Dr. Brij B. Agarwal
MBBS, MS (Gold Medalist), Dip. Yoga (Gold Medalist), FIMSA
Consultant Laparoscopic & Gen. Surgeon
Thank you very much for selecting me as your editor. The very meaning of this word is to put forward your collective wisdom with necessary moderation to accommodate them in our bulletin. So I request you to kindly provide me with material to edit. Your contribution and able guidance from office bearers are a most for any meaningful publication.
Times are changing. In this era of info-nano-cytomolecular-biotechnological convergence we can’t sit on our laurels and hope for society to regards us as demi-Gods. We have to strive continuously to justify our pedestal in social hierarchy. Need of time is to practice “Evidence Based Medicine” (EBM)
EBM is defined as integration of best research evidence with clinical expertise and patient values. We can’t shy away from knowledge in the era of the internet. Only an updated knowledge is true enemy of disease. We as medical practitioners draw upon a wide range of knowledge –
Profession knowledge – that is factual medical knowledge
Procedural knowledge – that is knowing how to do things
Intuition – that is appearance of informed action without the attendant thought
Sensory / embodied knowledge – that is developing “a good (safe) pair of hands” or “a good eye”
Tacit knowledge – fluent procedural knowledge that is invisible
Professional judgement – that is the heart of professional practice.
All this is possible if we fulfill our role which encompasses the roles of
Communicator
Collaborator
Manager
Health advocate
Scholar
Professional
While we can chose any predominant role for us but the mantle of scholar is the soul of our profession. The scholar’s role requires “a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge”
So let us resolve to do justice to various facets of our personality and shine in society. Let us ask our representatives for quality CMEs and support them with our attendance and involvement. Nobody can help us if we don’t help ourselves. Let us joint hands. As your editor, I am ready to moderate and facilitate sharing of knowledge. Please let me know your queries, area of interest etc. I will strive for views from best of experts from anywhere in the world. Let’s become true professionals. Let us concentrate on our profession.
“Study your physics well, and you will be shown
In not too many pages that your art’s good
Is to follow nature in so far as it can”
-Dante, The Inferno
Forgive me, for none of what I have said is original. These thoughts must have crystallized after my grey matter lifted these from somewhere else.
Please send me an email so that I can interact with you better.
Jai Hind
Dr. B. B. Agarwal - 9810124256
Email: bb@endosurgeon.org
Useful Links:
After the pleasant surprise of May the nature has returned to its usual best for June. Nature is back to its inherent best breathing fire. While many of us are off to cooler climes, some are busy with career evolution of their progeny the rest are dutifully serving the mankind. Apart from these preoccupations of self, family & vocation we owe it to ourselves to keep us academically fit. I had spoken for a role of scholar for us in the profession. Let us introspect and focus on its utility viz a viz other three preoccupations. I am sure of your approval as all of us know in our hearts that a sound academic approach draws our patient closer to us. Doctor-Patient relationship is a sacred bond. Communication is as important to this relationship as breathing is to life. Proper communication not only improves patient compliance and faith in treatment but also decreases the risk of professional litigation. Listening is the first step in forging this relationship. International studies have shown that we do not listen to our patients for more than 18 seconds on our first encounter. We hardly give the patient any chance to speak. As soon as she has spoken her chief complaints we bombard her with our questioning. So to begin with we can resolve that we will not intercept our patients while they are speaking. This is the beginning of developing Doctor-Patient relationship. I will speak more about it once I get your feedback. See you after I am back from European Association of Endoscopic Surgeons Congress 2007 at Athens, Greece. I am presenting 9 papers there. I’ll share my experience with you. I am grateful for your encouraging calls & answers to Medibrij. Keep it up! I am constantly watching my mailbox.
Jai Hind
Dr. B. B. Agarwal
Consultant Laparoscopic Surgeon,
Sir Ganga Ram Hospital
9810124256
My visit to Greece was an eye opener. I had gone there to present my papers. Of about 25 presentations, I was the only Indian given an opportunity to present from podium in three sessions. The revelation was regarding the changing perceptions in the society. What I saw there is surely a picture of times approaching us. The era of fatalism and mysticism when a doctor was revered as an artist or skilled magician is fading away. The medical practice is moving towards better service quality, accountability and respect to regulations and protocols. There is an emphasis on practice of evidence based medicine. My experience at the American Congress, the Asia Pacific Congress at Seoul and the World Congress at Berlin last year was same. It forced me to think on causes for poor acceptance of Indian Scientific work. When so many Indians attend and present their work, why is it that only a few or only one gets a podium presentation or publication in high impact journals? The reason is not difficult to see, we lack a desire to practice medicine according to changing times. Lack of “standard operating protocols”, disregards to “Best practice Guidelines” and failure to self appraise not only diminish our credibility internationally but throw up an opportunity to disgruntled social elements to vilify us. This leads to a tightening noose, may by way of political legislation, or administrative harassment or simply social maligning. Lack of uniform standards in healthcare delivery not only leads to the above said but also results in internal bickering and denigrative criticism from our own brethren. Everyone has her own whims and fancies. Everyone practices her own brand of medicine and everyone considers herself an expert. As is said in beginning, the times are not far when effectiveness and quality of our practice will be judged by the strengths of delivery mechanism willing to be scrutinized and challenged. To ensure that, we need to follow universal standard protocols, best practice guidelines and a uniform behavioral communication. Shying away from the need to change will be viewed as contemptuous by society. Better to move ahead of times rather than allow time to approach & force a paradigm shift on us. If we have identified the right, let us practice it – To know what is right and not to implement it in practice is lack of courage.
Dr. B. B. Agarwal
Consultant Laparoscopic Surgeon
Sir Ganga Ram Hospital
Mobile: 9810124256
Our Mental Kurukshetras – Prelude to emergence of leaders in Medicine
Democracy, throws the most antagonistic of free & fair opinions to an intellectual mind. May it be judging a popular figure for intended crimes against humanity or debating the implementation of seemingly crystal clear legislation like encroachment, sealing, licensing or granting of practice privileges etc. Simple as they seem in letter wicked they become in spirit. Even the most righteous and enlightened start arguing for or against their implementation. This leaves a baffled mental Kurukshetra for most of us. It confuses all of us, for somewhere our vision is clouded by the dreams conjured by us during the period of bliss we had innocently ignoring them. But we are all straightforward, educated, enlightened and honest. Then why this mental helplessness? Recently a batchmate of mine, doctor son of a great surgeon having a big hospital in old times met me as a vedic inspirational speaker at a school. I wondered what made him leave medicine because most of us feel let down ‘cause of lack of mai-baaps’. Here was he, born with a stethoscope in his neck and endoscope in his hands, yet he took the other path. Was it that the social millieu has become too muddled to be handled not only by people like us but by like him as well. He said “well friend not only us even Gods had mental Kurukshetras they could not escape” I was discussing all this and much more that maligns our society with another doctor from Mumbai. He told me that he had left medical practice and was now a Guru. He narrated a story from Mythology which I want to share with you.
Story
In Hindu mythology, God creates, sustains, and destroys the world as Brahma, Vishnu and Shiva. Of these three only Vishnu is visualized as a king or raja, which is the traditional equivalent of a leader. Shiva is visualized as an ash-smeared ascetic while Brahma is a priest or teacher.
Brahma is the first conscious being to emerge when the world awakens. He wonders who he is. So he creates the ‘other’ in form of a woman, a goddess called Shatarupa or she-with-a-thousand-forms. Brahma is so enchanted by this woman, his creation, hence his daughter, that he proceeds to possess her. She gives him the slip, changing into a mare, a cow, a doe and other creatures as she runs. He follows her, changing accordingly, taking the complementary male form each time as horse, bull and stag. Disgusted by this unbridled display of passion, the goddess cries out and Shiva appears. With one sweep of the sword, he cuts Brahma’s head.
Shiva, the skull-bearer of Brahma, or Kapalika, is the other extreme. He shuts his eyes and refuses to see the goddess, let alone be enchanted by her. He knows who he is and so does not need the ‘other’. In his self-containment, he withdraws from the goddess and becomes still. Such is his withdrawal that even his semen moves in the reverse direction. This urdhva-retas or reverse flow of semen ignites the spiritual fire known as tapa which generates heat. All this heat remains trapped within Shiva’s body and so the landscape around him turns icy cold and desolate, supporting no life.
Brahma’s curiosity makes him creator. Shiva’s indifference makes him destroyer. Neither is worthy of being visualized as king or leader. Because a leader needs to have balance, a bit of both.
Brahma, though creator, is not even worshipped because he is so attached to the world he has created that he forgets why he created it. He ends up identifying himself with it, becoming horse, bull and stag when she is mare, cow and doe. There are many Brahmas in world, who have lost all sense of self, and derive their identities from their organization/job. They are unable to step back and view the organization/job dispassionately as their own creation, a source of wealth, knowledge and power, a tool that enables them to self-actualize and eventually self-realize. This dependence on the organization/job for their identity makes them insecure and fragile. They spend all their time reinforcing their stranglehold, keeping away potential contenders to the throne. Eventually, they stop caring about the organization/job. What matters only is their control over it.
Then there are the Shivas of the world totally disengaged and disinterested in their roles, organizations and jobs. Their self-worth and self-esteem is not tied to the organization. Extremely intelligent, extremely capable, they don’t see the point of it all and often become cynical and withdraw from the rat race in the quest for something higher. They are angry with mediocrity. They understand so much that it immobilizes them. They pity all those who are entrapped by the ‘system’ and help everyone – the saints as well as the crooks, much like Bholenath Shiva who in his transcendental wisdom knows that what goes around comes around and so allows himself to be hoodwinked by Asuras and Rakshasas, the demons of the trade.
Between Brahma and Shiva is Vishnu, full of guile and smiles. Unlike Brahma, he is not attached to the organization. Unlike Shiva, he is not disengaged from it. Thus he creates balance, harmony, is wise enough to distinguish god from demon, fighting for the gods but knowing their frailties and defeating the demons but knowing their value. In the Hindu pantheon only the demons or Asuras, know to generate wealth, for they possess Sanjivani Vidya. Vishnu therefore uses Devas and Asuras, wealth distributors and wealth generators, to churn the ocean of possibility to create Amrita, sustainable wealth. And whenever there is a crisis in the world, Vishnu takes a different form, an avatar, either as Ram or Krishna, to set things right. All the while, as he re-establishes order, he knows that eventually the world/organization/job will reach its eventual climax and die. Either he will outgrow the organization/job and leave. Or the organization/job will cease to relevant. Till the parting, without a shred of cynicism or frustration, he will remain an enthusiastic participant in worldly affairs. This clearly is the model of a leader the ancestors thought of – a mixture of heart and head, engaged but not attached, constantly aware of the big picture.
So friends Brahma, Shiva and Vishnu tendencies are all there in all of us. They are fighting all the time for individual expression. But it doesn’t happen and we remain a hybrid manifestation of them.
Dr. B. B. Agarwal
Consultant Laparoscopic Surgeon
Sir Ganga Ram Hospital
Mobile: 9810124256
Let us be what we want to be.
Friends, it has been 25 years since I passed MBBS, & our batch celebrates Silver Jubilee this year. I went under a bout of nostalgia. It led me to introspect & wonder if I had fulfilled my desires or society’s expectations from me. Had I become what I wanted to be? Or I allowed myself to be drifted & swayed by the materialistic social currents. Voice of truth from the core of my heart was too taunting to be heard. All this became more relevant & compellingly obsessive because my Alma Mater, MAMC is celebrating its Golden Jubilee Year. Since our 25 years & MAMC’s 50 years are being celebrated together it felt special. MAMC is not only important for Maulanians but for parents of Maulanians & Delhi as well. All this burdened me with a thought of being not able to do as I ought to. Pardon me, but I feel that most of us do have similar kind of feelings. What is the reason? Have we failed to have a vision? Or we have failed to act. Are we to be same as ordinary fellow citizens/ politicians? Or we feel that we are different & have different roles, responsibilities & leadership mandate. As for myself I feel that we could do much more for fellow human beings & the society. Nobody imagined that light can be contained in a bulb, or a waterfall can make water flow in your house or you can carry a library in your pocket, but it is all happening. Science has progressed beyond fiction of yesteryears. Einstein’s “quantum theory” postulating that individual atoms have a communication system has been demonstrated last week. Similarly what we thought to be is not to be. Yale University workers are talking about the harmful effects of antenatal ultrasound. While we are aware of the scientific march yet we don’t join it. The choice is no longer with us. We can no longer be bystanders. It is high time we join the march. Failure to do so will keep on challenging us with issues like fake doctors or non-doctors (quacks). Rather than to helplessly criticize the events, better will be to create the events. The events which the society can be proud of and can associate with us. We have to put our own house in order. Do we really care about the quality of our practice? Do we really care about the quality of people we employ? I am personally aware of people for whom I may be responsible to pay but are ill qualified for the job. People who have not done well academically as well as in the practice continue to be part of our teams. The team’s performance, dependent as it is on everybody, including them, suffers due to such people. This brings a negative impression about all of us. So friends let us wake up and ensure the quality of our team members. Nothing is impossible. Everything starts with a vision and a dream. But to realize our dreams we have to wake up.
Dr. B. B. Agarwal
Consultant Laparoscopic Surgeon
Sir Ganga Ram Hospital
Mobile: 9810124256
Democracy or दॆ मोए कुरसी(De Moi Kursi)
Last time I put across my views on scientific progress and team quality. The idea is in focus at National level. What an irony of times that a progressive initiative like energy security is in a wobbling boat, thanks to lack of quality in the team. The team in question is our Government. The debate is not on better alternatives for energy security but on sustaining power. Sustenance of power in existing hands has become more important they sustenance of Governance. No wonder ours is a society of seekers of good for self rather than that of seekers of good. This is not a new phenomenon. We irrespective of our affiliations have failed again and again. Whether it was partition of subcontinent or denial of Punjab refugees to settle in J&K or lack of unanimity for Kargil or capitulation at Kandhar or offering the other check after Parliament attack or apologizing for Delhi / Gujarat riots or many such episodes, we have shown our true colour once again in not fending for ourselves viz a viz energy security. I say fending for ourselves because we all believe confidently about fending for self. The self has once again become superior to our collective self. Blame it on one or the team, there is no difference. It is said that a chain is as strong as its weakest link. This reminds us once again of the need to have the best possible weakest member in our team. It might seem incongruous to talk about national scene in IMA Bulletin. But friends the nation is nothing but a magnified view of our immediate communities. Our immediate communities may be our homes, our clinics, our health care set ups or our associations. The same national malady seems to prevail everywhere. We need to ask ourselves whether we are able to do ‘good’ or do what is important to us. The distinction between what is good and what seems important can be made only when we remove the sight glasses of our immediate self. We have to believe in the ultimate importance of good rather than the importance of imminent, inevitable or just important. We have to resolve to support “the good” even if it seems unimportant to self. We have to let “the good” prevail even if somebody else walks away with credit. The credo in my opinion is good for our homes, our clinics, our health care setups, our associations, our city, our country, our world and our universe.
Jai Hind
Brij B. Agarwal
Consultant Laparoscopic Surgeon
Sir Ganga Ram Hospital
Mobile: 9810124256
Agreeing to Disagree
“I may not agree with you but I will defend till death your right to say and disagree with me” so said Voltaire. The spirit of Democracy lies in differences of views. How to balance contradictions? There lies the essence of democracy. We grew up professionally by entertaining the notion of differential diagnosis. This approach made us into critical minds at ease with variety of divergent views. This attribute so innate to our grain can be a great pillar of strength for democracy. This is where we as intellectuals need to step in and educate the society. Society is in need of this endeavor at this time more than any other period in India history. Tasleema Nasreen and the passions aroused by her presence in India are staring at our ability to comprehend the rationale. The chasm in public arena created by Ram Setu and Energy Security remains wide open. And now Tasleema issue, should we allow the divide to broaden or put in a sincere effort to bridge the divide. Again, are these issues pertinent to our fraternity? May be not at a cursory glance but a thought will tell us that even in our profession and conduct the intolerance for different view’ is there for all to see. These are some of the professionally neutral issues showing a mirror to us. They are a timely reminder. Let us respect the divergent opinions and pledge not to be the stumbling blocks in progress of good doing.
Jai Hind
Editor’s Greetings
Future Nostalgia
Time moves on and walks past. Friends, time in motion usually coaxes upon us a sense of lost opportunity. But it is a privilege at this time of every year when passage of time becomes sought after and much waited for. So please allow me to sail on this wonderful transition in wishing you, your friends, colleagues, family and team, a very happy new year.
Swami Vivekananda said “The present is a most precious virgin moment in our hand. How we handle it decides whether it becomes a wonderful future or a past to ruminate about”. So we must value time.
Time is nothing but a measurement of passage of events. A phase of transition in time holds a hope for future but also wraps us in a blanket of nostalgia. My batch celebrated the silver jubilee of passing out (1978-82) this month so I had the occasion to travel in past and reappraise my actions. How we are going to conduct the future is guided a lot by our lessons from past. More importantly the experiences of those senior to us save us from negative experimentation. We have to constantly remind ourselves of the virtues of passage of time. Even our great leaders of past left a lot to be learnt from. Today, we as Indians will offer our leg and arm for a seat in UN Security Council, a seat that was offered to us in 1949 but our PM gifted it to “Elder Brother” China. The result China remains a “Big Brother” to us. Our deeds might have been one of commission or one of omission, either way it is sacrilege. Did we as a society do enough to save a Bhagat Singh or a Bose? May be we could have done more? May be we didn’t negotiate with the hijackers or abductors? May be we could have brought to books the culprits of 1984? May be we took better care of a Bhabha, Har Govind or Chander Shekhar? A result of throttled and stifled entrepreneurship is for the world to see now. A lot of our past experience will tell us of our extent of being wrong. They will also tell us the reason of our explicitly wrong action. Usually we will realize that we took a definitely wrong approach. We did so because that suited us in achieving our then immediate goals. Our “immediate goals” of the times gone by have become mill-stones around our necks while we grope for Milestones to count for. Friends there can be no more appropriate time than this transition of a year to resolve that whatever we do should make us proud not only us in future but our progeny as well. It is not a difficult task provided we just think about it.
Happy New Year Once again
Brij B. Agarwal
Consultant Laparoscopic Surgeon
Sir Ganga Ram Hospital
Mobile: 9810124256