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Dec 29
2008

Behind my back

Posted by: Ravi Ramakantan

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Ravi Ramakantan
be yourselfBe YOURSELF
Within a week of stepping into the department, our new residents get an earful of my “Welcome lecture” which lasts a full one hour. This is in the form of the “Ten Commandments” (often many more)! The first of these commandments, that gets repeated several times in the course of that one hour is –

Thou Shall Not Cheat!


I would like to hope that the residents stick to all these commandments – well - at least the first of the big list -and do not cheat - I hope they will not cheat on their patients, their teachers and most of all do not cheat themselves. I wonder if you have noticed it lately, but it suddenly dawned on me one day that no matter how hard you try, you cannot cheat yourself!! (As my residents say this is RR’s latest ‘One liner’; “God knows, how he comes up with these stupid ones”).

So when I see them explaining things patiently to patients, writing and answering calls politely and doing what I tell them to do.. I feel great - glibly feeling that my residents really do listen to what I say. Not that, it happens all the time - once in a while, I catch them lying (most commonly about a patient’s history which they never asked) and admonish them for not following the “First Commandment”.

In the olden days, when I used to be younger and had stamina to run around the department and was not addicted to computers and digital images , I would walk around the department a lot – often at odd times. Some of my older residents had a nice name for me – “The Ghost who walks”. So, they were always on their guard about what they said and did. Not any longer – I am often in my den and residents can be care-free.

It is all fine in normal times. Every one has their best foot forward and best face towards you. Unfortunately, many of us manage to hide the real “me” from public view and especially from the chief. It takes difficult times to test people and bring out the “true them”. And it happens when their normal routine is disturbed.

And so, not infrequently when I am not in their FOV but within ear shot, I see their true colors. Residents screaming at patients… and just plain ignoring them or picking a fight with a fellow resident from – say - OBGYN… they would not have dared do had they known the ‘Phantom’ was around. So I call them aside – give them a lecture on how it is important to be polite. even though the situation may be exasperating “I know it can difficult“ I say, ”But you should always try to be nice to patients; they are here not because they want to be here, but because they have to be” And I am off on my way thinking… ,”This must be an aberration… may he/she had bad night on call last night” and I think no more about it….

And one day, usually towards the end of a term, I ask around with my faculty and Chief resident about continuing some of residents for the 3rd or 4th years as supernumerary residents. What I hear then is often quite shocking.

So and so.. (who I may have so far thought to me a great guy or a sweet girl) gets painted as demon incarnate. He/She is rude to patients and other residents – shouts at residents from other departments… does not follow patients-up .is truant on call, ‘bats’ calls…..the list is unending.. Some of these are universal observations, others though are colored by personal bias; some others are doomed in an faculty’s cussedness…but at the end of the day you see a pattern and …I am shocked and disappointed. “Oh! they have let me down” I lament …….

Not because they shouted at a patient or a colleague or refused a call but because they thought it necessary to lie about it; because they felt it is more important to appear to be right than be truthful and especially because they pretended to be what they were not.

But, then what do you expect from 25 year olds who are mortally scared of what his/her teacher would do if he knew the truth; what if teacher chose to be vindictive… what if …... the list is unending

As teachers therefore, it is important for us to impress on our students how it is important to be truthful when they deal with patients and peers; for, this is the springboard of academic integrity. Ignore this and we are grooming megalomaniacs who think nothing of fudging data or palgiarising text….

It is important for us to stress that even as you can cheat on your parents, child or spouse and teachers, there is nothing called as cheating oneself. For, if you do that, at the end of the day when you hit the pillow, the deceit and shame of it all will unfold before your own drooping eyes!

When trust is lost – everything is lost!




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Behind my back 2011-04-21 17:26:57 poonam prasad
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poonam prasad Reviewed by poonam prasad    April 21, 2011
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Dr. Aditya Daftary said:

Aditya Daftary
...
Cheers! And then we have to carry this on into life after residency smilies/wink.gif
 
December 29, 2008
Votes: +0

dr kem kem said:

0
...
when will a kem resident see RR sir WRITING GOOD ABOUT RESIDENTS
 
January 12, 2009
Votes: +0

Ramesh Pandey said:

Ramesh Pandey
...
With due respect to Dr RR Sir, this is the story of all the deptt, not of Radiology alone.
And one of the HOD of Surgery in my college(I will say who was very very Student friendly) had once correctly said,try to enquire about the PG days of your mentor and then You will not feel bad facing him/her when they expect you to be very very polite and sincere all the times, 24x7/week whole month for 3yr.smilies/kiss.gif
 
January 14, 2009
Votes: +1

Ravi Ramakantan said:

Ravi Ramakantan
...
>>when will a kem resident see RR sir WRITING GOOD ABOUT RESIDENTS
When was the last time you heard me say good things about my son? :-)

 
January 15, 2009
Votes: +2

Ravi Ramakantan said:

Ravi Ramakantan
...
>>With due respect to Dr RR Sir, this is the story of all the deptt, not of Radiology alone.
I am talking of "trying"...
Being polite to patients is THE MOST important thing for a doctor...
 
January 15, 2009
Votes: +2

S said:

0
...
Resp Sir,
With due respect, I find your writing too idealistic. I personally have never been in KEM, but I have seen it, the environment, the workload etc.
I have once stayed in a KEM PG's room where minimum 6-7 persons share a room of such a quality where even animals wouldn't tolerate.
How can we expect a great politeness and honesty in such a climate ?
They are humans, aren't they ?
One observation. Especially with Mumbai faculty, they never think their residents are humans. They think they are slaves (of a system called residency)and they should eat lowest quality food (because thats what available) , stay at dirtiest neighborhood, but they should work 24 hours a day like a donkey. And morever, they should be grateful as they have a previlage to learn.
All the departments are understaffed with faculty.
How can you expect humanity from these (forced to become) animals ?
KEM or for that matter, all hospitals invest crores in machines, but they cannot improve human resource conditions for many years. They complain about lack of space etc, but never try to find out workable solution like renting nearby locations etc.

Moreover, the class of people these residents face is a lower class uneducated patients. Unfortunately, most of them are stupids or idiots.
You imagine, a huge list of patients are waiting outside. A stupid comes.. Resident says "please lie down". The patient lies with his feet up. A lady in USG never undresses herself. If asked, she will take at least 15 min. If the resident is polite, then, he will lose 20 mins, and many patient will be waiting. Have the resident got previlage to have two assistants ?
I want to emphasize that the system is not good, how can be student ? Good persons in bad system is equal to bad output. Of course, we cant change system, we have to work with whatever we have at our disposal and try to be best ect. but too idealistic.
About cheating.
That is also human nature. Everybody has to do some cheating. What these persons will say. "Sir, I shrieked my duty. I am rude. I am too lazy to follow the patients ?" What will it achieve. He will appear more rude.
These are basic flaws of human nature. Unfortunately, we are no more than animals. To bring out best from us, we need good system, environment, where rewards and punishment designs for expected and undesirable behavior. Your Gandhian demand for self conscience is far from attainable.
Regards
Sandeep
 
February 02, 2009
Votes: +2

Ravi Ramakantan said:

Ravi Ramakantan
...
Sandeep. Thank you for your candid comments.
Much of what you say about conditions in teaching hospitals in Bombay is true; but at least as far as KEM is concerned, the hostel situation will improve in the next 2-3 years. It is probably not correct to say that no body cares; but, that things take a long time.

I do expect residents to work hard, very hard. that is the only way to learn.

You are right about my blogs being idealistic, I strive to be an idealist.. though I have a long way to go before I reach there.

However, I take serious objection to your description of patients who come to our hospitals as being "stupids or idiots" and from the lower socioeconomic class and do not understand. If all of this was otherwise, they would all have been doctors. To judge patients on these categories is completely unpardonable. Where is it written in doctors rules that only intelligent people can be patients?

Not to tell the truth is not "natural". On the other hand, if one learns to be truthful during residency that will mold you during your consulting days. With each generation, medical ethics keep falling lower and lower; if we begin to take these as normal, only God can save our patients.
 
February 02, 2009
Votes: +2

S said:

0
...
Resp Sir,
Thank you for your reply.
Your point is true. I am sorry for it. We shouldn't classify patients on socioeconomic group. Sometimes, most high class people behave similarly.
You didn't comment on my point about system making person rude or polite or ethical or unethical. At least for average person (like me).
Just to illustrate. When I come to Mumbai, I travel by local train. You know the huge rush, crowd. We literally need to brush and fight with others to enter the train. If I don't do it, other people overpower me and get into train. Another train ? has same situation.
Once I went to Singapore. And, on evening peak hours, there was huge rush. I prepared myself for a battle and rushed to the metro train, and everybody looked at me like I was a bloody animal. Then I understood. Nobody rushed and scuffled. They were in queue patiently waiting, and moving. I was truly an animal.
Next time, I also was in queue. I even let a elderly board into train ahead of me. Back here, I would have brushed him, and even would have scolded him " How other people are supposed to get in if you are moving slowly ?"
So, that's how it works, at least for an average person.
Nobody likes to be rude, careless (in KEM) or unethical (in private practice). But what to do...?
Tomorrow I have a dream to start practice. They will ask me bribe to sanction loan. I have to pay bribe to get PNDT approval, 3 phase electricity, shop act registration and everything imaginable.
I have to pay 1.4 lac per year for CR and 1-2 lac for USG just for maintenance, apart form my loan installment. Practitioners will ask for more kickbacks from more senior people as they would favor me by sending patients. Some even will ask me to write report like probe tenderness in RIF, so that they can operate ( I have been approached once or twice by some ill reputed surgeons)..What to do...
And sir, if you think I am money minded... No. I can't earn millions even If I do all wrong things a radiologist can do. But just to be in business, i have to be unethical. If I take a private job.... I will be paid peanuts. Ok that issue apart. But, while I am in private job, I am part of an unethical chain. Instead of selling girls for prostitution, they do it, and I get money for being part of it.
Have I written too bluntly...
If so, sorry.
Regards
Sandeep
 
February 02, 2009
Votes: +1

Deepak Goyal said:

Deepak Goyal
...
Respected RR sir, I am your fan since the time I attended REF course.
I like your idealism. It inspires me.
 
February 04, 2009
Votes: +0

Ravi Ramakantan said:

Ravi Ramakantan
...
My apologies Sandeep, for being late in responding to you (re) comments.
The system does not make one corrupt and unethical. It is the person, who is willing to follow a system. Let's take the "cut practice". If all radiologists in an area, decide; ‘o cut'; probably the cut system will become less. The trouble is every one is thinking of increasing the cut so as to get more practice. This is GREED.

Being not rude is an easy option. I think there is no reason why one cannot be polite. Forget trains, why not in hospital corridors? Why not amongst faculty or amongst med. Students? That's because of the "we are like that only" syndrome. We can one change ourselves and if at all influence a small group. that is what we should try to do.
>>"Just to be i8n business I have to be unethical",
Each of us has to make choices. One can choose a private hospital as a career; it need not always be private practice.

I agree I have never been in private practice; so people will say, it is easy for me to preach. But I know of a few who practice ethical medicine and do not starve...and live reasonably good lives.
YOU have to make YOUR choices.
 
February 05, 2009
Votes: +3

Virupaksha Joshi said:

0
...
I witnessed on these pages an absorbing but an extremely touching 'dual of words' between Sandeep,'the angry young man'and Ravi,the 'idealist'.Ravi as a person,as a teacher,as a doctor is a member of the species that is on the brink of extinction.God doest produce men like Ravi anymore.What a pity!I wish I could sympathise with Sandip,but I can't.There simply is no excuse for being impolite to the patients.I myself have at times been rude with my colleagues-especially when they tried stepping on my toes.But being rude to patients is just not right.And to call patients stupid idiots smacks of arrogance.


I wish to ask Ravi a question.What is one to do when being polite is interpreted as a sign of weakness?
 
February 15, 2009
Votes: +2

Prashant Bhatt said:

Prashant Bhatt
...
We are all products of the system where we trained, gained experienced, learnt.

Though I do not condone or endorse everything which Dr.Sandeep says, I do have sympathies with him. At least he is honest and frank enough to admit his weaknesses.

But if you read his entries-there are many points which he has raised which relate to the life and existence of our institutions. Please do not single him out for one remark about patients which he has himself agreed was wrong.

Sometimes, to admit one’s mistakes openly (which is a very courageous thing) may be the starting point of the correction process.

For RR Sir, we are all waiting for him to restart his Blog entries in 2009. And also, if I may suggest to you Sir, please send your entries to the Wider Press-maybe a national level paper or international general website. The whole world will benefit from this collective wisdom accumulated over almost four decades.

And a book-KEM through the eyes of a teacher-will be a treasure for all medicos, of all specialties, the world over. We are all waiting.

I agree with Dr.Virupaksha Joshi’s observation “God Does not produce men like Ravi any more” for this was a generation of doctors whose experiences matured in the seventies in the mould of the greats like Dr.Sunil Pandya (SKP) and Dr.D.B.Deval.(DBD)

Another great inspiring person was Dr.Wishwas Rane. Those interested in knowing further can follow this link http://www.ijme.in/171ob54

The Idealists and the Realists. Where are we-ordinary people? Somewhere in the middle? Trying to improve

 
February 16, 2009
Votes: +1

Virupaksha Joshi said:

Virupaksha Joshi
...
I beg for unconditional apologies from Sandip,if I have hurt him.
I promise you Prashant,I will be a bit more circumspect while commenting on or judging others.

Yes. It does take a hell lot of guts to admit and write the kind of things Sandip has done.
 
February 16, 2009
Votes: +1

Ravi Ramakantan said:

Ravi Ramakantan
...
What do you do when your politeness is interpreted as weakness?
There is a simple solution for this. YOU are not being WEAKk.. you are BEING interpreted as one. You CANNOT control the world.. but, only yourself... remember.. walk away from a barking dog. Soon, people will realise your true worth. Be what you are comfortable with...soon others will fall in line.

Prashant.. I am not a 'natural' at writing.. I find it quite a difficult chore and write only when I really have something to say.

A book?? I am too darn lazy for that.

Thank you all for your comments.
 
February 16, 2009
Votes: +1

Virupaksha Joshi said:

Virupaksha Joshi
...
I have always felt quite strongly that the radiologists,of all age groups need to be retold certain fundamentallessons of life-humility,honesty etc.These things are as important as radiology of bone tumors,pediatric chest or a barium meal study.Dr.Ravi is doing just that.It pains me when anyone who talks of these basic values,is dubbed as a 'mere idealist'.I have a personal experience of being a butt of jokes when I tried talking about these things in one of our monthly meetings.Many of my radiology colleagues think that one is polite because in him lurks a low self esteem and that is something to be exploited.

Anyway,enough of these goody goody stuff.

Let us revert back to more practical things.Like the art and science of reporting for one.Dr.Keshav's article was excellent and extremely useful.

At my place,it is believed that a radiologist's expertice is directly proportional to the length of his report.One gentleman radiologist churns out reports-which is actually a booklet(even if it is a Chest radiograph).Soon I will be printing a dozen copies of the article by Dr.Keshav and distributing among my colleagues and hope that atleast then the wisdom will dawn upon them.(No prize for guessing that I am rediculed because of my short reports).
 
February 17, 2009
Votes: +1

Virupaksha Joshi said:

Virupaksha Joshi
...
I could not locate reply to my latest comment.
 
February 18, 2009
Votes: +1

Deepak Bhatia said:

0
...
Dear Ravi, I have great respect for you. Your contribution to Indian Radiology is invaluable. But, I have strong objection to your following sentences

Prashant.. I am not a 'natural' at writing.. I find it quite a difficult chore and write only when I really have something to say.

A book?? I am too darn lazy for that.


I have seen so many comments on iradix requesting you to write blogs. And i strongly DO NOT AGREE with above excuses for not writing blogs.

This is fate of India, where the capable people are shrugging their responsibilities by giving lame excuses of time and potential. While corrupt people with vested interests rule the World. For eg Indian politics where the educated people keep themselves away from Politics and give way to corrupt people.
Your blogs are source of inspiration to many Residents, Consultants guiding them in their practice.

I am sorry but the excuses of -
1.
chore time
we know your potential & skill in time management,
2.
write only when I really have something to say.
it is hard to believe by anyone when we all know there is so much in your head to tell us/guide us
3.
I am too darn lazy for that.
difficult to digest this excuse too- ask your resident :you are more energetic than any of your resident at this age –.
I am sorry for being straight forward but I want to tell you that you CANNOT shrug your responsibilities by giving such excuses for not writing blogs. Ravi, believe me your blogs are serving as LIGHTHOUSE.

Everytime I read your blog I feel I am sitting once again in your classroom. Hope to see your new blog soon.
 
March 20, 2009
Votes: +2

Virupaksha Joshi said:

Virupaksha Joshi
...
I agree with Dr.Dipak Bhatia whole heartedly.Gentlemen teachers like Dr.Ravi should not be hiding behind veil of anonymity,siting laziness as excuse, when actually their wisdom of Himalayan magnitude is very much needed.Kudos to Dr.Dipak Bhatia for his rather blunt but hard-hitting comment.I hope at least this will wake up the writer in Ravi.
 
March 20, 2009
Votes: +1

Ravi Ramakantan said:

Ravi Ramakantan
...
Dear Drs. Bhatia nd Joshi,

Thanks you for your interesting comments. Unfortunately, I am lazy and a bad writer. So I had suggested, any one of the residents attending my lectures could make notes and reproduce it for all. I do not plan my lectures (which is s stupid thing to do) ; most are extempore verbal diarrahea, I do not have course material ready and I can talk and talk ad nauseum,, but write - no. Many have told me to write; but truth be told,I cannot write for nuts. Re. blogs, I have written some more; but they being KEM-centric I am not at all sure they will be interesting to a general audience.. in any case that decision will have to be made by the blog editors.

In any cae, I REALLY DO APPRECIATE your candid comments.
 
March 20, 2009
Votes: +1

Dr. Sham Sunder Goyal said:

Dr. Sham Sunder Goyal
...
Sir,
What you call a "verbal diarrhoea" is precious gamuts; earned after years and years of unconditional commitment and practise.
Pupil like me will be enriched with your lectures. you can do simple thing just to post a normal class lecture on net for the international audience; even a audio lecture would do. I have one self improvement cassette telling me that "Best time management is utilize your time and enrich yourself even while travelling"

Sir, I can figure out the tons of respect you carry because of your noble ways of teaching.....This is high time when you can have life of significance....by the way of teaching
your lectures will benefit the society as a whole. Thanks and Deepest regards
Sham Sunder Goyal
 
March 21, 2009
Votes: +1

Dr Shilpa Domkundwar said:

0
...
this is in comment for all that conversation between sandeep and ravi sir
I am totally for ravi sir
not that its to idealistic
but that ..we all are to start with idealism
only then can each one , even the corruprt and rogues can decide whre to go
if we do not have a bseline whre does the good or the bad lie?
Coming to cut practise, buying machine, etc
i feel india trains the medicos with a mistake
though its not about all sewa
whre is the genre of medical ethics, and humanity
why medicine , its reflecting in every walk of life
the sooner we realize that it is the greed for the money that is the driving force the better
leave others
as for myself
i need to convince myself about my need and greed
that can really solve some frustation
also i guess we need to define success for ourself
the crux is money & power define all the parameters of success
i guess
ravi sir has none by conventional definition but he rules smilies/smiley.gif
the secret is simple
he has been a leader all through his radiology career
probably working only for his own self
neither for money
or fame
or
power
how many of we youngsters have it in us to give it all?
Try giving it........success is sure!!!
What today remains important is humanitarian practice
leave ethical , but humanitarian
and that needs sheer moral dedication and consistency in purpose
it doesnot need intelligence, rxtraordinary excellence in subject
but extra ordinary patience and faith in the law of humanity
We Youndsters should give this a thought
And yes a thought to mindless needs!
 
May 02, 2010
Votes: +0

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