Great note by Dr.MP Manoj

[5/11, 9:19 AM] Venugopalan Poovathumpara: Ten Commandments to a young medical graduate

1. Ask questions, most of all to yourself. Doubts enliven the scientific mind. Never believe implicitly in something until proven. When I was a postgraduate student at MMC it was one of the best departments in the country. But most of what I learnt then is obsolete. Science is a dynamic process

2. Set five year goals. If you haven't done anything worthwhile by the time you're forty, you're a step behind and there you'll stay. I did my first cochlear implant at 40 years of age. It took a long time coming but was totally worth it.

3. Insure adequately. Do not , I repeat, do not insure for savings. Use a term plan that assures enough money for your family to survive without you and health insurance to cover a major expense , say a liver transplant. Don't be fooled by plans offering great returns. See my next point for clarification. If I die today, my family will be able to pay my outstanding loans and enjoy 75% of the income that I have now.

4. Invest in your profession. This gives more return than any of the stock markets that you can ever imagine! My first loan was for a precision drill for ear surgery in 1994. It was money well spent. Invest in your profession before a big house , jewellery or a fancy car. Your profession will pay for all this

5. Never , ever receive Pharma funding. Free money is attractive, you can argue that it's only off their profits, but no money can compensate for holding your head high . Better medicines, lesser medicines mean happier patients and happier patients beget more patients. Never let factors other than patient benefit cloud your prescription. I remember the words Dr. PPN told me when I was leaving " manoj, if you become a better doctor, your prescriptions will become smaller" and so it is

6. Watch your teacher. Many young graduates feel that they have to do procedures to get better. Nothing is farther from the truth. As a young boy who loved driving but whose parents never had a car, I used to envy anyone who drove anything. My grandpa who was in Ooty then , realising my angst , told me to watch the bus drivers on the ghats intently- to anticipate when they shifted gears, brakes. Those lessons stayed. I feel that I've learnt more by watching than by doing. You have to anticipate the master teachers every stroke, every flourish. Soon you'll find yourself thinking and doing like him or her. That's true learning.

7. Make friends outside your profession, develop a social circle that's varied and interesting. People who live in company of diverse, interesting people live longer, happier. There's proof , and I'm not joking. My obsession with the Freemasons society gives that extra energy I so badly need.

8: spend quality time with family. Don't work Sunday's and come home early another day of the week. As your bank balance grows, your family should never look distant- it's your one real worth.

9. Know your strengths. It also means to be aware of your weaknesses. As a professional you have to develop what you're extremely good at and refer to a colleague patients  you can't give your best. At one time I was the surgeon doing maximum laryngeal cancer surgeries in north Kerala. But I knew I wasn't up there, not really up to the skill I possessed in ear surgery. Now I do 90% ear work and refer those cases to competent colleagues many of them who I aren't even friends with. Patients deserve to go to the best. This simple lesson is often forgotten

10. Last but not the least, indulge in yourself. Give yourself that occasional treat, do that fun thing that only you'd enjoy , get yourself a pet, travel alone. You aren't being selfish , but it purifies your soul. Linking happiness with your practice is ever so boring. And be truthful and pay your taxes. That's the most honourable way of doing charity

I felt that I should share some of my life lessons . It's not even an exhaustive list. Many of you might even disagree , add. But I wish I'd heard all this when I was 15😄😄
[5/11, 9:19 AM] Venugopalan Poovathumpara: I have been in practice for 28 years, nine of them as a teacher in a government medical college. I feel that I have reached the stage when I can say what I need to say. It maybe unpalatable for some, uplifting for another. But what is life without its glorious debates?

I have seen and nurtured youngsters through the process of becoming a doctor. I have seen their various emotions- pride, satisfaction, despair, low self esteem. But can anyone with a medical education have it in them to become a good doctor of medicine? I am afraid not. Let us think about a youngster, just finishing his school, and wanting to pursue a career in Medicine. Can we tell him or her that it is not within their ability to become a medical professional? I think we can and we must.

To become a doctor, it is important to have one primary quality- empathy. I would look at someone who is willing to give up his seat for an older person, someone who would not elbow his way into a crowd, someone who would, without thinking, help an animal in distress and I would tell myself, " that person should become a doctor!" When we are faced, as we often do, a problem in a patient for which there is no straightforward solution, it is helpful to lean back and think what would you do if you were in a similar predicament. I remember the time when I was nervously waiting my turn for my MBBS final year medicine Viva voce, well knowing that the slightest mistake would make me flunk, the pass percentage was a dismal 60% those days. My professor saw me and said " Relax my boy! The worst that can happen today is that you would fail and you may take another exam in the next six months. But later in life, if you fail, someone loses his or her life!"  Those words still ring in my ear, and never forgot it ever after. We must understand that when we stand before someone who is ill , or thinks he is ill, we have just one primary objective, to comfort. 

The next main nature a doctor must have is that he or she must be scientific. By scientific, I mean, being self critical, accepting nothing without proof and be willing to be self examined and corrected if found wanting. You can be truly scientific in profession only if you are scientific in life. You can't believe in nonsense in every aspect of your personal life and think you can be scientific in your profession.  Whatever we do, what ever we believe, what we preach and follow must pass this scientific test. We can't be bad drivers, cunning tax evaders, moral destitute, religious fanatic and yet be a doctor whose mind is clear and reasonable. 

A doctor must also be communicative. During our studies, presentations and research papers were not often looked up to as character building exercises, but more as a drudgery. We weren't forced to write good english, to use words cleverly to communicate quickly and clearly. If you want to put forth an argument in a presentation to prove your point that you had that rare case worth presenting,  in 3-8 minutes, what you actually are doing is developing  a skill set to use that little time to convince your patient that a particular treatment protocol was needed for curing him or her. Little do people understand how much this helps both the doctor and the patient. Poor communicators never really soothe the pain. 

A good doctor must be ethical. Unfortunately this word has a wide meaning. Ethics are often construed to be a set of behaviour that a medical professional exhibits to his or her colleague. This is not entirely true. Ethical behaviour is never to do wrong, never to prescribe what you would not take in the first place, never to order an investigation unless you are absolutely sure that the result may change your treatment protocol and never to do a more complicated procedure when a simpler thing would have had nearly the same result. There is this famous joke. What is the difference between God and a Surgeon? - God does not think He is a surgeon!. Many surgeons have this Godly attitude that they can cure anything, manage anything by surgery when a non surgical option would be as effective.  

A surgeon goes through many stages in life. First, he is in awe of what others can do, then he is happy that he can do the same, then he is in awe of what he himself can do, then he is worried more about what can go wrong than what can go right. The good ones get to this stage, where youthful, unintended enthusiasm gives way to calculated judgement and wise restraint. But a few, a dangerous few, go a level higher- where he or she doesn't  really care. This according to me is the failure of good morals, where power corrupts and lofty self belief ignores reason, much like the powerful heads in government and religion today.  

If you can point out one single thing in the society that has led to degradation of the image of the doctor in the society, it is the image that the physician has inadvertently created in the society that he is above criticism. One of the most endearing qualities of a good physician as perceived by the general public is his or her acceptance of failure or ignorance. It is impossible today to know everything in medicine. Unless we strive for knowledge every day, we find ourselves left behind. And, sometimes we have to tell the patient that we are unaware of something or that we cannot find out a reason and also reassure them that we will make every attempt to rectify. Strangely, this behaviour comes not out of lack of knowledge, but out of wisdom. And to reach this level, we have to update ourself every single day. It is often seen in doctors forums that there is a shocking lack of knowledge of protocols. If we all acted as one, our image in the society will reach a lofty level, that we were used to, in the not too distant past.

it is also desirable that we carry ourselves well. Not everyone is blessed with good looks, but the elegance of a well dressed physician creates a good first impression and that counts, more than we think we know. It is not only about our physical appearance, but our surroundings, our staff, all should exhibit this professional facade which is confidence instilling. 

If you have had the patience to go through this rather exhaustive post, you will realise that these are life skills that we usually pick up in school. And a good doctor is made much before he or she passes the graduation exam. If we have a ward, a friend or a acquaintance who we feel exhibits these qualities and expresses the desire to become a doctor, do sit back and watch with pride. He or she will never disappoint your lofty ideals. But it also means that if we find someone who is not of this special mould, gently reprimand him or her. For the lack of some of these these very qualities that doesn't augur a good medical professional life, maybe invaluable in another profession.

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