“Essentials Of Being A Smart Doctor”
Guest Lecture at National Undergraduate Students Conference ‘RESPIRARE’ at the
BJ Medical College
August 3 in B. J. Medical College
© Dr. Rajas Deshpande
My dear friends,
If you are sitting in this hall today, you have already proven that you are smarter human beings, but that alone is not enough for becoming a smart doctor. However intelligent or smart anyone else may be in the outside world, your ability to save their life, help them in illness gives you an upper hand, hence the perpetual tag “Doctor sahab” bestowed upon you by the world. To be able to gracefully deserve that tag is a difficult task.
Like success, riches and many other achievements in the world, medical smartness too is not an accident. One has to earn it with a great effort.
There are really smart and good doctors, and there are also those who pretend so. Most patients can tell the difference. So if you plan to be a really smart doctor, you will have to imbibe the essential qualities in your very subconscious, so they become your basic self, a part of your personality. You will have to force yourself to change certain habits, traits of your behaviour and thinking, and allow the inception of newer, better methods within your being. I am very happy that I can speak this to you at this budding stage, while you still have ample time to modify the DNAs of your medical smartness. Once you accept to change for better, never go back or compromise. © Dr. Rajas Deshpande
Let us consider a small question: What quality is universally liked in a human being by almost everyone, including their enemy?
Muscle power? Political Connections?
It is irresistible. Even when a patient has come to you with a prejudice or suspicion, the first thing that will change his / her attitude is your kind words, your compassionate attitude. It is not very easy to be kind and compassionate to everyone, especially the ill-behaved. This is where you will need to train yourself to be smart: by avoiding use of bad words, not raising your voice and not being aggressive. Keep your words to a minimum, and do not use negative, accusing words. Do not speak arrogantly with the relatives. You don’t know when things may take a bad turn.
However, the first few steps that you take to be kind to the patient will get you the biggest reward that this field has to offer: your patient’s trust, and if you care for it, it is usually lifelong. © Dr. Rajas Deshpande
When the patients come in, they are not willingly entering the hospital in most cases, but out of desperation. They are scared, angry and often extremely worried that something bad will turn up as their diagnosis. Add to this the resentment caused by having to be questioned and touched by a total stranger, whom they have to tell private information. This has already made them jittery.
A smart doctor understands this mental state of the patient completely, and makes the best effort to ease out the patient by welcoming them, wishing them, and initiating a genuinely friendly chat. Such simple sentences like “Good Morning, How are you?”, “Hope you are not very tired”, “I am sorry that you had to wait” reassure the patient that they are dealing with a nice human being, and put them at ease.
Whether the patient comes from rich or poor, educated or illiterate background, the doctor must have utmost respect for their privacy and dignity. Asking private questions, undressing and examination should never embarrass the patient. Standing up and wishing the patient while they enter and leave your room makes the patient feel respected, and adds flair to your smartness. © Dr. Rajas Deshpande
How should a doctor dress?
It is common to see few doctors, both junior and senior, wearing short sleeves and open collars, sometimes even low rise jeans, trying to show off their physique. One can only imagine what kind of reaction they will generate if things go wrong.
There have been many scientific studies about this. If you yourself want to be treated, you will never prefer a shabby looking, ungroomed, unclean person with a stink. You will want someone who looks healthy and positive to make health choices for you. The patient always wants to see a neat, clean and reassuring doctor. Your demeanour should not be frivolous: unnecessary excessive laughing, smiling, joking, bad language are not welcome to be used in front of a worried patient. © Dr. Rajas Deshpande
It is wise to dress up as good as one can, without too much show and fashion. A very richly dressed doctor in a suit may turn off an already nervous patient from lower socioeconomic classes. The best attire is formal, simple, clean and ironed clothes which cover you well, apron, shoes, and no jewellery. Fortunately, tattoos and piercings have not yet much entered this field. One must avoid religious clues, and refrain from religious and political talk while practicing as an allopath.
A smart doctor cannot forget that our field deals with people from different socio-economic strata. He / she should be able to irradiate the feeling of being a trustworthy person and invoke positive, peaceful feelings in those who come to see him / her.
Personal hygiene is an indicator of a doctor’s smartness, and such simple things as hand-washing after every case, using sanitizers, wearing gloves etc. speak a lot about a doctor’s dedication towards good health. Best clinical practices must be learnt and complied with voluntarily by everyone who wants to be a smart doctor. © Dr. Rajas Deshpande
Humility, manners and etiquette
A Spanish TV anchor who follows up with me for Multiple Sclerosis told me once: that many patients travelling to India complain about the doctors being very good clinically, but worst in manners. “I was amazed that you actually offered me a glass of water when I was crying during my first consult” she said. Such simple manners affect the patients so much!
Many doctors, as they ascend the merit scales in this profession, develop a complex that they are unbeatably smart. They end up becoming ego-balls disliked by almost everyone, because of their high handedness. A smart doctor will never let that happen to himself / herself. There are far more smarter people than most doctors in almost every other field, even some illiterates are sometimes smarter than the most literate. One must never shed humility, whatever one’s achievements. We often see students smarter than teachers, juniors smarter than seniors and we all know what happens in those cases. The best policy is to never presume oneself better than the other. A smart doctor always knows his manners and etiquettes very well. © Dr. Rajas Deshpande
Language and communication:
“What do you mean by dizziness?” my teacher asked a tired female patient once.
“Oh I feel abnormal noise in my ears” she replied. Dizziness, in patient’s language, may mean anything from imbalance, blackout, vertigo, to heavy-headedness or blurring of vision. It is always wise to dig into what they actually mean. A knowledge of regional language often helps resolve misunderstandings. Similarly, the patient may also misunderstand the words that a doctor uses.
A smart doctor will learn to communicate so as to make the patients from different streams understand exactly what is being conveyed. We do not always have too much time, hence it is necessary to develop the skill of using minimum words. One must use simple words, and know the colloquial alternatives (e.g. use “Heart” instead of “Cardiac”, use “Brain infection” instead of “Encephalitis” etc.). If the patient does not understand, one must encourage him / her to ask questions. Use pictures if necessary. Many patients / relatives do not stick to time or subject, often asking irrelevant questions based upon their googling, but a smart doctor must be able to steer them on to the right path with a smile and a gentle reminder of time limitation.
The most difficult part of being a doctor is conveying the bad news. There is no good way, one has to be very careful and diligent. On one hand one must offer sympathy and readiness to help further, while on the other hand, one must also be aware of aggressive, impulsive and shocked reactions, making sure not to risk one’s safety.
While conveying the bad news, surgical risk or complications, a doctor must have the patient / relatives sit down, have witnesses around, and speak compassionately but confidently, offering all possible help to ease out their suffering. A hesitant doctor invokes suspicion even if correct. However, an overconfident liar will invite more trouble, so be careful that you speak what is the exact truth. That never fails in long run. © Dr. Rajas Deshpande
Friends, as you become more and more specialised, you will unfortunately face rivalry and jealousy. Doctors are the most ingenious professionals in their ability of pulling legs or sabotaging careers, and you may sometimes be facing your own teachers in such situations. A smart doctor will never compromise his / her own grace or the dignity of our noble profession. Fight all that you must, and I will stand by you if you are correct, but always use the best language, think about and mention the best things about your competitor, and always keep the door for direct discussion open. Refrain from allegations, cheap comments, mockery and defamation. If you feel that a colleague is wrong in some clinical decision, please reach out to them and talk, before you discuss it with others. Everyone usually has a reason for their decisions, one must respect it. If your reaching out is unwelcome, then alone mention on paper what you think about the case. A smart professional will have no friends or enemies, no senior or juniors, but only colleagues. Immediate reporting of any adverse clinical events to the authorities, and correct documentation are essential. © Dr. Rajas Deshpande
Medico legal Smartness
We live in a country with too much poverty and illiteracy. If there is a chance that a doctor’s mistake can be proven, there is every chance that the relatives will drag that doctor into the courts of law, demanding millions in compensation.
In these days of exponential medico legal cases, where patients, relatives, authorities and even some colleagues are usually unforgiving if you commit a mistake, real smartness is to document everything perfectly. Just as an example, a young patient of mine recently had a stroke, without any known risk factor. Upon repeated questioning, he reported that he was taking some unknown herbal medicine since three months, in a mixture of some oils, to improve memory. One must mention every such detail on the paper, including poor known history, delayed admission and alternative treatments. Every interaction with the patient and relatives must be recorded on paper. Recording the date, time and your name and designation at the beginning of every note is an indication of you basic smartness. A proper written consent must be obtained for every procedure, however trivial. Information about dangerous medicine being given to the patient / relative should be recorded, a consent for the same signed by the relatives. © Dr. Rajas Deshpande
I do not know if I am enough qualified to talk about this, because I was often beaten up by my primary school teachers for not doing my home work and some other curiosities which I cannot mention here.
A doctor is expected to be on top of the pyramid of scientific advances, and there is nothing more pathetic than a doctor who quotes medical knowledge from decades ago. While we respect the past, we cannot disrespect what every standard medical textbook mentions on its first page: Medicine is an ever-changing science. A smart doctor, therefore, will still study on a daily basis even after achieving the highest degrees, and keep himself / herself updated with the most recent medical knowledge relevant to his / her field. Studying on a daily basis, I feel, is the most important basic quality every smart doctor must inculcate. One must register on smart medical sites like up-to-date, emedicine or many others, to stay updated about one’s medical interests. Yours is a lucky generation, having all information at your fingertips, thanks to your smartphones. Check drug interactions every time you use new medicines. Cross check your differential diagnoses. © Dr. Rajas Deshpande
Everyone is semi-addicted to their smartphones. However, they are also a great hindrance to the super-essential concentration required of a smart doctor while interacting with patients or making medical decisions. Smartphones can be wisely used to record data and expedite certain protocols, accessing information etc., but they should be switched off while with a patient. It is very humiliating and irritating for a patient when the doctor is occupied with a cellphone during a consult.
There is a competition now among some doctors to post everything they do on the social media. A colleague of mine recently posted a video of a huge tumor that she removed from the abdomen of a patient. She is now under an enquiry for compromising patient privacy. One must refrain from posting any information that discloses patient’s identity on the social media.
Most of you google your crush, actor or actress you like, don’t you? Well, some of you will honestly agree.
Patients are as curious and inquisitive as you are, and may google you. So please refrain from posting undignified pictures / matter / vulgar jokes, etc. and pictures while drinking / smoking, hugging etc. on social media. Also refrain from posting stuff that maligns your own profession or colleagues. You can improve things from within, not by publicising them.
A smart doctor will learn over time to refrain from giving out personal number to the patients / relatives, as this may lead to many disadvantages later, including unwanted calls, messages, advertisements and other misuse.
While patronising should be avoided completely, (“You are my brother, sister, mother, father etc.), in some cases it may reassure a frightened patient, hence it may only rarely be used. © Dr. Rajas Deshpande
It is not at all uncommon for a doctor or a patient to get a crush upon the other. In case you sense a love interest blossoming within your patient or yourself, immediately rethink about your life’s choices and refrain from any further progress in that direction, as this could turn disastrous for your career. Do not encourage meaningless chats, messaging or personal comments when dealing with patients. An allegation of molestation, sexual harassment or mal-intention can ruin you.
Most doctors feel proud of their excess hard work, and often mention that they work without proper food or sleep for days together. While this is really commendable, it is also a granted feature of this career. One must learn not to milk a pardon for one’s ill behaviour or mistakes by quoting excess work. A mistake is a mistake and the best policy about a medical mistake is being completely honest about it. © Dr. Rajas Deshpande
My recently published book, “The Doctor Gene” ends with the words “A good doctor is the best a human being can be”.
You belong to a community that practices the highest of morals not just because the society expects it, but because you have voluntarily sworn to. You have chosen this career yourself. Right from now, please imbibe the best of morals and truthful attitudes in your blood. Believe me, every human being has the hidden sense to perceive a genuinely good person, make sure that your patients get this feeling about you. © Dr. Rajas Deshpande
One important art in medicine is almost on the verge of extinction: that of immense concentration. What with the hustle-bustle and digital exposure that every medico must work with, we are fast losing the ability to switch off the world and concentrate, think or meditate. These things bring the serenity, so essential an ingredient of medical smartness. Learn to find time, preferably on a daily basis, to be with yourself, and sort out the tangles in your mind before they strangulate you.
I get atleast one question everyday from some or other medical student on my facebook page:
Which branch is best? What PG should I do?
You will eventually realise what you like. You may seek opinions, but not decisions from others. Be smart enough to identify what you want and respect your own inclinations. Keep a list of alternative options, as PG seats are limited. Don’t waste too much time in pursuing a particular branch, there are so many advances happening that every PG branch offers you good futures if you are dedicated enough. There are umpteen examples on the other side: doctors who got their desired specialties but never did anything significant after that, other than customary routine. © Dr. Rajas Deshpande
I am sure that in this very hall, there are beautiful dancers, painters, far better authors than myself, speakers, and artists of infinite ability. I think I should also say some potential models. But you will give up all that art and beauty within yourself, lost in the heavy duty career of being a doctor.
One absolute essential for every medico is a sure-shot de-stressing mechanism. We are all destined to face suffering, poverty, struggle, pain and death on a daily basis, and this takes a toll upon our minds. We tend to grow mentally old very soon. Many think that alcohol or smoking is a respite, but this is ridiculously stupid. A smart doctor knows to find his / her escape in arts, literature, family, travel and other hobbies. It is extremely essential to de-stress as your performance may be affected if you accumulate stress for long. © Dr. Rajas Deshpande
What do patients want?
The best compliment for a doctor is a happy patient, and the best feeling in the world is knowing that your efforts saved a life.
A smart doctor is the one who has the reputation of making the correct diagnosis in majority of cases. A smart doctor is the one who invokes trust in a patient by being genuinely honest and compassionate. A smart doctor is the one, most of whose patients are happy, not only because their health issues are well attended, but also because they met a caring, well behaved human being.
Never think about money or anything else when consulting a patient. Think of every case as an exam case, get the most correct history, do the best clinical examination and give the patient the best treatment options. You will make enough happy money with such practice, if you are smart enough to understand what that means. © Dr. Rajas Deshpande
Dear friends, one thing about smartness which I learnt early in my medical career is that a senior doctor should not give very long lectures, and should end up his speech before time.
I have written many more things about the essentials of being a truly good doctor, and the glorious traditions of our noble, almost divine profession, in my book “The Doctor Gene’. If you did not get a copy outside, please email firstname.lastname@example.org to get your copy.
I am sure that you will all be very successful doctors, and I will be very happy if my words today help you deal with your medical life smartly. I thank you for patiently listening to me today.
Love to you all and I wish you all the best, always!
© Dr. Rajas Deshpande
Thank you, Mr. Yashodhan Morye and BJMC UG Student’s Council