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….

My Fellowship Craze.

My Fellowship Craze.

So, last week I went for yet another examination to get myself yet another degree. Now before you move away from this page thinking that I am just showing-off here let me assure that this is not about my patting my own back in appreciation. This is more about how no one else around me could understand why I wanted to study yet again or go through all the horrors of examinations again and again at this advanced age. Every single person I confided the fact to was actively belittling and discouraging my urge to write exams. From my dad who asked me if they would give me a promotion at work if I got an extra qualification to my boss who let me stew for day’s on end without signing my leave letter to go write the exam, everyone around was against my writing it.

 Never mind that it’s my own money which paid for the course or my hard fought and saved leave (by working even on days in which I was sick) which I hoarded throughout the year to go write the exams. What they fail to understand and what I couldn’t make them understand was it was not the money or the prestige or whatever which drives me to go for these fellowships and degrees- its not even that I like the sound of them after my name. It’s simply the challenge- whenever I hear that so and so exam is soo bloody tough that it’s like climbing the Everest, and then I am oh so tempted to try and climb it metaphorically or go join the course, write the exam and measure myself against the best of the best. Its purely competitive, animal spirits. I want to see where I am, where I stand when I am pitted against the best, especially youngsters and fresher’s who have had the benefit of just finishing college and having the subject on instant recall, while I have been away from reading and jaded with clinical practice for all these years. 

I guess if I had been a swordsman I would have gone round challenging others to duels every time I felt jaded in life and wanted to prove a point to myself. But being a geek, I sign up for advanced courses and write exams as if my life depends on it. Even if they are kick ass tough exams which have me gibbering in fright the night before. Even if the exams (And results) have no real world effect on me or my career- nothings gonna happen if I fail or pass. It’s just the pressure of self pride and a love for education. There are dozens of ways I could waste my money and time. I choose to waste it in higher education, on doing interesting courses and spending my free times (the relatively sparse time I get off work) on studying, reading, writing and passing exams. Now is that such a bad hobby? I leave it to you readers to judge me.  

P.S. Continuing medical education is not compulsory in India- it’s discretionary. Besides once you reach a certain level of competence in your field there is nothing – literally- left to learn in a formal education setup.

If You Can’t Praise, At Least Don’t Criticize.

If You Can’t Praise, At Least Don’t Criticize.

Last week I was part of an examination panel to decide the winner of a fellowship/medal for undergraduates. From the 250 or so students who turned up to write the written exam we judges (5 of us) narrowed the field down to 25 candidates for the practical exams out of whom only 5 students survived for the third and final round of vivas. We recommended the winner and runner up to the director of the department who announced the results in front of everyone. He started his speech with these words – “Although I was watching only the final part of the selection process, I feel that none of you deserve this award but as we have to give it to someone, I am selecting so and so candidate as a formality though there is not much difference between all of you” and after such a gracious announcement he went on to lambast modern day students and their perceived lack of knowledge and hard work. 

I who was part of the audience had to mightily suppress a very strong urge to get up and ask the director a couple of questions from his specialty – maybe a classification and a definition to see how he answered as a proponent of olden days education. In my view (maybe biased) kids these days are no better or no worse at studying then what our elders were. This fact is conveniently forgotten by professors and HOD’s who are at the fag end of their careers. They always judge the present with a rosy remembrance of the past.  I am not defending any idiots here, the guys who got through the three rounds of examination genuinely deserved the prize in my opinion. And even if they weren’t as knowledgeable as the professors- as undergraduates they are not expected to be- to apply the standards required of a specialist or a postgraduate student to an undergraduate kid is not fair. As a student in the not so recent days I can sympathize with the kids who have to read for multiple papers and write all those exams in one go. Being hard on them is counterproductive and apt to discourage even enthusiastic kids from liking the subject in future. 

On the contrary whenever I go as an external examiner for undergraduate kids I try to encourage them by not failing anyone deliberately. I try to give a 100% pass result and despite that if anyone fails they do so by their own efforts. As long as the student knows the basics or at least to recognize when he is over his head and knows to refer to a specialist- I try to pass them. I have seen too many specialists who can write pages of notes discussing every possible reason for a fever but in the end cannot (or dare not) commit to a single diagnosis- but instead insist on a diagnosis of PUO- pyrexia of unknown origin which is fancy jargon for- fever I cannot guess the reason of. Even some undergraduate kids make the diagnosis immediately- sir it is malaria fever…how did you decide? Look at all the mosquito bites on the patients face sir…that’s the kind of ingenuity (and capacity to improvise) I appreciate when I try to pass the student despite his obvious lack of knowledge of the signs/symptoms of malaria. At least he knows it is malaria, will send the patient for a blood test and get it confirmed that way and by then would start treatment for malaria – instead of thinking over a hundred different diseases and treating for none of them in the end.

And finally if a student is on the verge of failing I always have a bonus question for grace marks- “Do you have a girlfriend? Does she distract you from studying?” If the answer is yes- he gets the two marks to push him over the pass line. For I know firsthand what it is to sit there in your room with a boring big book in your hand and keep thinking – what the hell am I doing sitting here when by all rights I should be in Udayam theater watching a movie with my girl. For making that supreme sacrifice in favor of studies the students deserve those two grace marks don’t they?

I would appreciate your views dear readers on the sticky issue of –whether the seniors are right when they always claim they studied better than the current generations. Are they? What do you think?

But Where Is The Other Banana?

But Where Is The Other Banana?

Patient : “Doctor, doctor, look at my lips, this is all because of you, all because of the medicines you gave me, my lips are all ulcerated and painful” screamed the patient at me.

I took my time trying to process it all in but the early warning signs were clear- my life as I knew it till then was probably over. This patient was going to scream and create a scene, maybe even file a court case against me and some stupid judge who had probably been in a fight with his wife over breakfast will find me at fault and order a compensation amount enough to wipe me out and all this doomsday scenarios revolved around in my mind in the ten seconds after I heard that screaming voice before my training automatically took over and careful to keep a blank professional look on my face (hiding my inner terror) I commenced further enquiry.

Me: "Mrs.So-and-so...I don’t remember you, when was the last time I saw you? And for what? Do you have any prescription of mine? (Denial is the best offence right?)

Patient: “I didn’t bring the prescription because I lost it, but I came to you for an infection and you gave me two tablets to take morning and night for two days”

Me: “And when was this?”

Patient: “Oh, I don’t remember, around ten or fifteen days ago I think”

Me: “Was it ten? Or fifteen? How many days ago did you see me? Tell me correctly for its very important”

Patient: now in a milder voice- “Hmmm, I think two weeks ago, but I don’t know the exact date”

Me: “And I told you to take the tablets for two days, right? Did you take it?”

Patient: “Yes, of course, I took it for the two days”

Me:  “And I must have definitely told you to come back after two days, right? I tell all 

my patients to come back for a check-up without fail. Why didn’t you come back after two days?”

Patient: now in a definitely hesitant voice – “I was busy”

Me:- moving my voice up a notch “Busy? Busy? Very busy? What’s more important than your health?”

Patient: “But that is exactly why I couldn’t come doctor- I had severe fever- viral fever they diagnosed it- for ten days after that- and then I was admitted in so-and-so corporate hospital for ten days to treat the fever and was not discharged till three days ago and so I couldn’t come see you as you said- only now I am free to come see you”

Me: in an exaggeratedly patient voice – “Yes Madam and can you tell me when exactly these lip ulcerations developed? When you first saw them?”

Patient: in a wary-unwilling voice- “Two days ago, I think, but I definitely noticed them yesterday” 

Me: “Madam, are you aware that fevers, especially, severe fevers like viral fevers (with increased body temperatures) can cause lip eruptions all by themselves - especially if they are of Herpes simplex virus origin (which is a sexually transmitted disease by the way, so where have those lips been hey?) And also the drugs they must have given you for a ten day old severe fever could also have been strong enough to cause an allergic reaction to your lips?” 

I took a significant pause to wipe my specs and stare at her in my most intimidating professional “who-are-you-kidding” manner

Me: “So how do you connect the mild, probably vitamin tablets I gave you fifteen days ago for two days with the lip eruptions you developed yesterday? Can you think of any reason?”

Patient : “Oh, ah, but the hospital I was admitted in for the past ten days told me that my lip ulcers were not caused by them, they didn’t even listen to me doctor like you are doing, they just chased me away, saying it’s a very minor thing and they will give me an ointment for it to apply for one week and they asked me to leave and so I was confused and then I remembered you”

Me: and so you thought about whom to vent your anger on and decided poor old me was the person to scream at? You know what, I am happy you got what you deserved there- such a crappy response- from that big corporate hospital – “Madam, what they said was correct, no need to panic for such a small thing, I think that ointment they gave you is enough and your ulcers will soon heal if you apply it.”

Me: “And oh, no fees, please no fees, you are after-all an old patient” and I will never touch your goddamned money as this will be the last time I will ever see you, bitch.

And that’s how some of the patients are. They blame doctors for everything which goes wrong in their lives (even unconnected things) and remind me of that famous banana joke of comedians Senthil and Goundamani (You-tube link of comedy scene) in which when Goundamani asks where are the two bananas he paid for, he keeps getting the same answer from Senthil “but this is the other one” a perfect example on how to do a matter-of-fact pulling of the wool over the eyes when wide-awake.

And this is just to show that some patients have no qualms in ripping-off doctors and contrary to what the media keeps telling all the time it’s not fair to accuse doctors as being always wrong while patients are angels.