Missing Dimension in Surgeons

CME Inaugural talk at the 29th Annual Conference by Chairman, Dr. Sharad M. Tanga

Dr. R. C. Bidri, Principal & Dean, Shri B. M. Patil Medical College, Chairman elect & Chairman Scientific Committee Dr. Tejawini, Hon. Secretary, Dr. M. Vijayakumar, Organising Chairman Dr. Arvind Patil, Organising Secretary Dr. Mallikarjun Patil, Executive Committee Members, Governing Council members, past Chairman’s of this august body, teachers & former President of ASI Dr. S. S. Narasanagi, members of the ASI, members of the press, Ladies & gentlemen.

On this pleasant morning, Karnataka State Chapter is happy to have you all here for the 29^th Annual Conference of our state Chapter.

Teaching:

Surgical Teaching is often thought to be the formal curricular, classroom based instructional teaching. Every surgeon is involved in some form of teaching be it training/coaching, formal instructional teaching or mentoring. Secondly, with the increase in medical colleges, dental colleges and paramedical colleges, most surgeons in a city are involved in teaching. Therefore let it not be presumed that only a niche group amongst the surgeons is being addressed.

It’s very fitting that this conference is addressing two important traits of a surgeon which were on the periphery till this time.

With changing times of students being exposed, having access to information, for teaching to be effective, content, our teaching style, methodology and technology needs to change. A traditional teacher was supposed to motivate, transfer information and guide the student. Thanks to the growth of communication, the gates that locked learning within the walls of nations have now been broken down. With Internet & digital technology, any information is available at the click of a button. That being so, knowledge transfer is relegated.

Therefore today, teacher and teaching methodology stands challenged. We need to learn on a continual process, innovate and be sensitive to the contemporary generation in order to be effective.

Infrastructure has improved, remuneration have scaled yet teachers are disgruntled. Two things which would make teaching a fulfilling experience are responsiveness from the student, recognisation from the college and social prestige from the society.

Service:

If teaching could be considered Soul of a professional, the Heart of Health care delivery is Service. Consciously or unconsciously, every one of us has ingrained that attribute. Yet it seems to be waning steeply. I don’t want to sermonise, as a lot of this is spoken on such platforms yet there is slip between the intent and action.

Post Graduate Students

Wish to communicate –

· Information Explosion - Knowledge to be mastered is both vast and incomplete.

· No instant Winners. We are everyday heroes

· Surgery is a trying profession: Trying profession because of lack of certainty and secondly dealing with lives.

· Betterment is a perpetual labour.

· Ours is a job of talking to strangers. Developing soft skills

Final communication for a life in medicine. Medicine & surgery in particular is facing many challenges in a short time like never in history. I don’t want to list them. The clear demarcation of primary surgical care and tertiary surgical care is developing; Super speciality tertiary care is breaking into the concept of Organ based specialists, technology is taking centre stage, small enterprises need to be scaled.

Two things need to be addressed: firstly define your niche area. Secondly, basically we are late adopters probably because we deal with lives. We need to understand the necessity to change, ingrain it in our discipline. We are resistant or late adopters, now there is need to be early adopters. Look for the opportunity to change.

Social Message

Patient orientation & education is needed There is needed to take steps that would improve the confidence of patients in the medical professionals. The expectations from the patients have increased tremendously. The hospital today is a system of increasing complexity. It is a hotel, a school, a laboratory and a stage set for treatment.

Medicine is a science of probability, with its own limitations. We in medicine are humans ourselves. Assist nature in just alleviating the suffering & making an effort to increase the longevity.

Our shock absorbers are Competence, character and concern for the patient.

Thank the organizers

We are in a wonderful ambience that is conducive for excellent feast of academics and leisure. We wholeheartedly thank the organisers for all the efforts and pain undertaken to make our arrival comfortable.

Thank you ladies & gentlemen for the patient hearing.

Presidential Speech at Annual Surgical Congregation

Chairman's Speech at 29th Annual Conference of Association of Surgeons of India – Karnataka State Chapter held at Bijapur on 4th February 2011

Chief Guest, Padmashri Dr. R. B. Patil, Hon’ble President, BLDE Association, Shri M. B. Patil, Chairman elect, Dr. Tejaswini, Hon. Secretary, Dr. M. Vijayakumar, Organising Chairman Dr. Arvind Patil, Organising Secretary Dr. Mallikarjun Patil, Executive Committee Members, Governing Council members, past Chairman’s of this august body, teachers, faculty members, distinguished delegates, members of the press, Ladies & gentlemen.

Its great privilege and honour to stand before you to address this 29th Annual Conference. Our sincere compliments to the local organizing committee steered by Chairman elect Dr. Tejaswini, Dr. Arvind Patil, Dr. Mallikarjun Patil and also their dedicated team for having organized this conference in a wonderful way. Matching it, conference has found excellent response in terms of registration and the number of papers submitted.

Preceding year has been an opportunity of attending most of the meetings across the state and witnessing the activities of various city branches. The detail report was just read by our Hon. Secretary, Dr. Vijayakumar.

Challenges
Today, General Surgery is under attack by profound challenges that are acute and sustenance in their nature. More importantly, they are glaringly situational for rural/small urban and bigger urban centres.

At the outset we are moving towards urban concentration of surgeons, narrowed vision, and increased daycare, driven by the rapid expansion of laparoscopic surgery. Added, we are witnessing changing patient attitudes. The patient has become the center of the medical universe. 24-hour personal patient responsibility is being anticipated. The health care delivery today is a system of increasing complexity. It is a hotel, a school, a laboratory and a stage set for treatment.

Continuing with the broader perspective, technology incorporation, entrepreneurship/collaborated corporatization, insurance and quality accreditations are becoming focal issues in health care delivery systems.

‘Specialization in General Surgery’ was the title of an editorial in the British Journal of Surgery, in which Johnson stated: ‘General Surgery has a future, but the future requires
increasing sub-specialization.”. We are seeing integration of medical and surgical specialists in organ-based units at premier institutions.

The consequences of these changes has seen middle aged general surgeon feel that more complicated care has to be given in a shorter period of time, less autonomy, more bureaucracy, and more part-time specialists—in other words, there is increased workload with fewer incentives. Some feel that we are spiraling downwards, towards being a mediocre profession. Obviously, these remarks come deep from the heart. Some surgeons are focusing on being entrepreneurial and some accept being employed by large group practices. It means they need not worry about the economics of practice, on-call schedules and thus enables them to spend more time with their families and hobbies. These individuals have come to understand that sick patients who are stabilizing must be handed over to other group members to handle as they realize that one surgeon can no longer take care of all aspects of surgery. Together we might cure better than each alone.

For the first time in human history, more people have started to live in cities. The world and India too is slowly turning urban. Not to ask of infrastructure or development, the rural environs are lacking basic amenities and ready access. Many rural surgeons and more particularly government doctors feel victimized as we see the government is passing the mantle of service & altruism on to them. For a profession that was the most desired while joining, it seems to be an unjust hand out by the society.

Whatever the current and future difficulties of surgery, they are essential to the provision of adequate health care. There will be place for super specialists, organ based surgeon and a General Surgeon. What it needs is to be aware of the situation; analyze their strengths and weaknesses and change early to adopt your niche area. Take the initiative to act, instead of reacting repeatedly to the initiatives of others. There’s always early movers advantage.

It might be observed, typically our country is having two contrasting faces; popularly described as Bharat & India. They are glaring. Our profession as a sector is rapidly growing industry. Our professional capital is well appreciated as on par with that of any country. India is quickly becoming a hub for medical tourists seeking quality healthcare at an affordable cost. Nearly 45 Lakh foreigners sought medical treatment in India last year. Indian brand of Medical Tourism is expected to experience an annual growth rate of 30%, making it a 9500 crore industry by 2015.

Public Health:
Public Health care delivery cannot be left to Private Sector to be a major player. What ever be their purported responsibilities, they are bound to be market driven. Added, our health care burden is still predominantly communicable diseases that are linked to sanitation, potable water and education. In recent times the burden of non communicable diseases has increased and here the Public Health initiative need to address tobacco use, harmful alcohol consumption and obesity related issues.

For reasons of lack of governance and meager budgetary allocation Public healthcare has not been able to be effective. India's healthcare allocation of Rs 23000 crores for 2010-11 amounted to only 2 % of GDP. The growing Tri-sector partnership model is a welcome move.

Surgeon & patient.
There is need for concerted effort to improve communication and thus educate the lay about the profession and health care. There are many images from the past that cloud the present. Understanding the diagnostic process can help both surgeons and patients make the best decisions and allay misunderstandings. Many patients rarely appreciate the complexity of the diagnosing process. The reality in some instances is that the clinical picture is ambiguous, and diagnosis is based on the conscious deductive process and science of probability. Today, the patient expects the doctor to make clear decisions with immediate cessation of suffering. Some armed with information about advances in medicine, are under the belief that the newer technologies have enabled the complete cure of disease. Highly sensitive investigations overdiagnose conditions while commonly used investigative methods underestimate the risks. The trade-off is essentially between sensitive investigations, which give false alarms, and regular investigations, which do not pick up the condition concerned. The diagnostic challenge for physicians is to use them judiciously.
IMA published a code of decent behaviour for patients. For the sake of novelty and simple need, few of them are here:
1. Doctors are human beings who assist the nature in increasing longevity of the sick wherever possible.
2. Do not expect your doctor to share your discomfort as he looses the scientific objectivity. Endure suffering a bit.
3. Do not expect the doctor to explain every aspect of diagnosis making and treatment. They are uncertain and profound.
4. Your doctor leads a busy and trying life and requires all the gentleness from you as well.
While advocating just approach to doctors, it is necessary that the fraternity takes steps that would improve the confidence of patient. That is possible by adhering to the three keystones of the profession - competence, concern for the patient and credibility. They don’t change.

Credibility
To start with, Intelligent Quotient (IQ)/Competence reflected the ability of the individual to analyse and understand complex issues. It was measured as the principal reason for success.

Later, Daniel Golemen, introduced Emotional Quotient/Compassion (EQ), which represented the ability to respond to issues and situations. He identified a very high correlation between success and EQ.

Yet, today, we see people no longer enjoy the legitimacy they need. So much depends on reputation that it makes the difference. The Gen Next is turning spiritual and an undercurrent seems to flow.

IQ and EQ are important but Credibility Quotient (CQ) is equally important, probably a bit more significant, as morality is not easy to muster. That’s the valuable intangible asset.

Unfortunately, many practices that were thought to be unethical and some even illegal appear to be normal today. It might not be nice to talk about absoluteness in the present world; however it is important not to shy away from the realities and atleast adopt the middle path. By just beginning to realize and accept the middle path, one starts seeing the path

Social Take
Today all the 4 pillars – Legislature, Executive, Judiciary and Press have weakened badly. It would be difficult to choose one or two pillars in the deteriorating governance by democratic means. Collaboration and intimidation between the pillars has lead to system failure.
I think transparency and accountability are two areas that can yield profound results. Right to information (transparency) is a great facilitating tool. The follow up of this information is conviction (accountability/responsibility). If transparency and accountability work effectively (includes timeframe also) the silent majority (some call it 5th pillar) will be roused. Escalating population has significantly contributed to the acute failure. Whatever governance is in place, the racing number makes development look pale.

Personal front
On the personal front, it’s been a mixed bag of journey. Prudence & providence has made it this far. It was a conscious decision to tread a path different than that walked by my father, Dr. M. R. Tanga. It might be interesting to quote a recent example. Its 5 years since he’s gone, yet I receive a card from a city chapter mentioning that Dr. M. R. Tanga will be inaugurating the CME! While growing under a banyan tree, the desire to demonstrate worthiness and the human nature looking for vindication/validation were all there. On a wider note, success in life is not a one-man show. I express my gratitude to my treasured family, teachers, colleagues, you members and the life itself that made it all happen.

Thank you ladies & gentleman for your patient hearing.

Dr. Sharad M. Tanga
Chairman,
ASI-KSC, ( 2010-11)