith and religion have an integral role in our lives. Factually, this is not restricted to certain culture or religion but humankind in general. Faith and spirituality are important throughout everyone’s life no matter where they are born or what culture or country they belong to. Faith tends to give a person joy and contentment, while spirituality has the ability to change a person completely by influencing their stance toward life and substantial factors around them. In medical care, spirituality and faith are important for both, patients and doctors. Spirituality is something that is very personal and individualistic. Everyone has a different meaning for it and a different role in their life. When one struggles with a serious illness, possibly terminal, it is spirituality and faith that helps them keep going with the treatment and keep struggling. If they do not have that kind of faith, the curative medical treatment is not likely to bring them a positive result. The patient’s zeal and willingness to recover and the faith that they will recover are highly important. It can relieve suffering and help them connect better with the clinician and those around. It can offer hope and better meaning to life even as they approach the end. Similarly, with clinicians, spirituality and faith play a vital role. Considering the profession we are a part of, it requires dealing with highly critical situations with unpredictable results. Responsible for the treatments that save the patient’s life or push them further toward risk, it is no easy pressure to tackle. Faith and spirituality then come as a major support to help you deal better with responsibilities and pressure. A lot of doctors struggle with depression and burnout

because they cannot deal with the work stress appropriately. This leads to dissatisfaction with the profession and also affects the physical and emotional health of the individual. At the same time, you need to understand the role of faith for the person you are treating. You will be surprised to see the improvement in your patient’s health when you embrace their faith in medical care. This will help them heal better and increase their chance of overcoming illness better and quicker. Prayer has remained a significant part of healing in ancient as well as modern times. Patients, while going to doctors for the treatment, trust that prayers will actually heal them and give them good health. This is a part of belief in a lot of mainstream religions such as Hinduism, Islam, Christianity, and Judaism. Prayer is given substantial attention in healthcare. Patients believe that praying is a mean to communicate with God, and is thought to have healing powers. Hindus have their temples to pray for good health and happiness. Similarly, Churches have separate ministries and individual members who pray for the sick and those hospitalized. Muslims have a practice of asking their Imam to say special prayers for those who are ill. According to the study, Palliative Care and Spirituality published by Narayanasamy in 2007, it is claimed that patients suffering from chronic illnesses and advanced diseases suffer an imbalance of body, mind, and spirit. In such a situation, spirituality can act as an adjunct to the curative treatment. The author emphasizes on how rewarding it can be for the practitioners and the patients to answer

their spiritual needs, and they both can experience spiritual growth and development. It can help in improving the quality of their life and enhance the meaning and purpose in life. According to a study carried out in Pennsylvania, 66% of the patients expressed higher trust and confidence in the patients who took time to talk about their spiritual beliefs. In the same study, 94% of the patients who practiced spiritual principles demanded their clinicians to consider their religious beliefs and their values. When doctors have an understanding of the spiritual needs of the patients, they are able to understand the thoughts and viewpoints of the patients better. Religious beliefs can have a deep impact on healthcare decision-making when it comes to treatment plans. Several researchers have explored the subject of the impact of spirituality on health. Bagiella et al., did a study in the United States and found out that a connection does exist between spirituality and health, but there are several other factors and variables too that play an integral role. Williams and Sternthal did a review in Australia and reported that a positive relation lasts between the religious participation and the criteria of health. The review illustrated that the greater the participation in religion and spirituality, the lower the mortality can be. Harvey and Silverman did a study on coping and compliance in Pennsylvania, (USA), in which they conducted in-depth interviews. The findings state that when it comes to chronic diseases, spirituality plays a critical role in the overall management and treatment. In the

clinical examinations carried out in Iran by Dehghani et al., praying is found to lower anxiety. As healthcare providers, it is the duty of the clinicians to keep into consideration our own spiritual and religious values and perform our job with complete sincerity. Everyone should address their spiritual needs to lead a happy and satisfied life. Spirituality in health varies in concept from one ideology to another, but the foundation remains the same, that it encourages one to have hope and positive approach toward life. Take-Home Message ➢ Medicine, health, and personal well-being have always remained closely associated with spirituality, care, and the elements of faith and prayers. ➢ Make an effort to sit with your patients, listen to them, and give importance to their opinions to encourage a strong doctor-patient relationship. ➢ Compassionate care helps the patient recover holistically. It improves

their

condition

physically,

mentally,

emotionally,

psychologically, and spiritually. ➢ Faith and spirituality come as a major support to help the doctor deal better with the responsibilities and pressure. ➢ Patients, while going to doctors for the treatment, trust prayers will actually heal them and restore them to good health. ➢ When clinicians have an understanding of the spiritual needs of the patients, they are able to understand the thoughts and viewpoint

of the patients in a better manner. ➢ It is the duty of the doctors to keep into consideration their patients’ as well as their own spiritual and religious values and perform their jobs with complete sincerity.

28. Leadership for Doctors

“Leadership is not about a title or a designation. It's about impact, influence, and inspiration. Impact involves getting results, influence is about spreading the passion you have for your work, and you have to inspire team-mates and customers.” - Robin S. Sharma The healthcare environment is changing across the globe. Clinicians are running their practice or working as salaried employees of a hospital or healthcare system. This has enhanced the necessity of leadership qualities among clinicians. The healthcare industry is under constant pressure to improve their care quality while limiting the delivery cost. The administrators and clinicians are now required to work together to ensure that the encountered challenges are collaboratively undertaken. Contrary to the previous settings, clinicians are now required to take up executive roles in the healthcare system to carry out the management effectively and meet the needs of the patients. When you look deeply into the profession we belong to, you will find it evident that clinicians, by nature of the practice, are leaders. They have to take the decisions pertaining to the treatment plan of their patients. They are responsible for the action calls they make.

They lead the interventions from the front, ensuring that the best possible outcome is delivered. Clinicians, even when running a private

practice,

have

to

lead

their

subordinates,

delegate

responsibilities and make decisions related to their clinics. This indicates how necessary leadership skills are for doctors. Unfortunately, this realization is yet to be made on a broader scale. Leadership training and education are not yet a formal part of medical academics. There are training sessions on leadership organized for medical professionals, but it is not integrated into the curriculum. This highlights the gap prevailing in the training of medical professionals. Training of medical professionals, and clinicians, in particular, requires identification of certain characteristics and attributes. These characteristics are to be developed so that they can turn into effective and successful leaders within their area of practice. As a matter of fact, there are several studies published about leadership in business, politics and other competitive fields, but its significance in the medical profession is rarely mentioned anywhere. Despite the dearth of research in this particular area, there is a lot that clinicians can learn from the business-related studies on leadership. This is because of the common factors, which doctors share with the executives of leading companies. The correlation between the two needs to be studied further so that it can be incorporated into the medical college curriculum. This will ensure the presence of clinicians as better leaders in the future healthcare industry.

Before we delve into the traits that are necessary for effective leadership, it is important to discuss what leadership exactly is. Leadership is an immeasurable quality. You cannot see it physically. It is a trait some people are born with, while others learn it through practice. Leadership essentially is the ability to take the risk. The more courage you have to stand up for your actions and defend yourself against the opposition, the better a leader will you be considered. There is no exact definition of leadership. It is, however, associated with what you do, how well you cope with the change and what direction you offer to those working alongside or under you. Leadership is the ability to motivate and inspire others. It is the talent of envisioning the future and leading a group of people to it. In the field of medicine, leadership is more collaborative. You cannot work alone. As a clinician, you will need the assistance of the nursing staff, physiotherapists, pharmacists, radiologists, and several other people. You all need to work as a team to ensure that the objective of optimum patient-care is achieved. This approach does not make the medical profession a part of the traditional leadership of command and control. It requires leadership that is more inclusive. Leadership in medicine is based more on shared purpose and mutual vision. You cannot expect to exert control on people around you by using your power. You have to prioritize the need and wellness of the patients before you make any decision. This can be a challenging process when you have to work on a shared vision and

enable others to act in a manner that contributes to the shared objective. The benefit that you have in this sort of leadership is that it becomes easier to bring organizational change than it is for individual leaders. Collaborative leadership in hospital setting emphasizes the significance of relationship-building. The more effective your relations are with your team and peers, the better management there will be. Even though the concept of leadership in the medical profession is different from the traditional, a clinician still needs to have leadership characteristics. These characteristics help them in leading matters efficiently. The traits that are mandatory for the clinicians to execute the purpose that are discussed in the headings below. The Factors of Trust and Respect What makes a person a leader is trust and respect demonstrated toward him by his peers and subordinates. Working in a healthcare setting, it is important that a clinician is showcased a certain level of respect. People will take inspiration from their leader only if they have respect for him. Certainly, no importance shall be bestowed on a person who is unable to attain the respect of those around him. Trust is another crucial factor that plays an integral role in the leadership qualities of a clinician. As a clinician, you should be able to develop a relationship of trust with your fellow professionals and the team working under you. If you are an employed professional, this trust and respect factor extends to the management as well. The

more people respect, the more inspiration they are going to take from you and this makes you a better leader. Effective Communication Communication is integral in every field. Be it business, economics, engineering, or medical, if you are good at maintaining communication with the people around you, you have the leadership tendency. As a clinician leader, you need to develop excellent communication skills. The better communication you have with your people, the more effectively will you be able to manage your practice. The previously mentioned traits like trust and respect can be only maintained if you are good at communication. When you communicate well, you are aware of what is going on around you. You will be able to stay updated with happenings and concerns arising in the hospital or clinic. Your interaction with others builds the level of trust with your subordinates and people start to respect you. Conflict Management This is a skill that is integral in maintaining a peaceful atmosphere in your workplace setting. Placed in a leading position, you must be able to resolve conflicts immediately. You need to ensure that all voices and ideas are heard and analyzed before you give your verdict. This will give the impression that you have made the decision with care and sans any biases. This is where your communication skills will come handy and facilitate management. See the ‘Big’ Picture

For a leader, it is important to be a visionary. It is your vision that takes the entire team ahead to reach the goal. Your vision determines what the goal is and how you are going to get there. You must comprehend the organizational objectives and then develop your vision accordingly. Once you do this, you can lead your team effectively to the predetermined destination. Keeping in mind the objectives, you also need to visualize out of the box and see the bigger picture that can help you reach your target point more efficiently and productively. Accountability As a leader, you have the responsibility to make a decision based on your best judgments. The choices are yours to make and you have to stand by the decisions that you have made. As a leader, you need to develop the capability to take the responsibility for your actions. You cannot put the blame of your choices on another person or build up excuses per se. You are accountable for your own and your team’s actions. When you start to take the responsibility of actions, this ultimately contributes to your reputation of possessing integrity and respect. Clinicians’ Leadership Roles – How is the Healthcare Industry Benefiting? According to the survey of Accountable Care Organizations in the United States in 2014, it is reported that 51% of the care organizations were headed by doctors. In the hospitals and

healthcare-related organizations, medical departments are led by clinicians themselves. The managerial role is mostly taken up by the doctors. Although they report to the executive team, sufficient decision-making is in their hands and they are accountable for the actions happening within their regime. According to another study, it has been found that almost 20% of the clinicians ceased to practice medicine in the 21st century and took up managerial roles instead. They have become more interested in administering managed- care institutions. Also, there is a practice prevailing among doctors to take up the roles of hybrid managers. These are the medical professionals who carry their clinical practices and management duties simultaneously. This has only served in expanding the scope of medical practice. Engagement of doctors in the managerial roles has resulted in producing improved organizational outcomes and performance. Integration of doctors in the healthcare management has instigated several benefits. It has enabled bottom-up leadership, improving the communication between doctors and senior management. This has consequently

curtailed

management

issues

and

promoted

improvised patient-care related decision-making. Leadership roles embraced

by

clinicians

haves

served

in

making

strategic

management better and has expanded the key accountabilities for patient-care quality. Besides this, several issues related to hospitals and clinics inventory management have been addressed. Multitasking has become a norm as well as a necessity in almost every field. The

leaders in healthcare do not have to be management executives only. They can be practicing doctors as well. Healthcare leadership is a task that ensures direction, offers alignment, and demonstrates commitment within teams and organizations. Hence, this role can be taken up by the clinician themselves. They can integrate elements from management, administration, and leadership in their roles as they continue to lead the organization. The Profession–Experience Debate It is often debated about the level of experience and training required for a medical professional prior to assuming the managerial role. Due to the lack of research in this area, it cannot be exactly determined as to what extent seniority and experience matters in the executive role. However, so far it is evident that management and leadership skills are the crucial factors that determine whether the person is suitable for the role. The experience, however, can give a sufficient competitive edge. A doctor, who has skills as well as practice history, will be able to lead the team better. This is because they are more aware of the challenges encountered at various levels. A younger clinician, who possesses leadership and management qualities, but has lesser experience in the practice can still serve as an effective leader. However, they may face challenges in relating themselves to certain situations as a senior clinician would. Similarly, the subject of medical managers and non-medical managers is also highly polarized. There are advocates of both options. It is emphasized that non-medical managers are less

effective because of their different mindset. Medical managers, on the other hand, do not possess the training and education that their non-medical contenders have. Scientific evidence states that managers with medical background tend to be more conservative and are inclined toward carrying out an individualistic approach rather than becoming a team player. The supporting points of both sides of the debate are justified. So, ultimately it comes down to the preference of the team under question. What do doctors want? According to the study of the United Kingdom's NHS Institute for Innovation and Improvement Coventry, 2008, doctors prefer to be led by doctors. It is supported by the medical community that doctor leaders can improvise healthcare better than non-medical managers. Though the debate will continue unless it is settled through adequate scientific evidence, the need for clinicians to develop leadership qualities and skills remains just as important. For you, as a clinician, these skills are imperative irrespective of whether you are in an executive position or not. Even in your current position, your profession's nature demands you to possess good communication skills and substantial visionary capabilities. You should be working on improving your reputation so that you are able to gain the trust and respect of your team-members and peers. For the better performance of your team and the improvement of your overall service, you need to have the skills to manage conflicts effectively. You may not be given the designation of an executive per se, but you are a leader nevertheless.

Take-Home Message ➢ Leadership in medicine is based more on shared purpose and mutual vision. You cannot expect to exert control on people around you by using your power. ➢ As a physician, you should be able to develop a relationship of trust with your fellow professionals and the team working under you. ➢ The better communication you have with your people, the more effectively will you be able to manage your practice. ➢ Being in the leading position, you must be able to resolve conflicts immediately. ➢ Your vision determines what the goal is and how you are going to get there. You must comprehend the organizational objectives and then develop your vision accordingly. ➢ When you start to take the responsibility of actions, this starts contributing to building your integrity and respect within your team.

29. How to Lead and Manage a Team of Doctors and Staff-Members

“Leaders are made, they are not born. They are made by hard effort, which is the price which all of us must pay to achieve any goal that is worthwhile.” - Vince Lombardi, American football coach, and NFL executive. The need for leadership and management roles in clinical care for clinicians has become greater than ever. However, the question remains unanswered whether this need has been addressed or not. The relationship between the clinical and the managerial staff has been subjected to rifts almost everywhere around the world. The non-medical managerial staff is often unable to relate to the clinical situations and their approach leads to disagreement with medical staff. To counter these issues, the clinicians’ role is in stepping up and taking the managerial roles themselves. This can certainly waive a lot of prevailing issues. However, it is important that the right approach is taken to lead and manage the teams by the clinicians. The managerial role may be new for medical professionals, but it is not something they cannot

do. As mentioned previously, doctors are leaders by the nature of their profession. You have patients’ lives to look out for and a team to manage in a way that they assist you in providing the best possible care to the patients. For a clinician, it is more important to know how to lead a team and manage them than any other marketing or corporate leader. Given the sensitivity and nature of their job, they require more coordination and compliance within the team to ensure that productive outcomes are achieved. But unfortunately, though the challenges faced by the clinicians are well-documented, the issues faced by their team and subordinates are seldom addressed. These challenges are often encountered during communication. When the message is not conveyed clearly, it leads the team to several confusions and hence, the quality of care is impacted. This highlights the weakness that exists in the governance structure of medical groups. In hospitals and healthcare organizations, it is important that clinical as well as managerial leaders who are assigned the responsibility of staff management are obligated to follow an effective governance model. In this model, the clinicians must ensure that no personal matter comes between them and their team, and the issues are resolved without the need for involvement from the department heads. The healthcare organizations that are managed and run by medical executives and managers are working more effectively and producing more prolific outcomes in terms of quality. The reason behind this is that when a doctor manages a healthcare organization,

they bear in mind the aspects of patient-care, the urgency of situations, and the welfare of the medical team. This leads them to make better and more patient and team-oriented decisions. As for non-medical professionals, their approach is more based on urgency and strives to meet the sales and marketing targets. This often leads organizations to take a more capitalist approach. So, in the contemporary age where the threat of capitalism is looming and endangering the nobility of the medical profession, it has become critical for clinicians to know how to effectively manage and lead their team so that they can take up managerial roles ahead. Managing the Teams Becoming a manager can be a difficult job but the reward it offers makes the challenges worth it. As a doctor, you may not have the theoretical knowledge about the management protocols, but that is not completely necessary to take up the managerial roles. Your personal skills and the ability to learn from experiences have a huge role in deciding how successful your tenure as a manager can be. Subsequently, your department’s success is dependent on how effectively you lead your team. Most clinicians often hesitate in taking up managerial and leadership roles because they do not consider managing or leading as their forte. They feel that their clinical practice is more suitable for them. This is mainly because of the comfort zone they have restrained themselves to. We, the clinicians, are capable of so much more. The years of academic experience that requires management of tremendous study-load, infinite clinical rotations, meeting tight

deadlines, and handling pressures of critical conditions certainly refine us to become better at management skills, if not completely proficient. If you look deeper, this is everything a manager needs to know: meeting the deadlines, handling pressures, carrying the workload, and resilient work attitude. For a good manager, in general, it is important that they knows how to assemble, motivate and retain a good team so that they can help the manager achieve organizational goals. As a clinician, your team is your greatest asset. You cannot expect to achieve everything on your own. You need to rely on your team to get tasks done optimally and efficiently. For this, leadership skills are necessary to ease the path for you and management skills to eliminate any obstruction in the way. Leadership skills are discussed in detail in the preceding chapter. Now, let us talk about the management skills you need to have to lead your team effectively: Organization Skills You cannot become good at management if you do not know how to organize well. If you are proficient at organizing your tasks and are leading yourself in a systematic manner, you certainly will be able to lead the team effectively. When it comes to managing and leading teams, your organizational skills are required of a different nature. Besides organizing your own tasks, you need to work on deciding timelines for the projects, assigning roles, and delegating work and responsibilities to the team members. Your experience in the medical college and the subsequent tenure in the clinical practice would

surely have refined your organizational skills. If you still struggle with this, you can get the assistance of your seniors or peers who are good at organizing. You can also make use of smart technology to help improve your organizational ability. Time Management Time

management

has

been

emphasized

multiple

times

previously. It becomes even more crucial when you are entrusted with administrative duties. You need to develop the ability to rapidly identify the type of action that is required for each task you are encountered with. Delegating the tasks and filtering them as per urgency and importance is highly helpful in making efficient use of time. You have to decide what things you need to do personally and what should be given to your team. Also, make a culture of meeting deadlines and punctuality. When you set the example, your team will follow your lead and eventually you will be able to improve overall time management. Confidence Team management highly relies on the confidence of the leader. You need to demonstrate substantial confidence in your team. This serves certain purposes like getting the trust of your team and standing out among everyone else. A manager who appears underconfident before their own team is likely to be not taken as seriously as they should be. This will ultimately lead to mismanagement in the team. Also, as a leader, you need to be sure of yourself.

You need to identify and portray your strengths to wear your confidence on your sleeves. To gain confidence, understand your strengths and weaknesses, and strive to step out of your comfort zone. When you are willing to touch new boundaries, you ultimately develop more trust in your abilities. This boosts your confidence level. Strategic Thinking Strategic thinking is a leadership skill that can be applied to the team management for doctors. Strategic thinking is important in making a strong plan or strategy. It helps you to weigh the pros and cons of every option and then make an effective decision. Strategic thinking can be helpful in team management as it aids you to contemplate factors thoroughly before making a decision and creating team goals. When you make good decisions and establish effective goals, it ultimately takes your team toward better management. These skills are mandatory for you as a clinician in order to manage your teams effectively. There are other things that are equally necessary for carrying your team ahead successfully. These things are discussed under the following headings: Effective Team-Building Your team is the most powerful and valuable asset you have. They are going to benefit you if you take the right approach to them. And, this approach begins with the foundation – the building of the team. When you take the right route from the start, it ultimately leads you to

positive outcomes. The way you build your team determines the possibility of success for you. The more integrity and binding your team has, the better their performance will be. But how are you supposed to build the team? This starts with bringing the people together. You have a bunch of professionals under your supervision; you make them a team when you bring them to a similar platform. Here, communication is key. The more you communicate with your team, and they communicate with each other the better team-building you will be able to achieve. Team-building is not given much importance when it comes to team management, but as a matter of personal opinion, this is considered highly crucial. You cannot expect to achieve the team goals if you have not invested much in team-building. Your team needs to think as a ‘team’. There should be a level of trust and reliability between them. This is only possible if you inculcate such culture. This culture begins with you. Set the example of effective communication and encourage your subordinates to follow suit. Communication acts like a bridge that leads to several other managerial and leadership skills like trust, reliability, and issues resolution. Effective Leadership Leadership is an important attribute for doctors to manage their teams effectively. You need to execute leadership skills to encourage your team for better performance. Leadership is not about imposing decisions and orders. It is about making your team feel valued. Your team should be able to respect you and accomplish their tasks with

dedication because they feel loyal toward you. This can be achieved through appreciation and encouragement. When you assess your subordinates’ performance and appreciate them for their achievements and buck them up on their low points, this ultimately generates a sense of respect and loyalty in them for you. When you have this, you can ultimately direct your team to better performance as they will be more willing to address the weaknesses. The nature of your job leaves only a little room for mistakes. Even the slightest mistake can lead you to significant losses, including loss of human life. So, you have to be highly careful in your approach. Achievements of your members should be acknowledged, publicized and rewarded. This will boost the morale of your entire team and will compel them to put in more dedication to fulfill their responsibilities effectively. Effective Teamwork To deliver quality treatment to your clients, you need to ensure effective teamwork. A good team is key to successful and quality patient-care. Teamwork can be promoted through clear propagation and understanding of the organizational goals. When your team members know what goals they have to achieve collectively, they will ultimately strive toward establishing a mutual ground to work together. Communication, as stated repeatedly, should be emphasized on. It is the ultimate solution to all issues. Effective teamwork can only be

achieved

if

you

and

your

team-members

are

effectively

communicating with each other. As Yehuda Berg has wisely said: “Words are singularly the most powerful force available to humanity. We can choose to use this force constructively with words of encouragement, or destructively use words of despair. Words have energy and power with the ability to help, to heal, to hinder, to hurt, to harm, to humiliate and to humble.” So, to ensure effective teamwork, you need to make use of your verbal skills. Use your words to construct a positive culture in your team. Wise and consistent communication can help you improve team management and keep the problems to a minimum. The better the level of communication you maintain within your team, the stronger the team you will be able to build. Management and leadership skills exist in doctors already. All you have to do is to identify them and polish them according to the needs of the organizations you are part of. Doctors, at all levels, are one way or the other assigned to run teams and departments. Effective team working is dependent on how effectively you use your management

and

leadership

skills.

Your

leadership

and

management skills are integral in achieving the organizational goals of delivering high-quality care to the patients. Remember that the way you treat your staff is the way they will treat your patients. You cannot ill-treat your staff, and then expect them to go forth and deliver inspired, compassionate service to your patients. What they see is what you will get. You are the role model

whether you want the job or not. If you want your staff to treat your patients with respect, treat your staff with respect. If you want your staff to listen to your patients, you need to listen to them. If you want your team to report to work looking sharp, pay attention to your own grooming habits. If you want people to be on time, schedule an arrival time for yourself and be at work when the schedule says you will be. As a clinician-leader, you need to acknowledge the importance of motivation and modify your leadership according to the demand of time and situations. A good leader is the one who understands his team and leads them while staying aware of the changing factors around. You need to have the skills that can assist you in developing and managing strong and effective teams in order to achieve the best possible outcomes. Take-Home Message ➢ Delegating tasks and filtering them as per urgency and importance is highly helpful in making efficient use of time. You have to decide what things you need to do personally and what should be given to your team. ➢ If you are proficient at organizing your tasks and are leading yourself in a systematized manner, you will certainly be able to lead the team effectively. ➢

To

gain

confidence,

understand

your

strengths

weaknesses, and strive to step out of your comfort zone.

and

➢ Strategic thinking is important in making a strong plan or strategy. It helps you to weigh the pros and cons of every option and then make an effective decision. ➢ Your team is the most powerful and valuable asset you have. They are going to benefit you if you take the right approach with them.

30. Negotiation Strategies for Doctors

“During a negotiation, it would be wise not to take anything personally. If you leave personalities out of it, you will be able to see opportunities more objectively.” - Brian Koslow As a clinician, knowing the right skills of negotiation can lead you to better career growth, reputation, and overall success. When you enter clinical practice, you realize that it is not just your medical skills that make you a successful doctor but there are several other things. Your

leadership

skills,

management

capabilities

and

most

importantly, the art of negotiation, all of them collaborate with your professional expertise to determine your overall personality. No matter how advanced the world becomes and how far it goes in terms of modernization, some things remain the same. Their importance does not wither with time, nor are there any replacements for it. The art of negotiation is one such thing. The negotiation skills you possess are never going to be at a loss. There would not be a time when you will not need them. Their necessity will always be there. You cannot ever undermine the power of negotiation.

Just like leadership, negotiation is unfortunately not a skill that doctors are taught in medical college or afterward. This you have to learn and develop on your own. Several clinicians often undermine the importance of negotiation, but this should not be the case. The necessity of this skill should be highlighted so that it can be integrated into the academic curricula for future doctors. As a doctor, negotiation remains a consistent and integral part of your profession. From agreeing to a contract for dealing with patients on a regular basis, or buying equipments everything requires that you should be good at negotiation in order to close deals successfully. Negotiating skills are not something that is limited to salespeople. They need to be embraced by doctors so we are able to get good deals. Why is Negotiation Necessary for Doctors? Doctors continuously have to face situations that require them to settle certain matters. Convincing a patient to take up the proposed intervention, for instance, requires doctors to be good at discussion. If you are good at negotiation, you can convince the patient to sign up for the option that is better than what they are choosing. Being a doctor, there will not be a time when your good negotiation skills would not come handy. Discussing treatment plans and options with the patients is something that you will go through almost every other day. Other cases can be signing up a contract with the healthcare organization you are considering to work with. If you are able to make a healthy bargain with your negotiation skills, it can turn out fruitful for your career growth. Moreover, demonstrating your

negotiation skills amidst contract discussion can certainly serve your benefit by giving you an edge over others. The importance of communication proficiency has made it a career skill for doctors, which serves as a competitive advantage. Negotiation skills in job planning are exceedingly necessary so that you do not have to suffer anywhere. Most doctors are unable to achieve the career growth they truly deserve as they lag behind in negotiation. You have to have the skills that can help you make a hard bargain in order to achieve your career goals and objectives. There are essentially two models of negotiation that are implied generally: positional negotiation and principled negotiation. In the positional bargaining, two sides are given a position each and then the argument is commenced until they both reach a compromise. Each side is expected to give up some demands and accept some from the other side. This model often leads to a locked level where none of the contenders tends to budge and show any further flexibility. Results of such negotiation are mostly unsatisfactory. As for the second model, i.e. the principled negotiation, both the parties are able to achieve a consensus and wise outcomes are acquired. This sort of negotiation is mostly carried on the basis of merits and leads to a win-win situation for both parties. What is Important in Negotiation? Negotiation is about trying to reach an agreement where both parties’ cases are taken into consideration and instead of complete rejection, a mutual ground is identified. Negotiation is about dealing

with conflicting issues and uncertainty prevailing on either party side. To negotiate, it is important that you are well aware of the knowledge pertaining to the case you are about to discuss. Knowledge, indeed, is power. It helps you understand the situation better and assists you in making better and stronger decisions that are more effective in the long run. It is crucial that you anticipate the other party’s side to see their perspective and identify where they are coming from. If it is your patient, your contractor or a new employer – the anticipation skills are handier than you think. They help you analyze the pros and cons of the situation and give you a direction to pursue. Art of negotiation will also help you to get better deal for purchasing medical equipments. You'd know how much you can push the other party toward your terms, and how much room you still have for convincing. To make a better bargain, your situation analytical skills are of vital importance. You have to be careful about the negotiation approach you take in a situation. Your realistic judgment skills, play a vital role in determining how well you can analyze the situation and then carry out your bargaining. Another thing you need to be careful about is the precision with which you start and carry your negotiation. Being a clinician, you need to take two things into consideration. Firstly, the person with whom you are about to bargain. You cannot assume the same approach in all situations. Surely, the bargaining approach you carry out with your employer cannot be taken with your patient. Second is, the issue about what you intend to negotiate.

Negotiation cannot be carried out until you show considerable flexibility toward the other person or party’s case. Also, you cannot achieve effective negotiation unless you are willing to give up some of your demands and make room for the other person’s terms as well. Under such circumstances, it is your anticipation skills that can prove to be highly effective for you. They can help you lead the bargain in your favor. When you know the right buttons that you need to push to make the agreement lean to your side, you ultimately know the skills to ace a negotiation. This is the reason why planning is necessary for negotiation. No bargain can be successfully made unless you are well-prepared and have your strengths ready at the best possible level. When you are prepared well for negotiation, you will be more in control of the entire process. You will know what information to take out for, if you know what the situation is about and what the interests of the other party are. With the use of analytical skills in negotiations, you will be able to detect what the other side is aiming to achieve from this bargain and how your offer differs from theirs. When you have realistic judgment ability, you will be able to analyze how far you can push your contender about the concessions they can offer and what options you can avail from their end. Being able to study the other party with whom you are negotiating, can help you immensely in getting more of your demands fulfilled. This becomes exceedingly necessary when you are trying to convince a patient for a better treatment option. By studying your

patient, you will be able to know what points you can touch to divert the negotiation so that the outcomes will be more beneficial for the patients. When your attempt is for the betterment of the patient, negotiation becomes more of a responsibility where you have to use all your abilities to ensure that your patient accepts the decision, which is beneficial for to him or her. Strategy is a critical part of negotiation. You cannot expect to execute a successful negotiation unless you have worked on planning a strong and capable strategy. As clinicians, the concepts of planning, strategizing and even negotiation may appear very corporate-like and you might as well wonder why this is even being talked about. The answer is that you never underestimate the value of negotiation. You can win wars and achieve the unachievable through negotiation. It does not matter if you are a doctor, a diplomat, a salesperson, or a car mechanic, negotiation skill is equally important for everyone. Additionally, you do not even need a degree to inculcate and learn negotiation skills. All you need is to be observant of the details around you and enhance your ability to listen keenly and talk efficiently. When you aim to negotiate as a doctor, you need to be clearly aware of what exactly your objectives are. They outline what you want to achieve in the end. While setting the objectives, you need to know what you hope to get out of the impending negotiation. Secondly, you need to set down the limit of your least expectation from the bargain. In setting thresholds, you have to be realistic. You

have to give yourself as well as the other party, a substantial room for bargaining. While working on the negotiation strategy, you should keep in mind the bargaining bracket and set the highest objectives, which must be demanding, and realistic. Similarly, the lowest objectives need to entail the options that you would go for if no agreement is reached at all. Your strategy must entail the best possible alternative to a negotiated agreement. The negotiating range that you set for yourself must include the most and the least limit that you can achieve out of a bargain. This is important both psychologically and strategically. For a good negotiator, it is important that you anticipate these goals from the beginning so that you know how to still make a fruitful deal even if no agreement is achieved with the other party. Medical Equipment: How to Negotiate with Companies to get the Best Deal? Medical science is advancing rapidly and various cutting-edge technology equipments are now available to help doctors to pursue their clinical-surgical work. Negotiation represents an important tool to get the best possible deal from the medical equipment manufacturers. In order to get the best possible deal, the doctor can follow some of the following methods: I. Ask for a list of other doctors using the same equipment. Call some of the users and ask for the details and performance of the equipment. Ask specifically about the post-delivery (after sale)

services done by the company. Ask the price as well given by the company, but this can be very variable. II. Get the demo unit of the equipment whenever possible. Use the equipment for 5 to 7 days and see its performance. III. Make a group of 3-4 doctors who need to buy the same equipment, to negotiate and get the best price for the equipment. IV. Always discuss to extend the warranty from 1 to 2 years. V. Discuss and freeze the price of AMC or CMC while buying the equipment. VI. You can consider buying the equipment by the bundling of surgical items like Intraocular lenses, viscoelastic solutions for ophthalmic equipments. VII. For pharmaceutical products (drugs, eye drops, and other disposable items), always discuss and negotiate the best possible scheme provided by the company. VIII. Once the equipment is delivered, always inspect it carefully (serial number, month and year of manufacturer, etc.) and sign the installation report after full satisfaction and seeing its performance. IX. Always write details of the complete deal on paper and share this with company office bearers. Some of the company employees may make verbal promises. This verbal promise will not hold any ground. Also, the company employee may change the company, so you must have a written agreement from the company about the terms of the agreement and ensure that all the details about the after sales service, AMC, CMC charges etc. are clearly mentioned.

X. If the equipment is not working properly, always complain in writing (by email) so you can retrieve it later if required. XI. Always go for CMC or AMC or take breakdown insurance for your equipment. Negotiation Strategies As a clinician, you may as well be continuously considering on what negotiation strategies to implement and what not. Well, there is no need for any hard and fast rule. You just need to figure out and focus on what works well for you. The approach does not matter. If it is getting the work done, you can embrace it. As a clinician, you can take bits and pieces from everywhere and make up a strategy of your own to refine your negotiation skills. Here are some quick strategies that you can make use of: Prioritize Interests When you are in the middle of a situation where you have to rely on your negotiation skills to achieve better outcomes, there are often two obstacles you have to combat: Interests and Position. In a conflicting situation, it becomes hard to decide what you should focus on out of the two. Healthcare professionals and administrators who develop the skills of effective negotiation will find that they are better equipped to heal, collaborate and innovate. Focus on Communication Techniques Communication is the foundation of negotiation. You cannot expect to negotiate without communicating. So, focus on how you are going to communicate your message when it comes to bargaining. You

need to let the other person know what exactly you are trying to get out of the deal and what your interests are. Your communication skills are integral in facilitating the collaboration and compliance. When you communicate, you let the other person know what you are proposing, the involved benefits for the other party, and the risks included. Your negotiation needs to be clear-cut. The person or the party, with whom you are negotiating, should know pros and cons of your proposition. This is the way you can achieve successful outcomes. Delineating the risks in your negotiation may make you somewhat uncertain about getting the desired outcomes. But, this is necessary. You have to communicate both aspects to the other party. If it is your patient, he or she must be aware of the associated risks in your proposed intervention. This will not only allow them to make a better and informed decision but will also protect you from any unnecessary legal trouble that may emerge because the patient was not expecting the risks incurred. Also, it is a reported fact that patients are more willing to start a new treatment or drug when they are well aware of the risks involved. Similarly, if you are on the hiring side, and are trying to persuade a medical professional, or otherwise, to accept the job offer for your clinic or healthcare organization, make sure that you outline the significant challenges they may have to face during their tenure, should they choose to accept your offer. This is for your own good. If you just emphasize on the positive aspects and leave the negatives unaddressed, you might be able to hire a good professional, but this

certainly puts their loyalty toward your organization in question. With time, as your hired professional is going to learn about the challenges involved, would they still want to continue working? This will ultimately increase the employee turnover, which will not only make you lose the time and effort you put into hiring the candidate, but it will also cause disruption in the overall work-flow. So, no matter what situation you are in, make communication a priority. Your message should be delivered clearly and objectively without any hints of ambiguity. Also, you have to be careful about how to deliver the message. You cannot take the same approach with everyone. If it is your patient with whom you have to communicate, you have to ensure that you talk in a language that the patient can clearly understand. Your sentences must not include any hardcore medical vocabulary, which the patient will be unable to comprehend. Similarly, when planning a job, your communication needs to be highly focused and objective-based. You need to know all aspects and communicate all your concerns effectively before you sign the contract. Take Everyone into Consideration If you are in a situation that includes more than one party (excluding you, of course) you should make a strong effort to consider the perspective of every party and bear in accordance the welfare of those stakeholders as well who are not present at the negotiation table.

Now, this can be highly challenging, but then so is the medical profession. You learn to deal with these challenges and eliminate them from your way as you take one obstacle at a time. When you are negotiating on bigger issues, such as that of organizational policy, it is not just about the people who are present at the table and negotiating with you but about the entire staff of the hospital who is indirectly a part of that negotiation as the staff are the ones who have to live with that changed policy. So, when you negotiate the policy, you cannot overlook the workers and employees working under you. Even if all the parties sitting at the negotiation table give their consent for a particular decision or conflict that is being addressed, it can fall apart completely if you do not integrate the other relevant parties into the equation. In order to make a negotiation successful, you need to take everyone into account and make a decision after gathering the consent of every individual who is in one way or another affected by the change or decision. Look for Solutions As a medical professional, your negotiation strategy must endeavor to have a problem-solving approach. No matter what situation you are in, your ultimate objective should be to identify a solution. You need to deal the issue with an approach that would limit it and eventually resolve it. To solve issues, you need to look at them sans any biases and analyze them from every perspective. Hear everyone out and learn all the possibilities that could have initiated

the problem and ways in which it could be resolved. Discuss the issue closely and leave no issue unaddressed. You need to be highly critical in your approach and think strategically to reach a better solution. Retain Diplomacy Negotiation is a critical aspect of diplomacy. You cannot become a diplomat unless you are good at negotiation. Diplomacy is not something that is confined to foreign ministers and bureaucrats. You, as a clinician, can benefit from it tremendously. It can help you achieve the goals that may otherwise seem impossible. The field you are a part of can be highly demanding. As the dynamics of the medical profession is changing, clinicians are required to work with teams of multi-professionals. The present interventional approach has become more integrated, requiring professionals from various backgrounds to come to an agreement and work on mutual ground to ensure better and improved medical outcomes for the patients. Being a part of such a working regime, it has become essential for doctors to have diplomatic negotiation skills so that they can be more persuasive in their approach. When you work with people from different backgrounds, the difference of opinion is inevitable. Various points of disagreements are bound to emerge. So, amidst these factors, if you are working with sufficient negotiation skills, you will be able to use diplomacy to your benefit. Take Time to Decide

This strategy is important when you are part of a negotiation where your job is being planned. Medical professionals, especially the young doctors, tend to quicken up the process and make hasty decisions. This usually compels them to make their call without analyzing all the aspects adequately. This is poor decision-making. When you are in the middle of negotiating your job or contract, you have the right to take time to decide. You do not have to give the answers right away. No matter how much pressure you have from the interviewer or the organization, never give into it when it comes to decisions such as these. It is imperative that you make your decision only after careful analysis. Study the job contract carefully and evaluate each of the conditions and terms mentioned in the document. Cross-check to ensure that your post-negotiation demands are added in the draft. If not, have them integrated before making the final call. Buy yourself the time you need to make a decision that is going to decide the next few years of your career. These are some strategies that can help you on the go as you take one step after another in your career path. These strategies are going to help you not just with your employer, but also on a daily basis as well as to interact with your patients. Convincing a patient toward a certain treatment or making them agree to change their drug can be a challenging task even for a senior doctor, having years of experience treating the patient. Where to Use Negotiation Skills

As mentioned in the preceding section, negotiation skills are not something that is restricted to a particular profession or certain level of an organization. It is equally important for everyone. You may be a highly-qualified surgeon, serving at the topmost career level, a board member, or a freshly-entered resident; if you have expert negotiation skills, you will be able to win many battles without even fighting them. To elaborate further, here are some areas where you can use your negotiation skills: Quality Improvement You are a private medical practitioner and have a sufficient regular patient-base following your intervention plan for years. You decide to upgrade your practice and implement new intervention plan that is better and more efficient. Your patients may not be as excited about the change in intervention as the older one is working for them just fine. They do not see the need that you are sensing to improve the quality of their care, as you know that it won't be much effective in the near future. So, in order to retain your loyal patient-base and also improve the quality, you need to have strong negotiation skills so that you can implement the change without losing your patients. To deliver the message clearly and effectively, you have to have the diplomatic skills necessary to achieve your highest objectives in the bargaining bracket. Your negotiation abilities can help you determine the areas that can help you win the discussion and the areas where you may face

resistance. With these areas identified, you can develop a strategy through which you can easily overcome difficulties. Teamwork This is the second area where your negotiation skills can prove highly valuable. The healthcare industry is changing dynamically. Patients are beginning to take more control of the intervention planning and the culture of multi-professional teamwork is increasing with each passing day. For more improved patient-care, the patients, as well as the organizational stakeholders, are emphasizing on bringing different professionals (doctors, health administrators, financial experts, etc.) together. This has completely changed the traditional approach where the clinician developed the care plan individually and the patient complied. There are multiple parties whose consent needs to be taken to approve the intervention plan. The objective remains the same, i.e. to provide the best quality care to patients, but the approach has changed and has become more collaborative. To ensure that your opinion is valued, it is mandatory for you to have negotiation and communication skills that can improve your team working relationships. You have to become more diplomatic if you want to enjoy a more significant place in the team. Work-Life Balance The third area where you will definitely need negotiation skills is the work-life balance. A lot of clinicians complain about not being

able to have a proper family life. They face challenges in maintaining an adequate work-life balance. They often have to give up social and family gatherings for the sake of their demanding profession. Also, their commitments are continuously subjected to rain-checks and rescheduling. This can get exasperating. That is exactly where your negotiation skills can barge in as a rescuer. Using these skills, you can turn any circumstance into a 'win-win' situation where you get what you want by trading. Career Planning This has been discussed previously as well. Negotiation capabilities can help you turn an un-favorable situation into favorable. You do not have to find yourself land on a poor job plan if you know how to negotiate well. You can stand firm with your job terms and compel your employer-to-be to reach a mutual ground. Negotiation does not let the job contract be one-sided. It helps you to get a balance out of it where your interests and preferences are not ruled out completely. The incidence of stress, burnout and depression in clinicians is escalating because of this reason as well as the circumstantial inability to have a workplace and a job description that would suit them better. So, for a prosperous future and career, your diplomatic skills are of excessive importance. These are only some of the areas where negotiation skills are important. As a matter of fact, there is rarely any area in the medical profession or otherwise, where you will find no need for negotiation abilities. In any interaction you step in, negotiation is an integral part.

You can utilize any method or strategy to execute it, the importance will remain the same. However, you need to be watchful of all the aspects as you pursue negotiation. You need to be prepared at your end before giving your final answer. Take some time to analyze your decision. Evaluate the pros and cons and analyze the risks. Envision how your decision will change your life in the coming years. Contemplate strategically on different aspects so that you know what exactly you will get in the end. Negotiation, essentially, is about understanding people and engaging with them more effectively. As a clinician, when you will refine your negotiation skills, you will realize that you are better equipped to heal, collaborate and work on new ideas. Take-Home Message ➢ Negotiation is about trying to reach an agreement where both parties’ cases are taken into consideration and instead of complete rejection, a mutual ground is identified. ➢ From agreeing to a contract for dealing with patients on a regular basis, everything requires you to be good at negotiation in order to close deals successfully. ➢ To negotiate, it is important that you are well aware of the knowledge pertaining to the case you are about to discuss. ➢ Negotiation cannot be carried out until you show considerable flexibility to the other person or party’s case.

➢ When you are prepared well for the negotiation, you can be more in control of the entire process. ➢ While treating your patient, you will be able to know what points you can include in the discussion, so he/she can be willing for particular procedure or intervention. ➢ You will have to give up a few things to take what matters more. Always prioritize interests over positions. ➢ Focus on how you are going to communicate your message when it comes to bargaining. You need to let the other person know what exactly you are trying to get out of the deal and what your interests are. ➢ You should make a strong effort to consider the perspective of every party and bear in accordance with the welfare of those stakeholders as well who are not present at the negotiation table. ➢ No matter what situation you are in, your ultimate objective should be to achieve a solution. ➢ When you work with people from different backgrounds, a difference of opinion is inevitable. If you have sufficient negotiation skills, you will be able to use diplomacy to your benefit.

31. Violence against Doctors: How to Overcome Confronting Situations

“In the sick room, ten cents’ worth of human understanding equals ten dollars' worth of medical science.” - Martin H. Fischer Sadly, doctors do not hold the same respect as they did in the past, and there is a steadily declining mutual trust and erosion of the sanctity of doctor-patient relationship. While patients often complain that doctors are proud, indifferent, do not give them expected care, charge hefty fees, are dominating, and confuse them with medical jargon; doctors are also bitter about the increasingly aggressive attitude of patients who do not respect them or their work, blame them for suboptimal outcome, and indulge in litigation, without understanding the disease and its consequences. This scenario is not good for society as hospitals are supposed to be safe havens for the treatment and care of the sick, and we cannot afford to let them turn into battlegrounds. While the decline in trust and values is a global phenomenon and affects all spheres of life, and the capitalist mindset and corruption have also affected the medical profession, we should not generalize

these negative qualities. Many of these doctors sacrifice their sleep and family life every day to care for the sick at odd hours. For every case of alleged medical negligence, there are thousands of cases each day, where doctors have gone beyond their comfort zones to help save many lives. Doctors also need to adjust to the heightened patient expectation in a changing society and make every effort to improve communication with the patients and their families. The government is introducing new rules and regulations that will affect doctors and hospitals. The autonomy of doctors with respect to intervention-related decision-making and the clinical approach is decreasing. The healthcare industry is undergoing a change and drivers like Govt. regulations, capitalists, insurance providers, and even patients are beginning to have a powerful share in decisionmaking. This transformation has converted the linear hierarchy that was a part of the medical profession for centuries. Also, with the advent of the Internet, medical knowledge is no longer restricted to doctors. People with non-medical background can get information about diseases, medical conditions and their treatment from the online databases using Dr. Google. They are now more informed about medical processes and tend to take an active part in determining the treatment approach. Moreover, as unfortunate as the fact is, medical treatment has now become a commodity. Government-run hospitals are overcrowded, poorly-equipped and poorly-staffed, and therefore desirable health facilities are not always available. Patients thus need to visit private, or corporate hospitals and they have to pay hefty bills to get quality treatment. Any deficiency in the optimal results or unintended

damages usually leads the doctors toward confronting dire situations. No matter how much consent you take from the patients and their relatives after outlining the possibilities and nature of risks involved in the process, the situations are prone to take unpleasant diversions if results (of surgery or treatment) are not as expected by the patient. Confronting situations between patients and doctors are now more common when patients do not get the expected treatment or results that they paid for, they are bound to get aggravated irrespective of the fact that you are not at fault. Such situations promote stress and depression in doctors and escalate the burnout rate. Also, it becomes hard for the majority of medical professionals to deal with the circumstances that may lead to violence. In past years, there have been several cases making it to the public news, showcasing how doctors have become a victim of violence in the hands of their own patients. Attacks and aggression against doctors have become one of the sore points for the entire medical fraternity. Referred to as angels and messiah in the past, this sure is a huge turning point where doctors are not just verbally bashed but are also assaulted and, in extreme cases, gunned down. According to a study done in the United States of America, every one out of four doctors has experienced allegations for medical negligence and 88% of the doctors have faced anger or violence of patients in their career at least once. This shows how the practice is picking speed. The trend is rising not just in India or in the subcontinent but across the globe. Doctors are being targeted everywhere. This is especially hard for resident doctors. They become an easy target for angry patients and their relatives to lash

out at. This kind of violent situation can take a terrible course if you do not know how to tackle them wisely and efficiently. Reasons for Violence against Doctors The foremost thing to know is the reasons that are actually fueling anger and aggravation in patients and the general public against the doctors. Surely, you cannot dismiss this behavior as completely baseless. There have to be triggers and causes that are compelling people to take a harsher stance against doctors. According to some studies conducted in this particular field, this has created a hostile and resentful attitude toward doctors. These reasons include less than appropriate conditions and services of the public hospitals, poor communication between the patients and doctors, lack of faith in the judicial process, and the escalating cost of healthcare and medical services. These are the primary reasons that mar the trust of patients in their doctors and lead them to frustration and anger, resulting in violent and harsh behavior. With the increase in the healthcare cost, when the patient pays a good amount of money for the treatment or even investigations, they expect a greater level of interaction and interest of the doctor in the process. They expect a better explanation and more time from the clinician. With more cost, patients have heightened expectations and demand more optimized and prioritized services to be rendered by the clinicians and the paramedical staff. Some of these reasons are discussed in detail here: Rising Healthcare Cost

One of the essential reasons behind the aggressive stance of patients against doctors is the swiftly and consistently rising cost of healthcare. In India, the cost of hospitalization has elevated to 300%. As per a survey carried out by the World Bank and the World Health Organization, out of the estimated 100 million people pushed into poverty worldwide due to healthcare cost, India accounts for almost half of that figure every year. This concerning fact is due to the high expenses paid out-of-pocket for healthcare. According to another report, published by the Lancet Global Health, it has been showcased that nearly 800 million people spend almost 10% of their entire household budget on expenses related to healthcare for themselves or their family members. If we just talk about India, there are almost 49 million people in the country who are suffering from extreme poverty only because the medical expenses are too high. These people are forced to survive on less than two US dollars a day. Comparing the healthcare costs in India today with that of 2004, the average hospitalization costs have nearly tripled. A person with an average monthly income has to spend almost 66% of his pay in case of hospitalization. Another thing, which makes this entire scenario worse is the unfortunate fact that the majority of the population is not covered by health insurance. They have no expenditure support when it comes to medical expenses and the entire burden has to be borne individually, making it more challenging for the family. Escalating Suicide Rates

Besides the high hospitalization cost, another important reason that sometime compels families to turn aggressive with doctors is the rising suicide rate of patients. With the lack of health insurance services and widespread poverty, patients and their families are forced to take loans from the private creditors. The debt then escalates with the high-interest rate and people are rarely able to pay it within time. This leads to stress, further impoverished conditions, and starvation. According to the survey conducted by the National Crime Records Bureau, 20,000 people committed suicide in 2015 in India because they were ill and indebted. They could not afford either the cost of the treatment or were unable to pay off the debt hence, they chose to end their lives. Consider the fact that the cost of healthcare is substantially lower in India and other countries in the subcontinent as compared to western giants like the United States of America, United Kingdom. Yet most of the people cannot afford it. People suffer under debts and have minimal sources of income with wretched living conditions and lifestyle. The treatment that is within their resource affordability is the one offered by public hospitals. These hospitals lack adequate funding and, also there is a dearth of such public healthcare centers that can cater to India's huge population. According to national statistics, there is only one public hospital for 90,340 people in India. What is more is that the healthcare staff or the doctors are more interested in private sectors where they are offered better salary packages and advanced medical technology to work with. Only ten percent of the doctors in the country are working in the public sector and there they have to suffer with less funding

and fewer staff to assist them. When public hospitals are understaffed, under-funded, and have limited technology, the patients are referred to private hospitals. Private hospitals offer better intervention and facilities but they are expensive (due to setup, equipment and running cost) beyond measure for the people who come from low socio-economic classes. To meet the financial demands of private hospitals, poor patients have to turn to private creditors to offer the loan. This loan is interest-based which turns into a debt trap with no easy way out. Few patients, who are unable to afford the expensive treatment and do not want to burden their families with the debt, may go in to depression, and a few cases may die due to lack of treatment. This turns their families against the hospital staff, blaming the doctors and others for the death. Medical Bills and Treatment Cost Health as a commodity has benefited investors, capitalists and business houses who are the owners of the corporate hospitals driven by profit and capitalism. They tend to make more money by exploiting ethical procedures. Sometimes the patients are subjected to unnecessary medical procedures which raises the bills. Despite no evident symptom of any health problem, patients are asked to conduct different tests and/or prescribed unnecessary medications or nutritional supplements. Doctors are under the compulsion of the hospital stakeholders and pharmaceutical companies to assume such a stance. This increases the negative feeling among patients. While doctors are not at fault per se, they are still looked upon as the reason behind the suffering of the patients. This ultimately makes them the target of the patients’ anger and resentment.

Doctor-Patient Engagement As mentioned previously, the approach of patients is changing dynamically with time. As advancement is increasing, patients are no longer uninformed or have lack of information related to medical conditions. Also, with the increase in cost in the healthcare services, they want more time, attention, and direct interaction with the doctors. They want priority when they are charged hefty bills. Contrary to this demand, doctors are unable to give substantial time to every patient as the demand is high. There are long queues of patients waiting to be catered to by the doctor. Hence, each patient can only be given limited time. According to a British study, at an average, a doctor in India sees a patient for less than two minutes (compared to 18 minutes time given by a doctor in the USA). This further infuriates the patients as they see doctors like money-making machines. It is therefore very important for you to allocate enough time listening patient complains and explaining him/her about the disease and treatment as well as the total cost. Also, doctors are the intermediary actors between the patient and the hospital. This makes them the victim of patients’ ire pertaining to excessive billing or any other malfunctions that do not concern the clinicians directly. In case of any shortcoming, patients turn their fury on the doctors, holding them responsible for every event. The demand for hefty bill payment from the hospital management is reported as one of the most frequent complaints made to the doctors by the patients.

What to Do in Confronting Situations In the contemporary world, the consumers (patients) are looking out for instant solutions to their health problems and are willing to pay more for a quicker, better and more optimized treatment. In the fast pace, patience, tolerance, and acceptance are lost. But, these are things that you, as a doctor, should hold on to. You will encounter several confronting situations. You will feel molested by the patients as they will question you for things that are not in your control. No matter what the circumstance is, you need to hold yourself back. This does not portray you as a weak individual. It projects you as a mature, sensible, and professional individual. You have to understand the other person too. Yes, they were informed about the risks. They were told about how the results may vary. But they are not doctors. You are! You understand medical processes better than they do. It's not your fault, but they are suffering, and not just monetarily, but physically and emotionally as well. It is difficult but if you are determined to keep your cool, you will soar right through the situation. For non-medical individuals, the long years spent in medical college, house job and then residency appear like infinite hours of study and a crazy schedule of rotations. Only a medical professional can relate to what these prolonged years teach them. They teach you patience, perseverance, permissiveness and the willingness to let go, the tendency to control and do what you want to do. They train you to weather the crisis with faith and confidence.

Medical college and its subsequent academic training make you learn how to accept exhaustion. These incredible years make you hold on to unfailing optimism and program your brain to see challenges as opportunities for growth, both as an individual and as a practitioner. If you decide to implement these lessons and training in your professional life, they will help you immensely, especially in situations where you encounter aggrieved and livid patients. Psychologically speaking, as a matter of fact, your demanding patient is going to get angrier and more violent if you show an equally offensive attitude. When dealt with calmly and with a controlled response, your contender will also cool down. So, whenever you find yourself in a challenging situation, never lose your cool. You can execute substantial damage control just by controlling your own temper. To prevent and address any challenging or confronting situation, it is important that you address the significant factors that play a vital role in the instigation of such interactions. There are two essential attributes in the interaction between the doctor and the patient; the healthcare setting in which the interaction takes place and the culture of interaction with doctor and clinician in the setting. In some healthcare settings, the place is overworked and the workhours are overstretched to meet organizational demands. This limits consultation time and interaction between the clinicians and patients. Doctors are under the pressure of catering maximum patients in less time.

The three important actors: doctors, patients and the system, all have various factors to contribute to the stimulation of confronting situations. Factors pertaining to the system include overstretched framework, limited resources, elongated waiting times, eleventh-hour cancellations, insufficient documentation, and constrained time. As for patients, there is a mixture of psychological, medical and financial factors that may lead to negative interaction with clinicians. These factors are inclusive of medical and psychosocial history, expectations from the professional service and staff, the impaired quality of life, and nature of disease, diagnosis and treatment. Besides these factors, the individual personality of the patient, the emotional factors, and the language barrier also play an imperative role in the interaction. At the doctors' end, there is a list of contributing factors, too. This includes the doctors' personality and feelings, ability to communicate, level of attentive listening, inclusion and exclusion of patients from the decision-making process, job satisfaction level, sleep deprivation, impact of personal life and health, and lack of empathy. These factors collaboratively impact patient-doctor interaction tremendously. If you want a positive interaction without the meeting turning into a confronting situation, all these factors need to be addressed. What needs to be remembered is that the patient is in need of the doctor. He/she consults medical services because he/she is in pain and is suffering. The interaction has to be facilitated by the system and possibilities of negative implications need to be kept at a minimum level. If there is no satisfactory or positive interaction, the patient will undergo emotions like frustration, lack of

control in the treatment process, fear, uncertainty about the care offered, and overall dissatisfaction. For doctors, if the situation is not pleasant, it ultimately increases the level of stress, depression, and anger. This impacts the performance and communication of the practitioners. To manage the challenging situations such as violence against doctors, it is important to take a stance that could avoid creating a confronting situation. There is a need to create a situation that is safe and open. The patient must not feel vulnerable and should be given the clear impression that he or she is being heard by communication. Here are some ways to avoid confronting situations and ensuring effective interaction: Advance and In-Detail Planning Preparing for a meeting (with difficult case) in advance can turn out to be highly beneficial for you to retain positive control over the upcoming interaction. Prepare beforehand to determine how you are going to communicate with the patient. If it is bad news, how are you going to deliver? If it is a proposition for a new, advanced treatment option, how are you going to convince the patient? You have to exempt negativity and focus on the positive aspects. Your tone should be chosen accordingly. Any stricter stance or pressure can lead to unpleasant outcomes. Break the information down into smaller chunks so that it is easier for the patient to understand and they can actively participate in the interaction. Your communication must be clear, accurate and should not cover

anything up. If there are risks, they should be relayed to the patient. The patient should be told about the possibility of negative consequences. While highlighting the positives, negatives should not be avoided. When you deliver the information correctly and the patient is taken into complete confidence about the pros and cons of the intervention, a teamwork kind of relationship is created. This ultimately leads to a positive interaction. Moreover, you have to bear in mind the role of other people as well who might have a say in the intervention care plan of the patient. This includes the partner or spouse of the patient or the family member, who show up frequently with the patient, or any other acquaintance who might have a major say in the treatment plan. These people can have their own set of questions and concerns that you cannot overlook or not give importance to. You have to include them in your communication and keep them abreast the clinical procedure. Also, they can be your support during the interaction especially when you have to deliver bad news to the patient. The patients may not take it as well as you expect them to. Considering that it is the patient who has to go through the suffering and the pain, they are ultimately more sensitive and emotional. Their partner or relative, on the other hand, can assist you in keeping the situation under control. This is also helpful when you keep these supporting actors informed about the risks and suspected repercussions of the process. With the fact that you have not only informed the patient about the risks, but have also taken their caretaker in confidence, it can reduce the possibility of certain unpleasant encounters. In

extreme cases where the patient loses a life during or after the medicinal process, doctors can be violently victimized at the hands of family members. The doctors may have gained the consent of the patient prior to the treatment and delivered the information about consequences, but not taking the same stance with the family members can turn out into highly unpleasant situations. So, do not underestimate the role of the patient's family during the consultation. This is for your own protection and benefit. While communicating with a family member, it is important that you take certain points into consideration. These include eye contact, proactive listening, suitable tone, and understandable information content. Also, if you have other people, like students, listening to your conversation, then it is integral that you take the patient’s consent to avoid any unpleasant argument later. Be Highly Attentive You have to be highly attentive when interacting with the demanding or aggressive patient. You have to look out for cues and information other than what is being provided to you verbally. Not everyone is good at communication; you have to bear this in mind. Your patient can be shy or is not that open to discussing his or her condition even with the doctor. So you have to be watchful about non-verbal

communication

as

well.

Aspects

such

as

body

movements, gestures, eye-contact, tone and other such things give out quite meaningful information. Bearing in mind the verbal and non-verbal communicating attributes, you have to subtly probe the patient to talk about their condition. This is the only way to attain

maximum information, which can be helpful in planning the intervention. Encourage your patient to communicate by providing them with a friendly setting and warm attitude. When you lead a positive communication with your patient, it gives you more understanding about the health problem your patients are facing. With this information, you can develop a better and improved treatment plan. With an improved treatment plan, better outcomes can be achieved and, thus, the possibility of unlikely results is reduced. Also, when you have strong communication with your patient, the level of trust ascends. When there is trust, there will be lesser chances of reaching any position where you have to face confrontation. Impart Knowledge and Show Support You have to keep in mind every aspect and possibility when interacting with patients. You have to see, interpret and take into consideration their side as well. Keep in mind that this is a difficult phase for them. They may not be as stable mentally, emotionally and psychologically under the influence of the illness, they are suffering. Their ability to comprehend the information you offer them verbally or during the meeting may not be in the best possible shape. Also, they do not have the same level of forte regarding understanding medical conditions. They may not be able to absorb or understand the entire information you provide them during the meeting. Aside from their lack of knowledge in the said area, you have to bear in mind this as well that revelation of the diagnosis can shock them and momentarily inhibit their ability to listen, let alone

understand, what you say afterwards. There is a persistent factor of nervousness and you cannot expect your patient to be completely attentive to what you are saying and stay focused on every point you make. So, you have to take additional measures yourself to ensure that your patient is fully aware of what medical condition he or she has, what intervention planning you are proposing, and what risks there are in the process. Once you have verbally communicated the details, make sure to give your patient some handout about the proposed treatment or give them resources to consult before taking the final decision. This will allow the patient to make a completely informed decision. The more informed your patient is, the better it is for you as it will diminish the possibility of any confronting situation. Make the Information Understandable You have made things easier for your patients. Ensure that the information imparted to them is in a language they can easily understand. The words you use should contain no hardcore medical jargon. You can take help of illustrations, flowcharts and other tools to assist you in the process. Also, keep asking the patient if they are getting what is told to them. Question them so that you know if they are able to absorb the information or not. Consider the Human Factor As a medical professional, the fact is not hidden from you that every individual is different. Your job as a doctor is to consider human factor, mind set, likings, etc., while treating him/her. The understanding ability varies from person to person. Every person

reacts to different news differently. This can lead to a confronting situation where the patient can react unreasonably even when it is not your fault in any manner. You cannot generalize when it comes to patients. As a clinician, this can be a challenging thing for you. To tackle the human factor better, one needs certain practice and training. You have to accept that you need training in order to handle these situations better. You can take help of your seniors, peers, and other professionals who can assist you better in improvising your communication skills. As discussed in the preceding sections, knowing how to communicate is excessively important for doctors. It helps you to build a good relationship with the patients and play a role of a diplomat in order to curb the risk of situations that may lead to confrontation. Be Interpretive While interacting with patients, you have to be highly aware of how things are proceeding. You have to be alert of the non-verbal communication and look for signs such as level and pitch of speech, transformation in attitude and behavior, and changes in the body language. These changes may indicate that the patient is getting uncomfortable or does not like how the conversation is shaping out to be. If you notice such symptoms, it is better that you change the course of the conversation and talk about something else. Your aim should be to retain the comfort of the patient. Address in a manner that does not provoke the patient. Keep your conversation within the zone that is easily understandable for the patient. You have to

constantly analyze the situation to see if it is going in the right direction. Encourage Trust in the Patient The relationship between a patient and his clinician must be of trust and reliability. Trust is the fundamental requirement for positive and constructive interaction between you and the patient. You have to give something to your patient that can make them trust you. A friendly tone, empathetic stance, attentive listening or giving him time to open up – it can be anything. You have to be the one to take the first step and create the bridge of communication to fuel trust. You have to be brave enough to take the risks and take the initiative to communicate openly with the patient. Make an effort to clear any doubt or ambiguity that may stem during the interaction. Create favorable conditions for the patient to be more at comfort. Reassuring the patient frequently can be another beneficial attempt to keep the person at ease and help them feel safe. The seeds of trust are sowed right in the beginning and then nurtured along the way. If you want to avoid any obnoxious event or interaction with the patient later on, you have to take measures from the start to prevent it. Focus on Solutions If you experience a confronting situation or a disagreement with the patient or their family members, always emphasize on offering a solution. You have to be a problem solver. Instead of getting defensive and trying to prove your own point, make room for negotiations and settling the conflict. You have to hear the other

person out and then, on the basis of the concerns and opinions of the contending party, come up with solutions that are acceptable to both of you. When you offer solutions, this ultimately leaves no room for any further argument. It allows the confronting patient to divert their focus on the solution rather than the problem. You have to use the art of communication to your benefit and explore a way out of confronting situations so that the matter does not augment any further. The conflict is going to get as big as you let it become. Even if you are not at fault, always aim to resolve problems. Shannon L. Alder beautifully explains about the conflict in these words: “If there is no communication then there is no respect. If there is no respect then there is no caring. If there is no caring then there is no understanding. If there is no understanding then there is no compassion. If there is no compassion then there is no empathy. If there is no empathy then there is no forgiveness. If there is no forgiveness then there is no kindness. If there is no kindness then there is no honesty. If there is no honesty then there is no love. If there is no love then God doesn't reside there. If God doesn't reside there then there is no peace. If there is no peace then there is no happiness. If there is no happiness - then there is conflict because there is no communication!” So, focus on communication. Emphasize on the solutions. Learn to bend instead of letting things take a violent turn. There needs to be modesty in the medical profession. You cannot consider yourself

above others. The knowledge and experiences you have earned do not mean you can be disrespectful to anyone. You have to show equal respect to everyone and understand their perspectives too. A concerning rate of the poor population still sleeps on the streets in India. There are thousands of people who starve every day. There are people who have to struggle beyond measure every day to meet their basic needs. Despite the fact that we have no role in the conditions they are facing, we have to show a certain level of empathy and compassion toward them. Make your patients feel valued. Show them that you are aware of their struggles. The goodness starts with a healer like you because you are the epitome of mercy and healing. The rate of violence against doctors is escalating because the public perception about them is changing. People no longer look at doctors as compassionate individuals. They are beginning to see them as profit-driven money makers who eat out of hard-earned money and debts of the poor people. While this isn't true in all cases, the public tends to generalize and direct the focus of violence toward the doctors. To avoid such repercussions, you have to take measures at your end. You have to be careful in your interactions right from the beginning. Trust, reliability, and consent, these are the few things you have to emphasize on the most. Achieving these will ultimately strengthen your relationship with the patient. Doctors are vital players in the welfare of the entire society. They put in rigorous and long work-hours, follow tough schedules, and make their patients their priorities. For this, they should be highly

appreciated and recognized. It is also time to reflect and contemplate on the changing scenario. It is essential for the doctors to make efforts to re-establish the lost trust. Professional organizations, healthcare authorities, and the government must map out strategies to assist doctors in rebuilding this trust. They must also implement clear laws for healthcare professionals to abide by. These steps are essential to take to improve the healthcare industry in India. Here's hoping that the medical profession is restored to the glory that it enjoyed in the golden era in the coming future. Let us make the required changes in our fraternity and our practices before the situation gets any worse. All of us should also actively take steps to improve the image of the medical profession because none of us is above this collective perception. Interested readers can view the following video by the author: aggression and violence against doctors: how to overcome confronting

situations?

https://www.youtube.com/watch?

v=s7MnbqHMZXE

Take-Home Message ➢ The rate of violence against doctors is escalating because the public perception about them is changing. People no longer look at doctors as compassionate individuals. ➢ Doctor-patient trust is eroding due to several reasons. Corporate hospitals are seen as profit-driven money makers who eat out of hard-earned money and debts of the poor people. While this is

not true in all cases, the public tends to generalize and direct the focus of violence toward doctors. ➢ To avoid such repercussions, doctors have to take measures at their end. ➢ You need to be careful in your interactions right from the beginning. ➢ Emphasize on trust, reliability, and consent. Achieving these will ultimately strengthen your relationship with the patient.

32. Multi-Professional Teamwork

“Teamwork is the ability to work together toward a common vision; the ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results.” - Andrew Carnegie The medical profession has been subjected to a tremendous paradigm shift in the past decade. The practices that were previously exercised for centuries are now completely transformed. It is not just the technology that has advanced and the treatment plans that have progressed, but there are substantial changes in the overall methodology and approach as well. A doctor was once considered the sole decision-maker of the patient's health, diagnosis, and the following treatment. There was little to no say of any other person. Moreover, the treatment plan was based on the judgment, expertise, and knowledge of the consulting doctor only. This practice has seen a massive transformation in the past few years. The interventional emphasis is more on team working and collaborative decisionmaking rather than just one-man game. The diagnosis is no longer carried out by a single expert but by a team of professionals who look at the case from multiple angles.

Multi-professional teamwork has become mandatory in the current healthcare setting. Considering the fact that the industry is now undergoing rapid advancements, the primary objective is to offer the best health facilities to the patients that can improve the competitive edge of the hospital organization as well. The offered services are now expected to be highly advanced and optimized to ensure that the patient is not just achieving the best possible care but is satisfied with the services, too. While this endeavor has helped substantially in improving the quality of care, it has also raised the competition among the health organizations. And, this has made the multiprofessional team working even more common. Aside from the capitalists’ approach, multi-professional team working has also become a necessity because of the fact that with the advancement of technology, the new medical conditions and new diseases have emerged as well. Every month, a new disease or virus is discovered. With every case, a new condition is encountered. This has necessitated the collaborative working of doctors from various specialty backgrounds. As per this approach, the multi-professional team is seen as an innate reality. Professionals from multiple backgrounds, come together to interact with their specialized types of work. Having a diverse working experience, they work with the hope of bringing solutions to the problems. A multi-professional team of doctors is conceived as a source of increased productivity, improved intervention planning, and service rationalization. Importance of Teamwork in Healthcare

Healthcare leaders keep looking for new practices that can help in building effective care providing teams. The multi-professional teamwork is one such initiative that is now widespread across the globe. This is seen as an effective tool to deliver satisfactory healthcare services and improve the overall efficiency and service of medical professionals. In delivering optimum healthcare, effective team work can produce immediate and effective outcomes and ensure optimum patient safety. The need for effective teams is increasing with the passage of time as the co-morbidities are enhancing. With increased complexity of specialized care, it has become important for multi-professional doctors to come together at one platform and serve the public. The evolution of healthcare and worldwide demand for quality patient care necessitates the regulation of a parallel healthcare professional development that is highly focused on the patientcentered teamwork approach. This can only be achieved if the patient is made the center of the care and all decisions are made by keeping the patient as a priority. Team-based healthcare is a provision of health services to the people by multiple health providers working collaboratively with patients and their caregivers to achieve the mutual goals of patient safety and high-quality care. When multiple medical professionals come together and their knowledge, experience, skills, and wisdom are pooled, the care plan developed is certainly of optimum quality. Conversely, in the healthcare practice, the shared responsibility sans high-quality teamwork can produce depressing outcomes that

can put the patients at risks. If the professionals fail to communicate effectively or are unable to show a flexible attitude and consider other professionals’ opinion, this can certainly take things downward. Teamwork has become a mandatory part of the healthcare setting. Where it offers tremendous benefits in improving the quality care, it is not sans barriers. You are bound to experience obstructions as you try to accomplish the health goals. Some of these barriers are discussed below. Barriers in Multi-Professional Teamwork There are a few things that can affect multi-professional teamwork in healthcare, and lack of communication is the most important of them. Poor communication between healthcare professionals can derail all the efforts and negatively influence the outcomes of the process. Moreover, this can lead to compromised care quality, causing conflict with the patient and caregivers. If you, a clinician who is part of a multi-professional teamwork on a health case, fail to communicate effectively with other members, there is a high possibility that you will be left out of the decision-making and the intervention will lack in your area of expertise. When you communicate, you actually deliver your point of view on the case and get the idea of what and how others are interpreting the same thing. This enables room for critical thinking, allowing all the professionals to strategize the intervention thoroughly. Interacting effectively with your counterparts keeps the ambiguity and conflicts to a minimum and boosts effective outcomes.

Besides communication and interdisciplinary experience conflict, multi-professional teamwork in healthcare is subjected to the barrier of resources. The amount of resources determines the composition of the team, the training opportunities, the communication and information regulating the system and the working space available. The increased load of work can escalate the threshold of resources. If these resources are not used appropriately, they can curtail the motivation of the team and affect the participation of the members. These barriers hold back the effective team working among doctors belonging to multiple professions. If handled adequately, the entire process can be improved productively. Improving Multi-Professional Teamwork To improve the multi-professional teamwork in healthcare, it is important that each member develops a set of shared values, principles and benefits. Here are some that can help develop better team working: Maintain Honesty When working with a group of professionals to accomplish a shared objective of quality patient-care, the first thing to consider is honesty. It should be maintained at all costs. Always remember the nobility of your profession. It is to serve humanity. You cannot do it unless there is honesty in your approach, thought process and endeavors. Honesty is a value that is strongly associated with the communication within the team. It requires you to remain transparent about the aims, objectives, decisions, mistakes, and ambiguities. If

you have done something wrong, own it up. Be honest about it. If you feel something is not right, do not cover it up. Bring it to the table and resolve the matter before it causes any influence on the life or health of the patient you are working on. To summarize, honesty is the foundation of a high-functioning team. Regulating Discipline Discipline is second yet an equally important attribute as that of honesty in teamwork. When professionals from diverse medical backgrounds come together to accomplish a shared objective, it is important that all members carry out their roles and responsibilities with discipline. This may turn out to be inconvenient at times, but it should be prioritized. Know that every person’s time is just as important as yours. If you are busy, they are too. But when everyone else is taking out time from their schedule to reach meetings, you should, too. When you make a determined effort to remain disciplined, this ultimately enables the team to develop productively and seek ways to improve while sticking to standards and protocols. Promoting Creativity Surely, there is not much room for creativity in the medical profession, but here creativity does not mean adding colors or embellishments to the process. It means to exploring various ways and opportunities to tackle challenges and problems. Thinking out of the box, while developing intervention refers to creativity. As a team of professionals, when you work on a case, you are likely to see errors and encounter unexpected outcomes. These encounters can turn into significant opportunities for improvement.

Benefits of Multi-Professional Teamwork There are several benefits of the multi-professional team. It is not only effective for patient-based outcomes but also good for organizational objectives, shared team benefits and individual team member benefits. For healthcare organizations, the advantages offered by a multi-professional team working are: ✓ Reduced hospitalization cost and time ✓ Reduced hospital admission rate ✓ Better services offered to patients ✓ Increased credibility As for the team collectively, it is able to achieve better and improve care coordination. The team can make more efficient use of healthcare resources and services. Also, collaborative team working can enhance the professional exposure, skills, and experience of the medical personnel. The patient benefits include enhanced satisfaction with the quality of care provided, a better acceptance of treatment, and a reduced ratio of medical errors. As a medical individual working in the multiprofessional team, the benefits offered are increased job satisfaction, greater clarity of organizational and medical role, and better personal and career development. The context of healthcare and support is changing dynamically. The proportion of the older aged population is increasing and this change is hugely impacting the future of healthcare. In the coming future, the demand for medical professionals to cater to the needs of

the older population is going to increase. The medical conditions are going to get more complex and expectations will be heightened. This will ultimately necessitate medical professionals to work in partnership, offering and engaging with people in making the best possible choices about their health. To meet the rapidly progressing demands of the medical service, multi-professional team working has become the most acclaimed and is expected to be an effective strategy. Therefore, it can be foreseen that if not at present, then tomorrow definitely is going to demand you to work in a multi-professional setting where you have to collaborate with other experts in order to ensure the best possible health outcomes for the patients. So, it is important that you anticipate this building need today and modify your approach accordingly.

This

proactive

stance

will

serve

your

benefit

tremendously. Take-Home Message ➢ The teamwork of doctors is a strategy to promote intensive specialization process where the intervention procedures can be enhanced, and greater knowledge is involved in individualized aspects of the health requirements. ➢ When multiple medical professionals come together and their knowledge, experience, skills, and wisdom are pooled, the optimum quality care plan is developed. ➢ Failing to communicate effectively with other members is the biggest barrier in multi-professional teamwork.

➢ Interacting effectively with your counterparts keeps the ambiguity and conflicts to a minimum and boosts effective outcomes. ➢ The multi-professional teamwork in healthcare is subjected to the barrier of resources. The amount of resources determines the composition

of

the

team,

the

training

opportunities,

the

communication and information regulating the system and the working space available. ➢ Honesty is a value that is strongly associated with the communication within the team. It requires you to remain transparent about the aims, objectives, decisions, mistakes, and ambiguities. ➢ When professionals from diverse medical backgrounds come together to accomplish a shared objective, it is important that all members carry out their roles and responsibilities with discipline and explore various ways and opportunities to tackle challenges and problems.

33. Why Doctors are Losing Public’s Trust and How to Regain Trust in Patient-Doctor Relationship

“A good physician treats the disease, the great physician treats the patient who has the disease.” - Sir William Osler The doctor-patient relationship has been defined as 'a consensual relationship in which the patient knowingly seeks the doctors’ assistance and in which the clinician knowingly accepts the person as a patient.' The doctor-patient relationship has remained a keystone of care in the history of medical science. It serves as a medium through which substantial data is collected, diagnoses is carried out, treatment plans are made, and productive outcomes on the basis of compliance and support are achieved. To ensure satisfactory health outcomes, it is important that the doctor-patient relationship is nurtured and grown on the basis of trust, reliance, and faith. However, in the past couple of decades, the trust of the public in the doctors and the healthcare industry is declining substantially. Why Doctors are Losing Public Trust?

These are the reasons why doctors are losing trust in India where this profession was considered one of the noblest professions of all. It is high time that steps are taken to deal with these issues. Health care institutions must create an ethical code that must be followed by all health care professionals strictly. Building patient–doctor trust must also be given utmost importance so that it enhances the overall quality of care. Continuous professional development by regular training, workshops, and seminars should be conducted for all doctors on the importance of communication, showing empathy and compassion to their patients. Health care professionals must realize the wonders that can happen when they actually listen and empathize with their own patients. It greatly helps speed up the process of treatment and recovery. When more and more health care professionals start adapting these practices, the patient–doctor trust will greatly increase. Loss of doctor–patient faith has led to patients being confused about which health care provider to go to, and then end up 'shopping around' for doctors with the hope of finding an ethical and a sincere doctor. Unfortunately, this practice increases their chances of making the wrong decision, which delays and also affects the quality of treatment. Such mistrust towards health care providers and unethical medical practices have become prevalent in other countries as well. Various studies on health care in different countries have also reported a lack of empathy which has also contributed towards this loss of faith. It has been reported that more importance is given to the physical health of the patients instead of their psychological and mental health. Moreover, the work environment in health care

industry is stressful and the attitude of medical colleagues is not much help either. This ultimately results in a lack of unity and empathy among the health care professionals. There are many doctors who have a firm belief that they are only responsible for enhancement of the physical health of the patients which is why compassion and empathy is not needed. When the patients are not empathized with and are not shown compassion, the patient–doctor relationship

is

further

affected.

Illogical

referral

results

in

unnecessary treatments and investigations. This also affects their treatment plan and creates patient–doctor mistrust. The Prevention of Cut Practices Act, 2017 is intended to make accepting or offering commissions for referral of patients by any healthcare provider as a legal offence. A handful of medical professionals are under the pressure of organizational

stakeholders,

pharmaceutical/medical

device

industries and corporate employers to compel the patients to take certain tests, medication, or treatment. This has only fueled negativity among the patients and therefore creating mistrust in the doctor-patient relationship. Another important factor that has tremendously impacted the clinician-doctor relationship is the aspect of generalization. One bad experience shakes the entire trust of the patients and they are no longer convinced to rely on the doctors. As patients are constantly facing the rising health costs, they feel that they are not getting the time, attention, and concentration they deserve from the doctor considering the hefty amount of fee they are paying for their examination and treatment.

As mentioned in the preceding chapter, the average time a doctor gives to a patient in India is less than two minutes (compared to the average consultation time of 20 minutes in the USA). After waiting in long queues for hours, patients are not given even five minutes and are quickly examined, prescribed and then the next patient is called. This certainly gives no empathetic vibe to the patient and they are quick to believe that whatever medication, treatment, or test is prescribed by the doctor may not be workable. On an honest note, the rate of mistrust between the doctor and patient is initiated from both sides. Even though it is not intentional at the doctors' end, but it is a fact that little efforts are shown by the professionals to actually improve it. This is the primary reason why excellent communication skills are mandatory. The fact that decision-making is no longer solely in the hands of the doctors has also substantially impacted the trust factor in the clinician-patient relationship. Increased legal litigations and violence carried out against doctors in the recent years is a serious indicator of how the doctor-patient trust and relationship is worsening with every passing day. A survey carried out in the United States of America demonstrated that out of 3700 respondents, half had negative impressions about the healthcare services they were provided with. Among the reasons highlighted, the most prominent was unsatisfactory and decreased quality of care provided in the past years. Another survey conducted in the United Kingdom stated that the rate of complaints against clinicians had increased exponentially by 64% within a limited span of three years. This showcases the

concerning speed at which doctor-patient relationship is deteriorating and public trust in health professionalism is falling apart. Here are few important causes that are making the patient-doctor relationship weak and draining the trust from this bond. Lack of Communication Skills As emphasized repeatedly, communication is an integral part of the medical profession, it is not just an obligation to accomplish and increase competence, but a mandatory tool to hold and strengthen the level of trust with the patient. One of the main reasons for the rejection of social trust in healthcare is the incompetency prevailing in interpersonal communication. In 70% of the cases pursued by patients against doctors, the dearth of communication efficiency is reported as the reason for malpractice. There is a significant connection between the interpersonal communication skills of the clinician and trust level of patients. Both are directly proportional to each other. The fact that patients are only able to have limited time with the clinicians and are scheduled to infrequent follow-ups does not help the trust element. Bearing in mind that there is only limited time for the clinician-patient meeting, the communication skills of the clinician are correlated with trust. When the clinician lags behind in interaction, this further derails the trust between the two parties. Lack of Medical Trust Medical technologies and procedures are advancing and this has almost eliminated the traditional methods of healing and aiding completely. While the modern means and techniques are more

advanced, improvised and efficient, some the patient population does not show much trust in them. They are more inclined toward the traditional approach they have been using for ages and have firm faith in their effectiveness. Considering that the previous medication and procedures were giving the patients their required results, they see no benefit or need to switch to newer treatment plans and methods. They have not developed the trust in advancements as much as they have in like in Complementary and Alternative Medicine approach. Such advancements have showcased highly promising results but the public is unable to build up their trust in them. How to Mend the Trust Bridges There are several studies available show that the trust of the patients in the practitioners is diminishing. The integral indicators are lack of medical trust, increased lawsuits against doctors, and the incidents of violence against doctors. Patient-doctor trust is becoming a concerning matter that requires several subjects to be addressed including the effectiveness of healthcare provision, clinical outcomes, quality care, and examination and interaction time. The fragile, dented, and staggering trust bridges between the patients and doctors need to be reconstructed and strengthened to ensure that the flow of healthcare services is carried out undisrupted. In order to secure the trust ties between the medical service providers and the patients, it is imperative that there is clear and transparent communication between the two parties. Both of them should disclose the conflicts of interests that are impacting the

relationship.

Expectations

should

be

created

for

long-term

relationships and shared-interests should be promoted. As a clinician, you must take initiatives at your end to lessen the power differences with the patients and make things easier for them by allowing them access to the information pertaining to their medical condition. Enable and empower them to make an informed decision for themselves. Let them have a substantial say in their treatment plan. Give them the assurance that they have control in the process. When you facilitate these things, trust is ultimately fostered between you and your patient. Trust is not limited to the time a clinician spends with the patient in the clinical examination room. It can be fostered through other means, too. We talked about the lack of medical trust. Patients’ trust is diminished because they do not have a very optimistic approach to the costly new medications and expensive interventions. that can be out of their budget. The clinician must ensure to prescribe the drug or perform the surgery or an implant that suits their budget. Treating patients within their budget also strengthen doctor-patient trust and enhance their satisfaction. In this entire phenomenon of the doctor-patient relationship, it is not just the clinician whom the patient chooses to trust or distrust, it is the entire health system that is associated with the clinician. Considering that the patient has access to the doctor only, they will be judged on the basis of the medical system, not individually. If the organization is raising the cost of service, the patient-clinician relationship will be impacted. Similarly, if a therapy suggested by one doctor does not work, the entire system will be subjected to distrust.

Hence, this can be inferred that it is not just a matter of trust between the doctor and the patient, but the system and the patient. This issue has to be seen holistically to ensure that no loophole is left unattended. Despite the fact that the trust issues are not about doctor and patient solely, you, as a clinician, have to play your part excessively well. Considering that doctors are the intermediary between the patient and the system, a lot is dependent on them to ensure that the relationship is carried smoothly and the factor of trust is fostered consistently. There are a number of strategies that you can use to strengthen the patient-doctor relationship. Strategy#1: Get the Training One of the core reasons why the trust between patients and doctors is deteriorating is the lack of training and knowledge among medical professionals in detecting and resolving the problems existing in the relationship. It is imperative that the practitioners and their staff are adequately trained in patient relationship care. You and your subordinates must be able to detect the problem in the relationship with the patient when they see one. Instead of seeking justifications, it is time to step up the measures and resolve the problems pro-actively. It is never late to learn things you do not know or the practices you are not good at. If you lack communication skills and have a hard time dealing with difficult patients, you can take part in training programs.

If identifying psychological symptoms is not your forte, it does not make you any less of a good doctor or getting the necessary training for the skill would not impact your reputation. Instead, it will boost your growth. When you accept your weaknesses and take measures to turn them into your strength, this actually denotes constructive personal growth. Strategy#2: Creating a Patient-Centered Culture As a medical professional, your ultimate priority should be providing your patient with the best health service and offer them an intervention that improves their condition. Considering the decline in trust in the doctor-patient relationship, you have to take measures that can make patients feel safe, prioritized and valued. This can be achieved by initiating a patient-centered culture. When you project the image of 'patient first' in your services, it ultimately delivers a positive message to the patient. Making healthcare instead of profit the center of attention can encourage patients to reform their trust in the system. Putting the needs of patients ahead of profit, politics, and personnel can help create a culture where the patients no longer feel vulnerable or taken advantage of their illness. Strategy#3: Rules of Communication Communication being the key-role player in the entire process, it has to be given substantial importance. Along with communication, substantial attention needs to be given to negotiation as well. It is essential that you know how to deal with patients. Certainly, you cannot say yes to whatever they ask from you, nor can you turn down every request they make. You have to take a middle-path that

benefits both the parties. This is why negotiation and diplomacy skills are necessary. You have to learn how to communicate and interact well with the patient and set administrative rules of communication. The rules outline the limits and nature of communication. These rules can state what is and is not acceptable when negotiating with the patient and how you are going to deliver the intended message so that it is clearly

understood.

Setting

these

rules

can

actually

work

constructively in mending the trust bridges between the doctor and the patient. However, you need to bring in systemic changes to ensure that these rules are implemented and followed consistently. Strategy#4: Encourage Accountability The trust in the doctor-patient relationship is maligned because of the accountability of medical professionals to employers. For instance, in the present setting, the interventions and care plans are largely influenced by employers who determine the available resources and the extent to which these resources can be used. The status of the employer in the middle makes the procedures further complicated and conflicting. Actors such as health insurance providers have bigger-say in the medical processes than the patient. This puts a further distance between the patient and doctor and reduces the trust of the former in the system. To make the situation better, it is imperative that instead of employers and insurers, the members or the patients have more say in the plan. When they know what they are paying for and services that are covered by the plan, they will be able to restore their trust in the system.

Strategy#5: The Organizational Culture The culture prevailed in the organization says a lot about how things are conducted. The elements of openness and honesty play the role of the stimulator in promoting trustworthiness. If patients are given the exact and authentic messages about the services and their results, it will make them trust the organization. But if they are deceived by stating false facts and wrong details, they will ultimately develop negative reviews about the organization. So, ensure that you remain honest about the information with the patient and be open about details. Do not raise the patient's expectations unnecessarily, especially when you do not have the means to fulfill them. Strategy#6: Maintain Privacy Privacy and confidentiality are the most important aspects of the doctor-patient relationship. They influence the disposition to trust. The patient expects you to remain discreet about their health condition. It is your ethical obligation to maintain the confidentiality of the patient’s health record. The cyber-security crisis that the health industry is currently a victim, made it highly difficult for the clinicians to ensure data security, but all possible measures should be taken. Strategy#7: Give Time and Attention If you want to regain the trust of your patients, you have to give them time and attention. Both are essential requirements of trust. While revising your strategy, you must determine a reasonable minimum average time for the visits. The patient must feel that you have taken the time to hear them patiently and attentively and have

not seen them as merely a source of money. The time must be decided on the basis of the type of visit, type of doctor, and the complexity of the patient, and the patient complaints about visiting time. These strategies can be beneficial if you choose to implement them successfully and follow them for the long-term. Trust is that crucial part of the medical profession that serves as the foundation of the entire framework. If trust is lost, there is nothing much left behind. What we do and why we struggle is all for the patients. If they choose not to trust us, the doctors, completely, that is an alarming concern. So, at this stage, it is important that the trust is mended and nurtured again so that it can be strengthened. Take-Home Message ➢ Doctors need to learn how to communicate and interact well with the patient and set administrative rules of communication. ➢ Practitioners must train their staff members to provide excellent patient care and satisfaction. ➢ The elements of openness and honesty play the role of the stimulator in promoting trustworthiness. If patients are given exact and authentic messages about the services and their results, it will make them trust the organization. ➢ The patient must feel that doctors have taken the time to hear them patiently and attentively and have not seen them as merely a source of money.

➢ Let us work together so that the medical profession restores the glory in the coming future that it has enjoyed in the golden era. Let us follow ethical practice, make the required changes in our practice pattern, before the situation gets any worse. ➢ All medical professionals should work together to improve the image of the medical profession, because none of us is above this collective perception.

34. International Health Careers: Opportunity for Medical Professionals

“Unfortunately, there seems to be far more opportunity out there than ability... We should remember that good fortune often happens when opportunity meets with preparation.” - Thomas A. Edison Healthcare is a diverse and expanding field. With globalization in complete swing, the interest and participation of medical students, residents, fellows, and senior medical practitioners are increasing rapidly with every passing day in international career opportunities. The global health career is just as vast and rich as the medical practice itself. The profession of doctors is no longer restricted to their national territory. They now have the opportunity to avail of an international career and become a part of global health services. Clinicians who choose global health opportunities are able to develop vast experience, in-depth knowledge, as well as clinical competence. For a doctor, a global health career enhances whatever they have learned throughout their conventional clinical training starting from the medical college to residency and the fellowship subsequently. Global health enables them to work with patients

having a diverse medical history, condition, and pathologies. Clinicians can improve their examination skills, team working capabilities, and research proficiency. Working in the regime of global health, as a clinician, you are exposed to a variety of circumstances. Sometimes, you have to work without relying on imaging and laboratory tests and use limited resources to produce the best possible outcomes. This ultimately unleashes your potential and enhances your clinical skills tremendously. Besides global health, there are remarkable opportunities for medical professionals to work in foreign countries. There are around 49,000 Indian doctors practicing in the USA and around 28,000 in the UK. This makes India the largest exporter of doctors in the world. According to the WHO, we already have an international deficit of doctors of more than 7 million. By 2035, the medical professional shortage will have reached approximately 12.9 million. Certain countries like United Kingdom, Canada, Australia and The Kingdom of Saudi Arabia face a shortage of trained healthcare professionals. These countries are dependent on other international medical graduates to fulfill their gaps. Taking the case of Canada, for instance, there are 15% international medical graduates in residency programs. In the Kingdom of Saudi Arabia, nearly 65.5% of the doctors are foreigners as the country itself does not have sufficient medical graduates to fulfill the requirement. This showcases the opportunity that lies in such countries for doctors and medical professionals. The Challenges in Global Health Careers

For medical professionals aiming to pursue an international career, the path certainly is not free of obstacles and challenges. They are obscured by different factors in different countries. At times it is the academic compatibility; other times it is the territorial policies and hindrances in acquiring an independent medical practice license. These challenges are delineated individually as follows. Academic and Training Compatibility As a matter of fact, every country has a different setup and follows a unique framework to execute its functions. There are different academic curriculum, rules and criteria that make a person eligible for medical practice in a certain sphere. For instance, an Indian medical graduate will be trained and taught according to the academic curriculum and rules and guidelines by the Medical Council of India/National Medical Commission. These requirements are not the same as that of the United States. The standard differs substantially. So, if an Indian medical graduate decides to pursue an international career in the United States, they have to first meet the requirements of the later country. They have to meet their eligibility criteria in order to get to the position originally intended. There are medical licensing exams (United States Medical Licensing ExamUSMLE) that Indian medical professionals have to pass and fulfill criteria to obtain license to practice medicine. Similarly, international medical graduates migrated to UK have to clear PLAB exam and take further training. Balancing Real Life Difficulties

Medical professionals, who choose to pursue an international career, undergo substantial challenges in establishing a firm footing. They have to face the dilemma of balancing not just their required medical training and exams that would bring them equal to the local graduates, they also have to keep up with family life, travelling between their workplace and home country, and the debts that might pile up during the global health career. For expatriates, there is a dearth of loans and funding during training and career development. This burdens the international medical graduates and emigrants who are planning to settle internationally. Obtaining a Medical License This is one of the biggest challenges you can face internationally – acquiring a medical license to practice independently. Starting a private medical practice in India may not be difficult for you. But if you decide to serve internationally, your route could be bound by several obstacles. There are different processes in different countries to acquire a medical license and the entire process may take time. In some countries, you have to get the help of third parties or recruitment agencies to offer you support in getting a license. In others, you have to go through a tedious procedure to qualify for the license. Moreover, in some countries, you might get a license for one province but not another. This ultimately limits your scope of practice geographically and otherwise. This is the reason why most international practitioners have a provisional license. To achieve a full-time license, you need to have time, patience to follow guidelines.

Despite the challenges mentioned above, the scope of doctors in the international medical field is exciting. The reason is that the field is quite vast and the growing health needs demand a high supply of foreign-trained medical professionals. As a matter of fact, the world is swiftly moving toward an aging population, which means there will be more human resources required to cater to the needs of the elderly patients and work on the health issues as they continue to grow. Therefore, there will be a greater requirement for healthcare professionals globally. Interested medical graduates can study the rules and regulations of the foreign countries they would like to explore their medical career and take help of Google and other resources available on their web page. Interested readers can view the following video: Overseas Medical Profession as a Career Choice for Young Doctors Today https://www.youtube.com/watch?v=5CCo2CWpwIU Take-Home Message ➢ Every country has a different setup and follows a unique framework to execute its functions. There are different academic rules and criteria that make a person eligible for practice in a certain sphere. ➢ Working in the regime of global health in low income nations, as a doctor, you are exposed to circumstances where you have to work without relying on imaging and laboratory tests, and use limited resources to produce the best possible outcomes. This refines your professional skills.

➢ For expatriates, there is a dearth of loans and funding during training and career development. This burdens the international medical graduates and emigrants who are planning to settle internationally. ➢ Acquiring a medical license to practice independently is one of the biggest challenges you can face internationally.

35. Global Medical Trends and Challenges: The Changing Health Environment

“Happiness is the highest form of health.” - Dalai Lama Medical science has progressed immensely over the past two decades leading to development of new drugs, devices and treatment modalities. While the twentieth century was able to accomplish a lot of public health achievements, the twenty-first century is on its way to a greater and better advancement course, aiming to make patient diagnosis and management simpler, and easier. Among the major achievements in the twentieth century, we witnessed the invention of vaccinations that helped us to eliminate diseases such as smallpox and polio. The maternal, as well as infant mortality rate, was decreased substantially. The concept of family planning emerged out successfully and the health of women across the world improved substantially. Food and water are much safer now, thanks to the various techniques of purification of drinking water and uncontaminated food supply regulated in the past century. Moreover, with health awareness, healthy lifestyle and the availability

of medications, the death rate due to infectious diseases like diarrhoeal diseases, tuberculosis, malaria, etc. were reduced leading to healthier living. While these are the achievements of the twentieth century, the medical researchers and professionals are not lagging behind in the present years. They are able to build upon the basis founded previously and are making progress at a remarkable speed. Diseases such as cancer now successfully detected at an early stage. The medical research field has grown significantly. It has enabled medical professionals to stay abreast of the health challenges and cater to them promptly in order to retain the optimum health of the world population. Incorporation of robotic systems, artificial intelligence and smart technologies in the medical procedures has indeed made the processes easier and more efficient. With the positive trends in the medical field, there are substantial challenges as well which the professionals and healthcare organizations have to go through. The medical field is surrounded by a number of challenges too. These includes- emerging threat of air and water pollution, increased use of pesticides, increased incidence of cancers and lifestyle diseases, lack of medical insurance, cybersecurity issues, rising healthcare costs and increased legislative actions, etc.The subsequent sections address about the rising trends and challenges faced contemporarily by the doctors and healthcare providers across the globe. Environmental Factors

The drastic change in the climatic conditions is the utmost challenge for the healthcare industry that has certainly coerced the healthcare providers to consider amending their strategies to accommodate the changing trend in a better and more appropriate manner. Global warming is escalating at an alarming speed. Air pollution has become a thousand times worse than it was in the past century. These environmental factors are directly and indirectly affecting the health and well-being of the human population negatively. The water sources are swiftly drying up. This is resulting in a shortage of pure and healthy drinking water. The compromised quality of water is leading the human population to certain waterborne diseases. The change in the climatic conditions has led toward untimely rains and melting of glaciers. As a result, water resources are drying up due to global warming, and natural disasters such as storms, floods and droughts are becoming a common entity. These environmental challenges have increased the prevalence of diseases in the human population. Ultimately, the load on the doctors is increased as they have to offer support and care to the sufferers and also aid in developing solutions for such problems. Global Disease Outbreaks As the medical world is swiftly overcoming the diseases and health conditions that were once considered incurable and several diseases have been eradicated through vaccination, a whole new range of diseases is emerging globally, making things highly challenging for the professionals. Examples include- Avian Influenza, Ebola Virus

Disease (EVD), Middle Eastern Respiratory Syndrome Coronavirus (camel flu), Zika Virus Infection, and Chikungunya, these are all global disease outbreaks that affected almost the entire world. Health threats imposed by viral diseases had put the entire medical fraternity on alert and are continuing to do so because these pandemic threats are unpredictable and cannot be resolved. The significant reason is that the symptoms for the virus are only identified when the individual is already infected. To curtail these challenges, it is imperative to invest in health education, responsible practices in agriculture, cattle farming, sanitation, and take measures that can help to prevent the virus from spreading. Economic Differences The imbalanced global economy plays a vital role in determining the trends and challenges in the healthcare industry and practice. Despite the advancement in the global medical practices, there are several places around the world where people do not have access to even the most basic health facilities, education, health awareness and this has led toward increasing death rates caused by preventable health conditions. Sexually transmitted diseases are still common even in developed nations as Europe and the United States. The United Kingdom is reported to have a large number of Human Papilloma Virus (HPV) cases. Swaziland (eSwatini) shows 27.20% prevalence rate of HIV/AIDS. These statistics denote that even in these times where the prevention and awareness is regulated significantly, these

diseases are common. It is not just the underprivileged countries but the people of developed nation are suffering from these illnesses. These issues are further complicated as the disparities stigmatize these populations irrespective of the geographical location. Factors like income inequality, social stereotyping, rising healthcare costs, economic recession, and inflation are contributing to the challenges faced in global health. To address these challenges, combined efforts by the government, health authorities, key-opinion-leaders, NGOs are needed. Barriers to healthcare must be reduced and the accessibility should be made easier. Rising Healthcare Costs Talking about economic disparities, it is pertinent to discuss the subject of rising healthcare costs. This issue of escalating treatment cost has become one of the significant global challenges that are concerning not just the clinicians and healthcare providers but the international healthcare policymakers as well. The healthcare spend rate grows faster than the GDP and this certainly causes a depressing impact on the overall economic growth nationally and internationally. As per the reports, the cost of healthcare in the United States alone has reached 3.5 trillion US dollars in 2018. This has led the economic superpower to spend a substantial amount of their GDP on healthcare. With limited capital resources and increased demand, the healthcare organizations in developing nations (like India) are facing challenges in providing efficient and cost effective healthcare services to its entire population.

Insufficient funding for healthcare and increasing challenges like environmental factors, aging population, and global pandemic by new viruses, has made it difficult for health authorities to regulate their service effectively. International health organizations and authorities are researching methods to overcome these new challenges. The Digital Health Trend Innovation has remained a significant part of the medical field and has escalated substantially in the past couple of decades. In the present age, it is quite evident how digitalization is swiftly integrating into the medical field. Digital health holds ample potential, and it entails considerable challenges as well as complete transition to the digital health is a new learning experience for the medical professionals. Among the changing trends in digital health, it is evident how the medical interventions and healthcare planning procedures are evolving. The digitalization has enabled patient-centric solutions using the services offered by smartphone and wearable health gadgets. These devices now offer huge data pertaining to a patient’s health that can be digitally analyzed and then used in designing customized interventions. This digital integration has facilitated monitoring

health

parameters,

symptom

recognition

and

identification of potential illnesses. While this data is highly helpful in curtailing medical conditions and diminishing hospital admission and stay, it has further obligated the medical professionals to remain

updated with this data so that they can guide and support the patients in a better way. Alongside the health-related applications that help in diagnosis, digitalization has introduced the trend of telemedicine. Patients can now get access to healthcare services through telemedicine, smart information technologies and virtual sessions. This is an effective way

of

managing

diseases,

chronic

illnesses

especially.

Telemedicine is a cost-effective, accessible and less time-consuming method of rendering health services. Legal Challenges From aggressive patients to angry former subordinates and employees: the situation can take a legal swing in any case possible. The healthcare industry has come under a constant threat of encountering legal issues that can emerge from least expected sources. The changed legal policies and legislation have made it challenging for the administrators to curtail the possibilities of legal actions against the health providers and the clinicians. Data Violation Among the legal challenges, the primary concern is the information infringement that medical professionals and stakeholders have to face. With the advancement of digital technology, where it has become easier for the clinicians to manage and utilize patient-related data, it has also become vulnerable to malignant attacks carried out by hackers.

The data stored digitally is exposed to the threat of information infringement as the practice of cyber-crime, and theft of digital devices has emerged as conventional means of a violation of information confidentiality. System-hacking and private information breach has led doctors and healthcare providers to significant lawsuits. This has necessitated strong protection of digital information systems and security of Electronic Health Records to ensure that no legal action is carried out against doctors. Whistle-blower Suits In the healthcare industry, a challenge that has emerged since the change in the legal policies is the whistle-blower lawsuits and false claims

against

doctors

and

health

providers.

With

more

compensation offered to the patients in the changed legislation, the administrators and practitioners are now more vulnerable than before to legal actions based on unauthentic claims. These fraudulent claims have caused not only monetary loss to practitioners but affected their reputation as well. To curtail these challenges and dynamically changing trends, it has become necessary for the healthcare organizations to partner with not just governments but with the private sector as well so that they can help understand how the landscape of healthcare is changing and how they can make the most out of it. Using clinical and IT solutions or public and private sector health organizations, there is a need to have a system that can anticipate challenges and achieve certain transformations which can help curtail the repercussions of these challenges.

Take-Home Message ➢ A whole new range of diseases is emerging globally, making things highly challenging for the professionals. ➢ Despite the advancement the global medical practice has reached, there are several places around the world where people do not have access to even the most basic health education, and this has led to increasing death rates caused by preventable conditions. ➢ Factors like income inequality, social stereotyping, rising healthcare costs, economic recession, and inflation are contributing to the challenges faced in global health. ➢ The healthcare spend rate grows faster than the GDP and this is causing a depressing impact on the overall economic growth nationally and internationally. ➢ Digitalization has enabled patient-centric solutions using the services offered by smartphones and wearable health gadgets. These devices now offer a large amount of data pertaining to a patient’s health that can be digitally analyzed and then used in designing customized interventions. ➢ Patients can now get access to healthcare services through video clips and virtual sessions using telemedicine system. This is an effective way of managing diseases, especially chronic illnesses. ➢ The data stored digitally is exposed to the threat of information infringement due to cyber-crime. Theft of digital devices has emerged as conventional means of violation of information confidentiality.

36. Pharmaceutical Industry and the Medical Profession

“It's easy to complain that pharmaceutical companies place profits over people and apparently care more about hair loss than Tuberculosis. However, many in the pharmaceutical industry would be glad for the opportunity to reorient their research toward medicines that are truly needed, provided only that such research is financially sustainable.” - Thomas Pogge The pharmaceutical drug and medical device manufacturing industry, the medical profession, and the patient have a unique relationship.

The

relationship

between

doctors

and

the

pharmaceutical industry has been long subjected to scrutiny and analysis. The intent of the industry and the vulnerability of the doctors are widely spoken about in professional discussions. However, despite the debate, the relationship has become highly polarized

and

pharmaceutical advancement.

an

ethical

houses

is

collaboration deemed

of

essential

clinicians for

with

scientific

The concept of shared aspirations needs to be revived and the general public interest should be prioritized. Ethical conduct must be carried out to ensure that only safe and effective medicines are regulated in the market. Considering the changing global health scenario and the challenges in the medical industry, the time has certainly arrived that both medical and pharmaceutical professionals establish an alliance with a common goal of spreading health awareness, and promote the latest trend in drug development to doctors with honesty and authenticity. It is an established fact that pharmaceutical companies support and sponsor scientific conferences, continuous medical education (CME), continuous professional development (CPD) programs that are mandatory for the advancement of the medical field. Innovations, development of pharmaceutical agents and medical devices is important for continuing improvement in healthcare. Developers and manufacturers of pharmaceutical agents and medical devices assist doctors in the pursuit of their educational goals and objectives through the financial support of various medical, research, and educational programs. If the promotional information and support are not offered by the pharmaceutical companies, the field is going to lag behind substantially. Drug development, pharmaceutical innovations and development of medical devices is exceedingly necessary because it is one significant way of offering excellent patient-care. It is in the best interest of the medical industry to coordinate in a manner to develop new drugs which improvise the treatment of patients. The interaction between practitioners and Pharma houses needs to be promoted for the sake of medical innovation and

progression but the ethical code of practice should be strictly adhered to as well. Indian Pharmaceuticals as a Global Leader In the past three decades, the pharmaceutical industry of the country has boomed and has emerged as the third largest producers of drugs in terms of quantity. The industry has seen a swift growth in the past couple of years and has become worth US $36.7 billion and is expected to reach US $55 billion by year 2020. The sector continues to outperform others in the country and retains a constructive growth, making its place in the top five emerging markets in the pharmaceutical industry globally. India’s exports for generic drugs continue to grow at an impressive rate of 24% annually in the past four years. The pharmaceutical drug exports are mainly directed to the regulated markets like Africa, European countries, Australia, Japan, and Latin America. This shows the efficiency in the quality and competitive pricing of Indian drugs. In summary, the pharmaceutical drug and medical device manufacturing industry, the medical profession and the patient have a unique relationship. The industry makes products (drugs or medical devices) which it cannot sell to the patient (consumer) directly. On the other hand, the medical profession cannot treat the patient without drugs produced by the industry. Thus, the industry and medical profession are interdependent with a common aim. One should be able to evaluate them according to the principles of beneficence, non-maleficence (non-harming or inflicting the least

harm possible to reach a beneficial outcome), patient autonomy, and medical ethics. The industry must develop latest drugs for the patient, not manufacture drugs that have harmful effects. It must make reasonable profits to help in the research of newer drugs. Healthcare awareness in public and development in global healthcare necessitates improved interaction between doctors and pharmaceutical leadership. Each has to acknowledge the positive aspects of the other and align their ambitions to serve the public interest in a better manner. Take-Home Message ➢ The pharmaceutical drug and medical device manufacturing industry, the medical profession, and the patient have a unique relationship. ➢ The industry and medical profession are interdependent with a common aim, the industry makes products which it cannot sell to the patient directly and the medical profession cannot treat the patient without drugs/medical devices produced by the industry. ➢ It is an established fact that pharmaceutical companies support or sponsor scientific conferences, continuous medical education (CME), and continuous professional development (CPD) programs that are mandatory for the advancement of the medical field. ➢ India’s pharmaceutical industry has grown by leaps and bounds over the last three decades. As a result, it has emerged as the world’s third largest producer of drugs in terms of volume.

37. Future of Healthcare in India and Worldwide

“The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease.” - Thomas A. Edison The bright future of the Indian healthcare industry is possible by the team effort of government, medical professionals, key-opinion leaders and the leaders of the health industry. In the growing Indian market, there is a huge opportunity for the pharmaceutical and medical devices industry. Being one of the fastest expanding markets, it is expected to reach the pinnacle of US $280 billion by 2020. India also has become one of the trusted and preferred medical destinations in the world that offers high-quality healthcare services at competent pricing. The healthcare industry is the booming industry. This industry shows an upward graph, whereas all other industries, may it be telecom, electronics, software industry show ups and downs. This is primarily because of the growing population of India. As the population grows, more and more people will need access to health facilities. According to WHO standards, the number of beds required is 4 per 1,000 population, so there is tremendous scope for growth. Out of this growth, small hospitals will

contribute to 80% of the beds. Presently, it is almost Rs. 600,000 Crore industry. Being one of the largest sectors in the country, healthcare contributes extensively in terms of employment and revenue generation. It has advanced swiftly and is continuing to grow at a rapid pace. Bearing in accordance the changing global health dynamics and the speedily progressing medical technology, it can be said that the scope of the industry is wide. It is going to grow and advance magnificently. India is already witnessing privatization of secondary and tertiary healthcare services in semi-urban and urban parts of the country. The culture is expected to expand further. The country has been fortunate enough to have wide resources of trained and qualified medical professionals, who are consistently working to improve the quality of healthcare and cater effectively to the rising health needs. Indian healthcare is currently controlled by these significant drivers: escalating economic performance, rising population, and the increasing trend of lifestyle diseases. The health industry, like several other sectors, is getting privatized and providing excellent services in terms of availability of diagnostic and therapeutic tools, qualified medical professionals, and therefore medical tourism is increasing substantially. If the present healthcare industry is analyzed, as per the reports of the India Brand Equity Foundation, the worth of the health industry is nearly US $160 billion. As mentioned before, this figure is expected to touch US $280 billion by 2020. The demand of the industry is expected to rise as the income levels are subjected to rise, there is increase in the aging population,

and there is changing attitude toward preventive healthcare approach. The pharmaceutical industry also is expected to boom in India in the coming future. The market is assumed to grow at the compound annual growth rate of 15.92% and will increase in size from US $36.7 billion to US $55 billion by 2020. Medical tourism is also anticipated to grow to double its size from US $3 billion in 2017 to US $6 billion by 2018-19. The infrastructure and expenditure of healthcare in India are continuing to rise substantially. It is expected to be more diversified in the coming years. The health services are advancing well as modern technology is getting integrated into the interventional approach and new drugs are developed on a regular basis. The bright future of the Indian healthcare industry is possible by team efforts of government, medical professionals, key-opinion leaders and the leaders of the health industry. Suggestions to improve healthcare in India were appropriately made by K. Srinath Reddy, President, Public Health Foundation of India. These are as follows: Increase Healthcare Spending to 2.5% of GDP At the moment, the Indian Government spends about 1.15% of its Gross

Domestic

Product

on

healthcare,

according

to

the

Organization for Economic Cooperation and Development. The Government is planning to spend 2.5% of GDP by 2025. The public spending is 33% of the GDP, of which only 4% is spent on healthcare. Compare this to Thailand, a country with a robust

healthcare system, where health spending makes up 14% of total public spending. Using Existing Tax Revenues The Government should use existing tax revenues to pay for health system. As the tax base widens, the Government could also consider levying a specific income tax to support the national healthcare program, in which case user fees on people above a certain income would be equivalent to charging them twice. User fees do not actually help the system pay for itself. That is because they generate their own expenses like paperwork and salaries for staff to handle billing and collections. Even minimal user fees can deter the poor from seeking care. Focus on Primary Care Additional funds should not go only to maintaining the present health system, with its skewed spending choices. Much as in education, Indian health spending has often favored treatment at hospitals in large cities over more widely available basic and preventive care. The increase in spending should be accompanied by making changes how that money is spent. Over time, 70% of public spending should be in primary care. Primary care is distinguished from other levels of care by the medical qualifications of the attending doctors and the sophistication of the healthcare facilities. Pre-natal check-ups and regular deliveries would be primary care, for example, while a cesareansection delivery would be secondary care. Indian health spending also favors cities over the countryside, Urban areas have four times

as many health workers per 10,000 people as compared to rural areas. Work in a National Public Health Service The country needs an all-India service of public health workers along the lines of the system in Tamil Nadu that is considered as one of the best in India. In general, to make a national health system that works, more medical and nursing schools will need to be set up and thousands of more basic health workers will be required, particularly in villages. Reduce Out-of-Pocket Spending Out-of-pocket spending on medicine has gone up in India and now accounts for almost three-fourths of all private healthcare spending. The Government could take a clue from Tamil Nadu, which purchases drugs in bulk and provides many medicines for free to patients. That would involve significantly increasing public spending on drugs from around US $1 billion now. Health Scenario in India and Govt. Ayushman Bharat Yojana India spends only 1.15% of its Gross Domestic Product (GDP) as public expenditure on health when compared with 6.5% by Australia, 7.4% by Canada, 7.7% by the United Kingdom, 8.5% by the United States, and 9.5% by Germany and hopes to increase it to a suboptimal 2.5% by 2025. Only 106,415 doctors are employed by the Government in India, of the 938,861 doctors registered to provide healthcare to a population of over 1.2 billion. Of these, only 27,355 are posted at primary health centers, which typically serve

the rural population. Poor infrastructure and lack of manpower in government hospitals make the situation further grim. On September 23, 2018, Government of India launched 'Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY)', to provide health insurance worth Rs. 500,000 (US $ 7,124.54) to over 100 million families every year. The Government of India has launched 'Mission Indradhanush' with the aim of improving immunization coverage in India. Healthcare in the Year 2050 Considering the pace at which we are moving now, the medical industry is expected to boom tremendously in the coming years. In the next thirty years or so, the industry is envisioned to be highly digitalized and efficient than it is today. Several speculations have been made and expectations drafted by medical experts regarding how the industry is expected to progress. The population needs to prepare for the adoption of innovative, supportive and smart technologies that can offer better and more efficient care to the patients than what they are receiving today. Clinical Trials Technology is expected to change the face of medical treatments and research completely. There would not be any need for conventional clinical trials and animal testing can be completely eliminated. Experts are looking forward to the in-silico clinical trials that would use tiny microchips as models of human cells, organs or entire systems. They can be used to test the effects, benefits, and consequences of drugs on human use. This can save a lot of time

and efforts and bring out more accurate results as compared to the trials being executed on animals. Medical Education It is expected for medical education to undergo extensive reforms by 2050. Considering that the shift in the clinical practice is already evident, we can expect more innovative integrations in the teaching methodologies. For instance, colo-rectal surgeon, Dr. Shafi Ahmed of the Royal London Hospital (UK), performed an operation using a virtual reality camera at the hospital for everyone to participate in the operation in real time through specific website and application. This was a first of its kind case in the history of medicine. This showcases the possibility of how learning experiences can be transformed using the right digital tools and media. Digital Wearables and Devices The use of wearables is already in trend. By 2050, it is expected to become more of a norm. There will be more sensitive devices that can be worn, implanted or built into the homes to measure the medical parameters, observe behaviors and keep track of the location of the patients. Devices like Fitbit and Jawbone are some of the wearables that are presently common. They are unnoticeable and do all the required work without creating any trouble for the patient. These technologies are expected to get more sophisticated with time. Better Integration of Artificial Intelligence

Artificial Intelligence holds a lot of potential, which will be significantly utilized in the next thirty years. The medical practitioners will have better technology and software to process the wealth of data pertinent to the health and well-being of the people. This data will be accumulated by keeping track of users' everyday activities. The trends and patterns with respect to the environment will be combined together to deduce the possibilities of diseases and illnesses the user might be suffering from or have the possibility of developing them. This can instigate proactive treatment and resolve drastic medical conditions beforehand. Also, this will cut down the hospital

admission

rate,

making

it

convenient

for

hospital

administrators to provide efficient facilities and services. Online Patient Data Access The data revolution is expected to unfold successfully by 2050. The health information record could be accessed by the patients online and they will be able to keep an effective track of their health progress without any hassles. This will aid them in leading a healthier and better lifestyle. Digital Diagnosis Health experts are positive that patients need to be physically present at the clinics or laboratories to get the diagnoses. By 2050, computers will be advanced enough to support tools for medical diagnosis. The year 2050 has a lot to look up to for the medical the professionals as well as the general public. There is a whole lot that can be done in these thirty years. Considering the paradigm shift of

the past 100 years, we can expect several times more rapid progress in the medical field now. The above mentioned expected progress also suggests that the cost of the medical treatment will be reduced significantly. Considering that the above applications propose better health management and more reliance on digital procedures, the frequency of hospital visits and subsequent hospital stays will be curtailed. This can be economically beneficial for the overall medical industry. In summary, healthcare is one of the booming sectors of the country and India is swiftly moving toward advancement. But it would be of no use if the general public is not benefited by it. We have to take measures individually to bring a positive change and follow the dictum, 'prevention is better than cure' by increasing health awareness among public. As doctors, it boils down to our professional ethics to always maintain quality patient-care as the utmost priority. Take-Home Message ➢ The health industry is getting advanced and development in terms of diagnostics and therapeutic equipments, highly trained medical professionals, pharmaceutics, medical applications, and medical tourism is increasing substantially. ➢ While advancements in healthcare are making patient-care services better and far improved, the year 2050 has a lot to look up to for the medical professionals as well as the general public as artificial intelligence and digital diagnosis will become a norm.

➢ The Indian Government spends about 1.15% of its Gross Domestic Product on healthcare, according to the Organization for Economic Cooperation and Development. The Government is planning to spend 2.5% of GDP by 2025. ➢ The bright future of the Indian healthcare industry is possible by the team effort of government, medical professionals, key-opinion leaders and the leaders of the health industry. ➢ India need a leap in healthcare spending. Govt. of India allocated Rs. 6,400 crore for implementation of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY).

38. The Final Word: Your Journey as a Medical Student to Become a Successful Doctor

“Focus on the journey, not the destination. Joy is found not in finishing an activity but in doing it.” - Greg Anderson It is easy to feel powerless being a medical student or a new doctor, especially when you work with senior doctors and healthcare providers. You can feel intimidated, especially when you are already stressed about having the responsibility of caring for a patient’s health. But, remember you have great power to change the world. There is nothing that you can not do to create a positive impact on this world. Even if you manage to make one patient smile, or help calm them down, you have completely changed their world from world of fear to that of hope. Be honest, open and understanding with your patients, as well as your colleagues. Keep a tab on your attitude, adjust it accordingly, and build positive and collaborative relations around you. Be kind, not just to others but to yourself as well.

In this book, I have shared several tips to become the best and successful doctor and I sincerely want medical students and young doctors to learn and follow these. Your passion, your zeal to go after what you want, and refusal to give up — these are the traits that will help you to tackle the setbacks and problems that come in your way. These are the qualities that not just medical students and young medical health providers but people from all fields can adapt to become successful. Go after what you believe in, no matter how impossible it might seem. As Thomas Alva Edison has said, “Many of life's failures are people who did not realize how close they were to success when they gave up.” In order to find joy as a doctor practicing art and science of one of the medical branches, you need to find meaning in your profession. Good patient care is an essential part of being valued and clinicians are fortunate to do clinical work that can provide so much professional satisfaction. Doctors are presented with new challenges every day; they can apply their medical knowledge combined with kindness, compassion to successfully solve many of the problems of the patients and therefore they command respect and status in society. After medical graduation, find an area of special interest in your field which you enjoy and acquire a depth of knowledge in this focused area. Once you have mastered an area, then master its intricacies. Not only is it personally rewarding, but it will also be professionally fulfilling. Your colleagues will refer the problem patients in this area to you (allowing you to become an even bigger expert in the topic), and you will also acquire a reputation among

patients as being one of the best in this area. For example, as an ophthalmic surgeon, it took me several years of dedication, determination and hard work to master the intricacies of the field of ocular micro-surgery. Now, I really enjoy my profession and consider myself fortunate to have been able to make a difference to the lives of blind people by giving the gift of sight. I was passionate about becoming an eye surgeon since my early childhood, and my 25 years of experience in this field suggested that ophthalmology is one of the most satisfying branches in medicine that has a combination of

medicine

and

surgery

and

has

excellent

doctor-patient

satisfaction. A recent survey indicates that dermatologists and ophthalmologists are the happiest and most satisfied among all doctors. In addition to strong medical knowledge and outstanding surgical skills, developing attributes (compassion, care, kindness, etc.) and an adequate work-life balance is essential to becoming a happy and successful doctor. In those moments when you will feel that you are a good doctor, there will be a corresponding circumstance that will teach you something to improve upon. A successful doctor has several qualities. Professionalism in medical profession endeavors to depict your attitude, behavior, and attributes that are expected out of someone belonging from this auspicious career. To become a successful doctor, you have to interact with the people that have certain expectations from you. These expectations are inclusive of the assurance public needs that you're capable enough to provide them the healthcare they require. Under the societal norms, the doctors are expected to behave with

certain morality and integrity, and display a sense of objectivity and accountability. Besides professionalism, open-mindedness is another attribute that is expected to be a part of a physician’s personality. You must be able to treat all patients equally irrespective of the ethnicity they belong to or the set of values they believe in. Your job, as a healthcare professional, is to treat the patient and not judge them. You may have preconception in your mind when coming across a patient from a different background. Instead of letting that rule your judgment, you must respect the trust that the patient has put in you. Empathy comes next when you are about becoming a successful doctor. When you make an attempt to understand how a person feels right in the beginning, you are successful in making a connection with them and make them believe that you understand their struggles and suffering. When a patient experiences that their doctor is trying to understand their situation, it instigates a therapeutic relationship. The patient ultimately feels that they are valuable and eventually trusts the doctor more. Compassion is another quality that makes you a successful doctor. You need to have a kind heart that is capable of understanding the vulnerabilities and fears your patients may have. When it comes to skills, you need to learn and master all the clinico-surgical

skills

and

continue

learning

about

effective

communication and art of patient satisfaction. You need to keep striving to refine your communication and interpersonal skills. Having

these skills is mandatory to master your profession and successfully provide the best patient care. If delved deeper, calmness comes as an essential thing when you are working in a busy hospital and taking care of critical cases. The healthcare setting is bound to become hectic and situation can get riled up with the patients and their attendants. Amidst such situation, you need to keep yourself calm and strive for resolving the problems. Practicing medicine is not always pleasant. You will encounter unfamiliar and unexpected events and developments that may or may not be in favor. You need to have a clear and calm mind to deal with such situations and work out solutions. Such things are more likely to happen in intensive care units where unexpected events can evoke a response from the public and create a chaotic situation. It is your composure and calmness that will help you get through it and make the right decision. Attentiveness is when you make eye contact with the patient and take time to get to know them. Greeting them with name, looking at them as they talk, asking them how they are feeling are all ways of paying attention to your patient. This can help you build a good rapport with the patient. Communicating effectively with your patient and providing them referrals and resources for their better care are all parts of paying attention to the patient. This capability enhances patient satisfaction and turns one into a successful doctor. Adaptability is another attribute that is necessary for a successful doctor. Being adaptable to the newest medical technologies and staying abreast and well-informed about the latest discoveries can

be highly helpful in improving healthcare delivery. The healthcare environment demands the doctors to be adaptable to the advancement and be willing to adjust to the external factors to ensure best quality healthcare is made available for the patients. Being a clinician, you need to keep looking for a way of selfimprovement. Continuous learning and frequent self-reflection are keys to improve yourself. You have worked towards perfection and explore ways to improve the overall healthcare delivery by following the 'protocols', 'check-lists' to enhance patient safety to minimize errors, and training of entire team to deliver the best outcomes. For doctors, learning never stops. From the day one of their medical school to perhaps the last day of their medical career, they learn through

various

professional

mechanisms

development,

including

attending

medical

medical

and

education, scientific

conferences, joining journal club, teaching, online tutorials, and from everyday clinical experiences. When it comes to working in a medical profession, passion and enthusiasm are rather imperative to keep you going, not to mention they are infectious and can easily get propagated. Your patients can see it right away that how passionate you are about your job and whether or not you love it. The more enthusiasm you show, the more positivity it will emanate. You will see that patients will be more drawn towards you than to a doctor who holds a stoic stance and shows a lack of passion for the job. About passion and enthusiasm, there are different views. Some state that spending long hours studying and training makes you lose your enthusiasm and ultimately makes you more sober and serious. In some cases, it even leads to

burnout and occupational depression. This calls for an effective work-life balance for doctors. They need to pay heed to their personal needs just as much as their professional obligations. You must maintain a healthy diet and good sleep cycle to keep yourself fit, positive and enthusiastic. Next, come confidence and humility when we are talking about the attributes of a successful doctor. These qualities are necessary for a doctor to prevent turning confidence into arrogance and keep the doctor humble. Being a doctor, you need to keep learning all your life and remain open-minded while dealing with clinical cases. If you start believing that you know everything, it will ultimately start bringing arrogance in you and take away the humbleness that should be necessarily present in a successful doctor. Lastly, you need to be an advocate for your patient. This will help you develop effective communication and encourage a trustful relationship between the two. Poor communication leads to more cases of malpractices and compromised healthcare quality. I wish you the best for your journey ahead, from a medical student to a successful doctor. I hope that you always care for your patients with compassion and regard them as your utmost priority. The medical profession remains one of the most noble endeavors of humankind, and it is your responsibility to maintain the dignity of the profession. Go after your dreams. Never give up. Learn from your mistakes and become a happy and successful doctor!

Acknowledgements The herculean task of writing and compiling a book of such a magnitude is not possible without the help of several people. I take this opportunity to thank all the people who have been the pillars of strength behind the creation of this book. To start with, I would like to acknowledge the valuable assistance and contribution of my wife, Dr. Vidushi Sharma. I offer deep gratitude also to my adorable daughter, Ishita, who thoroughly understands her Papa’s passion for writing, and held on even when I was away for the past few weeks for this project. I would like to express my deep gratitude to Prof. Frank Billson, Prof. Jagat Ram, Prof. Randeep Guleria, Dr. Devi Prasad Shetty and Dr. Naresh Trehan for writing the forewords in this book. I would like to thank the doctors and staff-members of SuVi Eye Institute and Lasik Laser Center, Kota — Dr. Meenal Gupta, Dr. Nipun Bagrecha, and Dr. S. K. Gupta for their assistance. I sincerely appreciate the help of Mr. Neil D’Silva in editing this book and helping me out with his suggestions. Special thanks to Dr. Abhishek R. Kothari for his inputs in suggesting the title of the book. Last but not the least, I am indebted to Maple Team, all medical aspirants, medical students, my patients, and my friends and wellwishers, who share my dreams and motivate me to do better in the future.

References • Kalanithi, P. (2016). When breath becomes air. Random House. • DePree, M. (2011). Leadership is an art. Crown Business. • Austin, P. (2008). Something for the Pain: One Doctor's Account of Life and Death in the ER. WW Norton & Company. • Skloot, R. (2017). The immortal life of Henrietta Lacks Broadway Books. • Elliot, C. & Lantos J. D. (1999). The Last Clinician: Walker Percy and the Moral Life of Medicine. Duke University Press Books. • Barkin, L. (2011). The comfort garden: Tales from the trauma unit. Fresh Pond Press. • Relin, D O. (2013). Second Suns: Two Doctors and Their Amazing Quest to Restore Sight and Save Lives. Random House. • Mehta, P., & Shenoy, S. (2011). Infinite vision: how Aravind became the world's greatest business case for compassion. Berrett-Koehler Publishers. • Rothman, E. L. (2000). White Coat: Becoming a Doctor at Harvard Medical College. • Topol, E. J. (2015). The patient will see you now: the future of medicine is in your hands (Vol. 2015364). New York: Basic Books. • Groopman, J. (2008). How doctors think. Houghton Mifflin Harcourt. • Mukherjee, S. (2015). The laws of medicine: field notes from an uncertain science. Simon and Schuster.

• Kidder, T. (2009). Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World. Random House Incorporated. • Shem, S. (2003). The house of God. Dell Publishing Company. • London, O. (1987). Kill as Few Patients as Possible: And 56 Six Other Essays on how to be the World's Best Doctor. Ten Speed. • Verghese, A. (2012). Cutting for stone. Random House India. • Nuland, S. B. (1995). How we die: Reflections on life's final chapter. Vintage. • Nuland, S. B. (1998). How We Live: The Wisdom of the Body. Vintage. • O'Mahony, S. (2017). The Way We Die Now: The View from Medicine's Front Line. Thomas Dunne Books. • Selzer, R. (1996). Letters to a young doctor. Houghton Mifflin Harcourt. • Sacks, O. (1986). The man who mistook his wife for a hat. Ducksworth, London. • Kleinman, A. (1988). Suffering, healing and the human condition. Encyclopedia of Human Biology. • Jauhar, S. (2007). Intern: A Doctor's initiation. Farrar, Straus and Giroux. • Chin, E. L. (2002). This side of doctoring: Reflections from women in medicine.

• Mukherjee, S. (2010). The Emperor of all maladies: A biography of Cancer. Simon and Schuster. • Klass, P. (2010). A Not Entirely Benign Procedure, Revised Edition: Four Years as a Medical Student. Kaplan Publishing. • Chen, P. W. (2007). Final Exam: A Surgeon’s reflections on Mortality. Vintage. • Konner, M. (1988). Becoming a doctor: A journey of initiation in medical school. • Transue, E. R. (2004). On call: A Doctor's days and nights in residency. Macmillan. • Reilly, B. (2014). One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine. Simon and Schuster. • Montross, C. (2007). Body of work: Meditations on mortality from the human anatomy lab. Penguin. • Weston, G. (2009). Direct Red: A Surgeon's view of her Life or Death Profession. Harper Collins. • Gawande, A. (2010). Complications: A surgeon's notes on an imperfect science. Profile Books. • Marion, R. (2012). The Intern Blues: The Timeless Classic about the Making of a Doctor. Harper Collins. • Parrott, T., & Crook, G. (2011). Effective communication skills for doctors. Arawak publications. • Groopman, J. (2004). The anatomy of hope. The Permanente Journal, 8(2), 43.

• Gawande, A. (2010). Checklist manifesto, the (HB). Penguin Books India. • Fadiman, A. (2012). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. Macmillan. • Guinan, M., & Mather, A. D. (2016). Adventures of a Female Medical Detective: In Pursuit of Smallpox and AIDS. JHU Press.

Video Resources 1. Career Choice for Young Doctors Today: https://www.youtube.com/watch?v=U8yinKmTSZM 2. Overseas Medical Training: https://www.youtube.com/watch?v=5CCo2CWpwIU 3. How to Start New Medical Practice: https://www.youtube.com/watch?v=sj_JcNrKF6g 4. Dawn and Dusk in the Life of Doctor: https://www.youtube.com/watch?v=euqT7io6jr4 5. Changing Face of Medical Practice & How to Respond to These Changes: https://www.youtube.com/watch?v=cKrTTjJGvK4 6. Social Media and Medical Tourism- The World at Your Fingertips: https://www.youtube.com/watch?v=SO233GCcLZk

Praise from the Medical Pioneers Being a skilled medical professional is not an easy task. The journey of medical students to successful doctor takes years of hard work, sleep deprived nights, dedication, and compassionate care. The 'Secrets of Successful Doctors' is timely written excellent text by my student, Dr. Suresh K. Pandey. This book explores and addresses most of the very important issues related to medical students, young doctors and medical professionals. -Padma Shri Prof. Amod Gupta, Ex. Dean, PGIMER, Ex. Chief, Advance Eye Center, PGIMER, Chandigarh, India. 'Secrets of Successful Doctors' provides insight into the complexities faced by the medical professionals at individual and institutional level. This book is a timely contribution to enlighten medical students, practicing doctors and medical professional about the changing trends in medical practice and how to respond to them. I congratulate Dr. Suresh K. Pandey on this excellent treatise that will be helpful to strengthen doctor-patient trust. -Padma Shri Prof. Atul Kumar, Chief, Dr. R. P. Center for Ophthalmic Sciences, AIIMS, New Delhi, India. 'Secrets of Successful Doctors' is an excellent book written by Dr. Suresh K Pandey to motivate medical students, doctors-in-training, and young doctors to do well professionally. The author has shared practical tips about career options, leadership role, healing the healers and maintaining work-life balance. This book will be very helpful for young doctors.

-Padma Shri Dr. Natarajan Sundaram, President, AIOS, Director, Aditya Jyot Eye Hospital, Mumbai, India. In today's scenario, medical education and medical practice is in a state of flux and rapid churning due to regulatory upheaval, raised expectations and evolving educational modalities. It is equally perturbing for the seasoned medical practitioner to adapt to the changing scenario as it is for the young medicos taking their first baby steps in the profession. 'Secrets of Successful Doctors' is an excellent treatise written by Dr. Suresh K. Pandey, which admirably fills the gap in our formal medical education and encourages the medical professional to apply his/her knowledge, skill sets and ethos in his/her daily practice for universal benefit. A must read for anyone connected to the healthcare domain. -Padma Shri Dr. Mahipal Singh Sachdev, President Elect, AIOS, Director, Center for Sight, New Delhi, India. I congratulate Dr. Suresh K Pandey for bringing out this excellent book 'Secrets of Successful Doctors'. This book addresses several challenges doctors and medical professionals are facing today. Violence against doctors and deteriorating doctor-patient relationship are few issues of serious concern. There is an urgent need for both the medical profession and the society at large to introspect and take corrective steps before it is too late. I am sure the book will be immensely useful for medical professionals. -Dr. Amar Agarwal, Director, Dr. Agarwal's Eye Hospital and Eye Research Center, Chennai, India.

About the Author

Dr. Suresh K. Pandey Date of Birth : August, 1968 Place of Birth : Kota, Rajasthan, India

Phone : +91 9351412449 Email: [email protected] Website : www.suvieyehospital.com www.drsureshpandey.com Facebook: https://www.facebook.com/suresh.pandey.71 Twitter : https://twitter.com/drsureshpandey?lang=en YouTube : https://www.youtube.com/user/Drsureshkpandey/ http://secretsofsuccessfuldoctors.com

Dr. Suresh K. Pandey is an author, world-renowned eye surgeon and Director of the SuVi Eye Hospital and Lasik Laser Centre, Kota, Rajasthan,

India.

Ophthalmological

He

is

Society

the

President

(KDOS),

of

Kota.

Kota He

Division completed

ophthalmology residency from prestigious Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh and pursued anterior segment fellowship in USA and Australia. He has also performed Live Surgery at various national and international conferences

and

has

received

several

awards

including

Achievement Award (American Academy of Ophthalmology), Bestof-Show Video Award, Best Poster Award, Best-Paper-of-theSession Award etc. at American Academy of Ophthalmology (AAO), American Society of Cataract and Refractive Surgery (ASCRS), Asia Pacific Association of Cataract and Refractive Surgeons (APACRS), European Society of Cataract and Refractive Surgeons (ESCRS) International Conferences and was awarded Gold Medal by Indian Intraocular Implant and Refractive Surgery Society.