Sunscreens – Are You Buying Them Right?

Sunscreens – Are You Buying Them Right?

I read a very interesting research paper yesterday –published in the prestigious New England Journal of Medicine (read here- http://www.nejm.org/doi/full/10.1056/NEJMp1504912) - detailing the current research trends in melanoma – a skin cancer condition. And the research paper in passing touched upon something of interest to all of us- namely how effective were sunscreens in preventing skin cancer. Now the two commonest skin cancer types are Carcinomas and Melanomas. A melanoma (often called a malignant melanoma because it spreads so easily and so fast) is a cancer of the melanin pigment producing cells of our body. Melanin is the protein which gives us our skin colour- dark or fair and and also protects us from the radiation of the sun- in effect its a natural sunscreen. Dark skinned people have an abundance of melanin pigment in their skin naturally and require lesser quantities of sunscreen to protect their skin, while fair skinned people with less melanin get tanned and sun burnt easily and also have more instances of getting skin cancer- melanomas. So with that small introduction let me get onto the meat of the matter.

 Sunscreens as we all know are classified as over the counter cosmetic products which do not need a doctors prescription. But we must remember that cosmetic companies make certain tall claims regarding sunscreens and their effects touting them as wonder drugs as they contain certain chemicals which, in effect prevent skin-tanning, anti-aging etc. Now the American Food and Drug administration has specified certain guidelines for sunscreens based on recent research

1)    Anything less than SPF- 15 is no use for cancer prevention but can only be used for anti-tanning- so this means the FDA has now effectively barred anything which uses less than 15-SPF.

2)    Anything above SPF-50 has been shown to be useless for skin protection- which means that more than that is an overkill and unnecessary.

3)    Both cream and liquid based sunscreens work equally well when applied as a coating- but all of them last for only 90 mins to 120 mins for single application- which means you are protected for one and a half to two hours only with a single application. So covering up exposed areas with adequate clothing becomes important for long term prevention. And there goes my dream of ogling at all those bikini clad beach babes.

4)    Any sunscreen which only protects against UV-A is not effective as anti-cancer but only for anti-tanning. Hence check out for the sunscreen prevents both UV-A  and also UV-B rays from affecting the skin. So only broad-spectrum sunscreens prevent  skin cancer while others are just for the beach.

5)    Ingredients like  ecamsule and enzacamene come under banned substances – no longer safe and effective and hence check out that you are using a product which no longer contains these.

6)    And finally remember that background radiation exists even indoor- so anything which promises anti-aging should protect your skin all the time and not just under direct sun exposure.

So these few pointers should help you choose the best sunscreen for avoiding skin cancer and not be taken in by the tall claims made by cosmetic companies.

Waiting For The Doctor

Waiting For The Doctor

A friend on twitter was recently moaning about the time she spent waiting outside doctors rooms as some of the most stessful periods of her life. I agree with that sentiment. Never mind the fact that you are anxious to go in there and find out from your doctor whether you have a life threatening disease or not  the very fact that you are sitting surrounded by other obviously sick people with no hope of a happy ending in sight will give the heebie-jeebies to anyone. Including me. I too like everyone else have spent time waiting outside doctors rooms even though its more out of a sense of delicacy on my part not to announce myself as a colleague and just barge in ignoring others waiting in the line.

Anyway this post is not about the people waiting outside doctors rooms but about why doctors make people wait outside their rooms? A few pointers

1)    Ego- Yes the number one reason why you spend hours waiting outside your doctors room is to satisfy your doctors ego- the ego to be wanted, needed and validated as someone worth waiting for. I know this might shock you but its the truth. The reason is, its not easy to get people to wait outside doctors rooms for them to turn up as the competition in medicine is killing and there are umpteen number of doctors out there waiting to see you whenever you want to. To be recognised as a good doctor it takes a minimum of ten years hard work, of hours and hours spent alone in the clinic waiting for that solitary patient to turn up for a consultation, hours spent peeking outside the curtain separating the inner room from the waiting hall everytime a mild footstep is heard imagining that atlast here comes the patient who will pay for this months rent atleast so you can still continue practicing at this same palce next month and so on and on. And after all this long struggle when the doctor reaches a place where he becomes recognised- he turns the tables on the very people he waited for and gets a perverse pleasure in making them wait for him. Believe me when i say that there is nothing to equal the joy felt when you walk into a consultation room and see it full of patients waitng for you. It makes you appreciate the sweet success of having arrived. It stokes the ego and gives you a feeling of being invincible and god-like for the only other place people wait so patiently for a glimpse is at the temple.  So even though doctors know they can manage their time better and stop wasting others time, still to satisfy their own cravings for popularity they will intentionally make you wait hours to meet them. The bitter truth.

2)    The medical representatives- if you see a bunch of medical representatives waiting outside the doctors rooms with you to meet the doctor be assured that your doctor is going to wantonly make you wait outside for hours. The reason is simple- just like politicians need people at their mass meetings to show the media their power and popularity to draw a crowd, similarly doctors need crowds of patients to show medical representatives their drawing power as busy practioners with loads of people waiting to meet them. Medical representatives are by far the biggest gossips of the medical field- they are the ones who go around spreading stories about which doctor is popular with a dozen people waiting outside and which one is sitting alone in his clinic – despite being a good time manger and being prompt in seeing his patients off rather than making them wait. And guess which doctor gets that all expenses paid trip to egypt to see the pyramids – sponsored by the drug company? Yes, its the same doctor who will make his patients wait for hours showing off his overcrowded waiting hall as a sign of popularity.

3)    Other patients- yes this might be a shocker to you but the biggest time waster in any practice is the patient who went in just before you. I have had many patients who have made me want to physically throw them out for wasting my time but have survived because i remembered the hippocratic oath in time. Some women are the worst offenders in this. They come in with their husbands and children and a whole bunch of people and after consulting for a small problem and paying the fees instead of leaving promptly they stand by the door and then casually start discussing the assorted medical problems of the hubby, the first kid, the second kind, the mother in law, the next door neighbour and everyone else on the street on the mistaken assumption thant once having paid a small fee for a single consultation the rest of it should be all free advice on the basis of – well we are just talking, arent we, you re not actually seeing the patient, so it doesnt count- never mind that all this talk consumes the better part of an hour or so just to make sure she doesnt poison someone with her home remedies. So blame those people who troop into doctors rooms with an army of supporters and sympathizers who have no business being there.

4)    The unexpected – yes things like surgeries which can sometimes throw in complications which no one can anticipate- remember every individual is unique with a unique anatomy and blood vessels and nerves can never be found in the same place as shown in textbooks and you can appreciate why surgeons can be late for appointments.  And add the occasional friend or realtive who drops in to talk only at the busiest time of a doctors  practice and can never be got rid off politely and fast and you can see how the unexpected can impinge on your doctors time.

5)    Greed- and now we come to the one reason which can be altered by your doctor if he really wishes to- over selling appointments. If your doctor appreciates that your time is every bit as valuable as his- he will never over book appointments and try to fit in everyoone at the same time. It is simply callous time management and can never be tolerated in any other field. To see three  patients in one hour is different to seeing three patients in three hours. The difference can be life saving for you and can certainly save you a load of money in hospital bills in future if your doctor can spend enough time concentrating on you and you alone for the fees you pay instead of shunting you out as fast as he can to get the next patient in. Believe me,  no doctor – however  popular he or she is-  is worth your time and money if they act like that because they are going to miss catching your disease at its earliest stages if they are in a hurry and you will be paying the price for it later. Its better to change over to a another doctor who even if he dosent have a reputation as the best will atleast lisen to you patiently. Remember its your health and your life and you are paying the bill for it.

So to conclude i leave you with the thought that all that waiting outside doctors rooms is not accidental but a well thought out strategy by your doctor. Doctors are rarely helpless when it comes to efficient time management – they can stop wating your time or not. And if your doctor chooses not to then its time to stop waiting for him or her and simply move on to someone else who knows the value of others time and respects paying patients enough to give them their attention to. So choose a doctor who is satisfied with seeing three patients a day and buying a maruti suzuki rather than the one who sees thirty patients a day to buy a mercedes benz.  The first one might or might not save you but the second one will definitely kill you. Be wise and move on to a better doctor.

Communist Medicine In A Capitalist World

Communist Medicine In A Capitalist World – The Evidence Based Medicine Conundrum

Any casual reader of history or anyone at all with any general knowledge know that the discredited philosophy of communism and its paramount creation the soviet empire were both destroyed because both economically and even with common sense it beggars belief that decisions can be made in central committees and by fiat be implemented in all places and in all situations without a single thought for local conditions or differences. Crops to be sown, fertilizers to be used and harvesting times were all imposed on farmers from afar by fat-cat bureaucrats sitting in distant Moscow committees who thought they knew better than the local farmers born and bred up on their lands for generations. The result was total collapse of the agriculture sector and widespread famines everywhere in Russia. Production quotas and processes to be implemented in factories led to so many shoddy products that anyone who was just anyone at all in Soviet Russia preferred to use imported products for everything from shavers to ovens.  Rule by distant committee was comprehensively proved to be the stupidest idea to have ever been invented by the human race and believe me we as a species have made many, many more such mistakes.

So if I now told you that the same discredited theory of communism is now being touted as the only way to practice medicine what would you say? I kid you not- search evidence based medicine on the internet and you would find plenty of laudatory articles as the way to go for practicing medicine as per modern protocols. But read past the platitudes and rule by central committee is exactly what you would find.  And just because the committee distributing it is the internet itself it finds its greatest advocates on the net who tout it as the only way to go and not as one more way as it really is. Now enough with all the historical references and let me start explaining what evidence based medicine really is all about.

Sometime in the last decade of the last century (the 1990’s anyone?) there arose a new system of medicine called evidence based medicine. As with everything else when it was first introduced the intentions were noble and its advocates were sincere and it was definitely a step forward to the future. Doctors everywhere welcomed it because it seemed to offer a way forward during those times when doctors most need help- decision time. Evidence based medicine involved putting up the results of large scale clinical trials on the net to help doctors everywhere follow those same guidelines in their treatment for their own patients. It showed what worked or what didn’t work to others who were hard pressed to make difficult clinical decisions in real time. As such it definitely was a step forward. It even helped simplify which drugs to prescribe or which not to. For instance many of the old time doctors used to rely heavily on antibiotics where were popular during their heydays often not realizing that such antibiotics were no longer active due to an effective resistance built up by bacteria continually exposed to the same drugs for so long. Hence evidence based medicine pushed the medical fraternity into discarding old, tried and tested beliefs and adopting newer treatments. And that’s when things started going wrong.

When the popularity of evidence based medicine picked up worldwide big pharma was as usual right there to swing things in their favor. They started sponsoring the large clinical trials needed to get their evidence – often using low cost outsourcing firms in under developed countries where patients signed up for medical trails for a pittance- and used the results of such biased trials to push heavily in favor of their own drugs which had been used in such trials. Other drugs, even tried and tested ones didn’t stand a chance because all the latest evidence (sponsored of course) freely available on the net pointed towards such and such drug – as the only one with enough evidence available to show it worked. If a doctor wished to use any other drug which he felt could be equally effective he stood in grave risk of being taken to court by the patient for not following “internationally accepted standards of care available on the net”. Which led to all the doctors falling in line cowed by threatened medical malpractice suits and patients reading up the results of such biased trials on the internet and demanding of their doctors the same treatment that dr.google recommends.

If to take an example you have constipation and I as your doctor want to recommend to you a single plantain (local banana) every night and you go on the net and read that florida oranges grown in glass rooms in chilly Alaska when given to 5000 people led to 4000 people rushing to their toilets every morning and you quote that study to me and demand that I prescribe only Florida oranges to you- imported straight from Alaska- then I have no choice except to write a prescription of the same. Because I or anyone else for that matter have no evidence at all that bananas work, forget the fact that every single individual we know all around us for thousands of years have used bananas to evacuate their bowels. There is no large clinical trial for local bananas- no one paid money to large groups of people to eat a banana and shit in the morning and hence no evidence for banana which makes it a false treatment under the evidence based medicine guidelines and if despite this I want you to eat a banana, god help me, I would end up losing my license for practicing medicine- for not asking you to eat imported Florida oranges which might beggar you with just one months treatment cost. And this is the literal truth and I am not exaggerating. The costliest drugs are the ones which drug companies prefer to send for large clinical trials by recruiting thousands of patients. Hence when the results come out its the same costly drugs which become the default treatment option worldwide and any doctor who differs is branded a witch doctor for not following the evidence. Individuality has been stamped out and creativity rooted out in the name of the evidence based medicine fad.

Just like communists used to prescribe their guidelines from a central committee for everything, evidence based medicine has a central treatment guideline which every doctor has to follow to save their own skins or woe to them. Such evidence gathered in distant populations does not take into account individuals or their idiosyncrasies. Medicine is not an exact science and most prescriptions are based on informed guesses but that doesn’t mean that in the name of standardization a one size fits all variety of medicine becomes the only way to practice. The evidence based medicine fad has been taken to such ridiculous levels that surgeons who often make small incremental advances in surgery by trying out newer and innovative surgical techniques on individual patients cannot publish their results anymore as case reports and case series- which are about smaller groups of patients – are increasingly being not published or downright derided in favor of larger clinical trials. Surgeons are being forced to fall in line with the same efficiency as robots and an individual surgical technique (even surgical flair) is being eliminated in favor of standardization.

The day is not far off when patients can print off their own prescriptions off the internet from a published list of symptoms to treat themselves and a doctor (or a middleman) becomes superfluous to medicine. Is that a step forward? Or will it lead to more chaos? Based on the history of communism I am very skeptical of the future of evidence based medicine as it is now. But I can’t speculate on what the next medical fad will be. Will evidence based medicine escape the stranglehold of big pharma and sponsored clinical trials and evolve into something more inclusive and egalitarian taking into account individual knowledge. Or will it act the monolith and seem impregnable till it suddenly implodes on its own like communism did? Only time will tell.

Coma- Not by Robin Cook.

Coma- Not by Robin Cook.

So I was chatting with a surgeon friend yesterday when he commented on the paucity of Indian patients who suddenly wake up from a coma of many years to get back their lost lives- as shown by many American medical sitcoms. The reason, as we jokingly termed it was, we have don’t have enough facilities and resources to support the long term unconscious patients who would occupy beds which more traumatized immediate patients would need. And also the unspoken reason which lingered on both our minds- we declare more patients as brain dead than any other country worldwide- because we need their organs to transplant to others. As my friend added- the worst thing anyone who is in an accident can do is to carry along an organ donor willingness card- which literally guarantees that you will not be resuscitated but harvested for your heart, liver, lung and kidney to sell to rich NRI patients. 

Now before you think that I am making unsubstantiated statements and casting aspersions on fine medical personnel who work selflessly to save patients- please go to your nearest government hospital to find out how many trauma/accident victims with brain injuries were/are admitted with coma and placed on ventilator support? And how many were declared brain dead immediately on arrival and their relatives coerced into donating their organs? And how many of those organs were actually transplanted into needy patients in the same government hospitals? Or how many were immediately transported to other private hospitals with the police providing special traffic arrangements and all, for transplanting into NRI recipients? The answers will surprise you.

Organ transplants are a thriving institution in India- because we lack the strict regulatory oversight mandatory in foreign countries. Brain death is inevitable only when the brain stem is affected and the patient cannot self support respiration but nowadays people are eager to certify any neuro injury as brain death simply because they find it the easiest way to legally obtain organs for transplant.  As various films have shown- most recently in the case of “yennai arindhal” the ajithkumar starrer- people will go to any extent to obtain organs to transplant into failing patients. And the easiest way to assist such unscrupulous folk is to, as my friend suggests, carrying a card around saying you are a willing donor. So the next time someone dear to you gets certified as brain dead- get a second opinion and a third opinion (from different doctors) - don’t take it at face value. After all as so many stories around the world have shown- miracles do happen- people do wake up from coma – to gladden the hearts of their near and dear.  

Hope is everything when it comes to saving someone close to us and even the best of us would hesitate to cut corners if it means the difference between life and death. We can only conclude by saying that organ donation is the noblest of acts a human being can perform for others- but only if it’s voluntarily from a willing donor.  On any other basis- it is purely evil. Let us wait the good days – not too far into the future when we can make artificial organs every bit as good as original and not have to depend on donor whims and fancies. And hopefully those days will also include treatment for resuscitating patients in coma and making them live normal lives again.

P.S. The opinions expressed in the above post are fictional and does not reflect on any real doctors or other medical personnel anywhere- all characters and conversations merely imaginary.

Fat Shaming And Scare-Mongering

Fat Shaming And Scare-Mongering

So the other day I was on a visit to a friend working at a large (lets leave it unnamed) famous corporate hospital where I was waiting in the reception while my friend was busy with a patient in one of the consultation rooms – professional courtesy requiring that you did not disturb a man who is busy earning his living and just by happenstance I managed to overhear what seemed to be a doctor couple counseling a patient in one of the adjacent consult rooms – telling him candid stuff like “you are too over weight, don’t you know that obesity kills?” and such stuff. While I waited for the hither though unseen patient to exit out of the consult room curious as I was to see such a morbidly obese patient on the verge of getting a coronary, I was shocked to see a pretty normal looking guy in his mid thirties with a mild paunch walk out of that room with a dazed expression clutching a bunch of sheets full of tests to be taken. I was shocked to say the least and I couldn’t wait to discuss this with my friend in the privacy of his consult room. But he was largely dismissive of my concerns with “it’s just the practice around here to get people to sign up for regular screening programs”. By then I was seriously wondering whether I too should sign up for one of their screening programs since I was way too over weight compared to the guy who had just come out of the adjacent cubicle. In fact if I had even accidentally popped my head into the other consult room- the doc’s there would have taken one look at me and immediately admitted me into the ICU for a heart surgery. I guess I am just exaggerating here or maybe not.

The thing is, ever since- for the last six months or so- I moved out of doing cosmetic surgery and into working with a surgical oncology group doing facial reconstruction for cancer patients I have achieved a far better perspective of life and my profession than what I used to believe in my younger days. Treating real patients with real diseases- life threatening diseases made me realize the kind of stress I was dealing with in my past practice- suppressing it with sweet words directed at clients who were never satisfied and always wanted more –even if they (or their husbands/parents) were paying for it through their noses. I feel such mental relief that I don’t have to think anymore naughty thoughts about paying clients like “madamji,  all that botoxing and firming of your upper back and arms to fit you into that sleevless, backless, strapless dress is still not going to change the bitch you are basically”. I wish I had never thought of such things but once the thoughts came in I wish I could have detoxed them earlier from my consciousness. Pardon if I sound like an asshole but I am, again, detoxing here.

Anyway to get back to the topic in question- dealing with death, real death row patients just living out their lives raises uncomfortable questions in my mind about the practice of the medical profession to use scare mongering and even death mongering to make a living. Haven’t we all – basically all doctors including me, been guilty of saying at some point or the other of “oh, you are over weight? You are obese? You have diabetes? You have hypertension (high BP)? You are going to die- you are going to have an heart attack you are going to have a stroke or you are going to have a so-and-so” just to get a patient to agree to some test or treatment which we feel that they may hesitate to commit to? Even though we may justify it as being in the patients best interests surely we alone know the truth if it really was for the benefit of the patient or if it was a tight month with a lot of unpaid bills piling up for us. I am not pointing fingers but just throwing up some hard truths here.

Besides, the worst culprits in such scenarios are not even the doctors themselves who know when not to talk too much but the support staff - especially in the corporate hospitals who prime the patients with fear before unleashing the doctor on the frightened patients. Naturally people who cannot make the distinction between causal and casual take association studies seriously enough to believe that they are going to die soon and hence sign up for whatever unwanted treatment fads the corporate hospital is pushing currently. At least when I was practicing cosmetic treatments the most I could do was appeal to people’s vanity “I can make you look as young as your daughter, madam, so that on her wedding night people will wonder who the actual bride is” and such marketing spiels. But people who throw words like heart attacks, strokes and deaths so casually frighten even me into believing that a little bit of weight around the waist and you are a walking corpse who doesn’t know it yet. Seriously dudes (fellow docs?) do we have to resort to this level to make a living? Why don’t we tell those corporate receptionist/front office types where they get off and stop scaring our patients? After all the real judge of people’s lives are they themselves and if they do feel they don’t mind, who are we to predict death for them?  After all we live in India- a place where death is a constant companion- your building may collapse on your head any day you sit relaxed at home, a rich young brat may plough his jaguar into you any minute on the road and even the police may do an encounter death on you if they don’t find anyone else to fill their caseloads by the end of the month- shit happens in India naturally so why add to it by scaring people?

All I am saying is lets advice and counsel our patients to our hearts content but lets do it in a postive way stressing on the benefits of healthy living and being fit. Lets not use the threat of impending death to make patients take notice/care oftheir own health. After all if it for their benefit shouldn’t they invest in it? As someone once said, the truth shall let you free- so lets all tell the truth and hope our patients take care of themselves because they want to and not because they are afraid. Lets trust our patients to make the right decision for themselves, ok?

The Cult Of Mediocrity

The Cult Of Mediocrity

So there I was one day this week, arguing with a colleague about the relative merits and demerits of a bunch of students of whom a few were exceptional, most moderate and fewer were really pain-in-the-necks. We were collating the yearly attendance to forward to the university for exams and as the painy-types had been absent for more than half the working year – making them ineligible to appear for the exams- my colleague was arguing for giving everyone the required percentage of attendance regardless of whether they had actually turned up or not to the clinics. I, on my part, said it was unfair, unfair to equate the kids who had come in at all times, on all days, rains or riots notwithstanding, to attend to patients who required care; if they were in the end to be lumped along with others who had probably taken it easy by sleeping off all day and turning up only when/if they felt like it. Colleague argued that it was not fair to punish the students life like this over such a little thing like lack of attendance to which I replied “but madam if they didn’t attend the clinics, didn’t treat actual patients, didn’t learn anything, I shudder to think of the damage they will do to people, real patients in the real world, once you release them like this on an unsuspecting world”.

Colleague demurred and said that they still have to pass the university exams to which I reminded her of the unspoken but neverthless strictly enforced regulations of giving a 100% pass percentage to every batch of students (by the simple expedient of punishing the teachers if a student fails) on the theory that students are sensitive people and they will not take the rejection of failing so easily and cant be forced to read and appear again for the same subject after six months. If everyone knows that they are all going to pass anyway, I argued, then what the hell are they going to study for? You are removing the incentive to study, to learn, the incentive of humiliation- of being left behind in a class of your juniors while your batchmates go on ahead. Remove that fear and you remove all necessity for knowledge. And I said I really sympathized with those idiots (for want of a more apropriate word) who knowing all this, knowing that they simply have to appear for an exam to pass, knowing all this and still working hard, still studying so much, waking up in the early mornings, reading all night, the kids who are dedicated to learning and to shining in the profession – those kids who don’t know better but are simply moved by an inner urge to succeed.

And it was only when the said colleague sympathised with and continued to espouse the cause of the lazy shits by arguing and pushing strongly for them that I realized that she had a different (hidden) agenda- she was merely demonstrating the “like bats for the like” principle or the “cover your ass by covering your people’s ass” thing. Those who thrive in mediocrity recognize only the mediocre- they are intentionally blind to the bright and the exceptional. Those who benefit and get through for reasons other than pure merit and talent are perforce forced to defend those of their own ilk as they remind them of themselves when younger. The mediocre at all levels and ages hate the bright and the brilliant- even if the brilliance is a product of hidden hard work and uncounted hours spent slaving in preparation while others take it easy and sleep. It’s so sad to see this cult of mediocrity spread even to educational instituitions- where donkeys are encouraged to amble while horses are hobbled. Everywhere I look in our country I see this same indifference to excellence and an encouragement to mediocrity –for the lazy are an abundant lot while the hardworking are we few.

After the above said episode I am reluctant to pass on my knowledge to the next generation as I am more and more convinced that it is going to be unwanted, unappreciated and an exercise in futility. I am even rethinking working here at the teaching hospital, watching the tragedy of bright students getting crushed everyday while the idiots are coddled and feted. All this unnneccessary stress is giving me heartburn and ulcers. So I am planning to shift back to hospital practice and leave the trainign of the next generation surgeons to the wise administrators and their numerous followers who act on the principle “that everyone is equal and no one should get hurt”. This kind of egalitarianism should work out very well for our society when these same batches of student passouts start practicing in the coming years. I am pretty damn sure that my practice will shine all the brighter and my waiting rooms will be fuller once  people realize the kind of doctors they have everywhere because of their encouragement of the mediocre and incompetents. To borrow from Actor Vijay (of Thupakki fame)- I am waiting. 

Too Much Info…..

Too Much Info…..

This happened in a large teaching hospital with a patient who had reported for a minor surgery and was allotted an intern to be operated by

Me : Call me when you are ready to start- after anesthetizing the patient. I have to check this PG student’s surgery which is nearly over and I will be with you to oversee your surgery.

Intern : yes sir, yes sir,  all right sir. (leaving out just the 3 bags full)

Me : (approaching a few minutes later) Everything ready? Shall we start?

Intern : yes sir.

Me: (taking knife in hand) – Let me make the first incision. So, which area?

Intern : First I was living in vysarpadi sir, now we have shifted to perambur.

Me : (giggling into my mask which is thankfully hiding my face)- I meant the area of surgery- right or left? Which side?  And I don’t mean your house site…

Intern : silence.

And I wonder why this kind of thing happens only to me. 

The Art of Plastic Surgery

The Art of Plastic Surgery

How do you teach art to students? You can teach science but how do you teach the nuances of art? How for example do you teach someone to look beyond the lump of stone in front of them; at the beautiful statue it is going to turn into at the end of your chiseling? This question – the how-to communicate the excitement of the end result at the initial start is something which has been plaguing me ever since I got to teach a bunch of interns the nuances of plastic surgery work. 

Let me confess- I am a bad teacher. I just don’t have the inclination or patience to stand by watching people mutilate tissues in the name of learning while I, the expert am standing there hands tied behind, itching to take the knife in my hands- my expert hands- to finish the case and get a beautiful result. But working in a large teaching institution means I have to bear these crosses and trials everyday – to stand by and just watch and direct – all in the name of teaching. And I have found by empirical study of the students that although surgery can be taught- plastic surgery cannot be taught- at least not that easily. It not only requires good, make that “great” surgical hands and tissue handling skills it also requires a fantastic imagination to see the end result before you even start- to stare at clay and see the statue. I don’t know how art teachers do it- how they inspire sculptors or painters to exceed their limitations as students and learn to produce masterpieces and I for one, would certainly like to learn the secret of how-to-teach imagination, a bold rethinking from mundane objects- if anyone who knows can share it with me.

And all these weeks of teaching has shown me only this- most people, make that the majority aspire to just mediocrity- if I can do such and such as a basic minimum that’s enough to earn a comfortable living kinda mentality. It’s very, very rare to find someone who wants to go beyond this morass of mediocrity and aspire to be a great surgeon- someone who can compete with the best internationally- like I aspired to do when I was younger and in training to be a surgeon. That kinda ambition, that hunger, that pride is absolutely not there now and I don’t know why- is it the educational system or is it individual drive which is lacking. But till now- all I have seen are also-rans. I am still looking forward to gaining a thoroughbred as my apprentice- someone worth teaching all my techincal skills to. Am waiting guys….